Customers, Not Patients: The Nairobi Women’s Hospital Saga15 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.
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.”
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.
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.”
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”.
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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The Dictatorship of the Church
From the enormously influential megachurches of Walter Magaya and Emmanuel Makandiwa to smaller ‘startups,’ the church in Zimbabwe has frightening, nearly despotic authority.
In Zimbabwe, the most powerful dictatorship is not the Zimbabwe African National Union-Patriotic Front (ZANU-PF) party. Despite the party’s 40 year history of ruthlessly cracking down on opposition parties, sowing fear into the minds of the country’s political aspirants, despite the party’s overseeing of catastrophic policies such as the failed land reform, and despite the precarious position of the social landscape of the country today, neither former president Robert Mugabe, nor the current president Emmerson Mnangagwa, nor any of their associates pose as significant an existential threat to Zimbabweans as the most influential dictatorship at play in the country: the church.The church has frightening, near despotic authority which it uses to wield the balance of human rights within its palms. It wields authority from enormously influential megachurches like those of Walter Magaya and Emmanuel Makandiwa, to the smaller startup churches that operate from the depths of the highest-density suburbs of the metropolitan provinces of Bulawayo and Harare. Modern day totalitarian regimes brandish the power of the military over their subjects. In the same way, the church wields the threat of eternal damnation against those who fail to follow its commands. With the advent of the COVID-19 vaccine in 2020, for example, Emmanuel Makandiwa vocally declared that the vaccine was the biblical “mark of the beast.” In line with the promises of the book of Revelations, he declared that receiving it would damn one to eternal punishment.
Additionally, in just the same way that dictators stifle discourse through the control of the media, the church suppresses change by controlling the political landscape and making themselves indispensable stakeholders in electoral periods. The impact of this is enormous: since independence, there has been no meaningful political discourse on human rights questions. These questions include same-sex marriage and the right to access abortions as well as other reproductive health services. The church’s role in this situation has been to lead an onslaught of attacks on any institution, political or not, that dares to bring such questions for public consideration. But importantly, only through such consideration can policy substantively change. When people enter into conversation, they gain the opportunity to find middle grounds for their seemingly irreconcilable positions. Such middle-grounds may be the difference between life and death for many disadvantaged groups in Zimbabwe and across the world at large. The influence of the church impedes any attempt at locating this middle ground.
Additionally, because the church influences so many Zimbabweans, political actors do not dare oppose the church’s declarations. They fear being condemned and losing the support of their electorate. The church rarely faces criticism for its positions. It is not held accountable for the sentiments its leaders express by virtue of the veil of righteousness protecting it.
Furthermore, and uniquely so, the church serves the function of propping up the ZANU-PF party. The ZANU-PF mainly holds conservative ideals. These ideals align with those of the traditionalist Zimbabwean church. In short, the church in Zimbabwe stands as a hurdle to the crucial regime change necessary to bring the country to success. With a crucial election slated for the coming months, this hurdle looms more threatening than at any other time in the country’s history.
The impact of the church’s dictatorship on humans is immeasurable. Queer people, for example, are enormously vulnerable to violence and othering from their communities. They are also particularly vulnerable to sexually transmitted diseases and infections due to the absence of healthcare for them. The church meets the attempts of organizations such as the Gays and Lesbians of Zimbabwe to push for protection with cries that often devolve into scapegoating. These cries from the church reference moral decadence, a supposed decline in family values, and in the worst of cases, mental illness.
Similarly, the church meets civil society’s attempts at codifying and protecting sexual and reproductive rights with vehement disapproval. In 2021, for example, 22 civil society organizations petitioned Parliament to lower the consent age for accessing sexual and reproductive health services. Critics of the petition described it as “deeply antithetical to the public morality of Zimbabwe” that is grounded in “good old cultural and Christian values.”
Reporting on its consultations with religious leaders, a Parliamentary Portfolio Committee tasked with considering this petition described Christianity as “the solution” to the problem posed by the petition. This Committee viewed the petition as a gateway to issues such as “child exploitation … rights without responsibility … and spiritual bondages.” The petition disappeared into the annals of parliamentary bureaucracy. A year later, the Constitutional Court unanimously voted to increase the age of consent to 18.
A more horrifying instance of this unholy alliance between the church and the state in Zimbabwe is a recently unearthed money laundering scheme that has occurred under the watchful eye of the government. Under the stewardship of self-proclaimed Prophet Uebert Angel, the Ambassador-at-Large for the Government of Zimbabwe, millions of dollars were laundered by the Zimbabwean government. Here, as revealed by Al Jazeera in a four-part docuseries, Ambassador Angel served as a middleman for the government, facilitating the laundering of millions of dollars and the smuggling of scores of refined gold bars to the United Arab Emirates. He did this using his plenipotentiary ambassadorial status to vault through loopholes in the government’s security systems.
Importantly, Prophet Angel was appointed in 2021 as part of a frenetic series of ambassadorial appointments. President Mnangagwa handed out these appointments to specifically high-profile church leaders known for their glamorous lifestyle and their preaching of the prosperity gospel. Through these appointments, Emmerson Mnangagwa’s government earned itself a permanent stamp of approval from the church and access to a multi-million member base of voting Christians in the country. Mnangagwa’s gained access to freedom from accountability arising from the power of the endorsements by “men-of-God,” one of whom’s prophetic realm includes predicting English Premier League (EPL) football scores and guessing the color of congregants’ undergarments.
In exchange, Prophet Angel has earned himself a decently large sum of money. He has also earned the same freedom from critique and accountability as Zimbabwe’s government. To date, there is no evidence of Angel ever having faced any consequences for his action. The most popular response is simple: the majority of the Christian community chooses either to defend him or to turn a blind eye to his sins. The Christian community’s response to Prophet Angel’s actions, and to the role of the church in abortion and LGBTQ discourse is predictable. The community also responds simply to similar instances when the church acts as a dialogical actor and absolves itself of accountability and critique
Amidst all this, it is easy to denounce the church as a failed actor. However, the church’s political presence has not been exclusively negative. The Catholic Commission for Justice and Peace, for example, was the first organization to formally acknowledge Gukurahundi, a genocide that happened between 1982 and 1987 and killed thousands of Ndebele people. The Commission did this through a detailed report documenting what it termed as disturbances in the western regions of the country. Doing so sparked essential conversations about accountability and culpability over this forgotten genocide in Zimbabwe.
Similarly, the Zimbabwe Bishops’ Justice and Peace Commission has been involved in data collection that is sparking discourse about violence and human rights abuses in Zimbabwe. In doing so, the Commission is challenging Zimbabweans to think more critically about what constructive politics can look like in the country. Such work is hugely instrumental in driving social justice work forward in the country. What uniquely identifies the church’s involvement in both of these issues, however, is that neither touches on matters of Christian dogma. Instead, the Commission responds to general questions about the future of both God and Zimbabwe’s people in ways that make it easy for the church to enter into conversation with a critical and informed lens.
The conclusion from this is simple: if Zimbabwe is to shift into more progressive, dialogical politics, the church’s role must change with it. It is unlikely that the church will ever be a wholly apolitical actor in any country. However, the political integration of the church into the politics of Zimbabwe must be a full one. It must be led by the enhanced accountability of Zimbabwean religious leaders. In the same way that other political actors are taken to task over their opinions, the church must be held accountable for its rhetoric in the political space.
A growing population has, thus far, been involved in driving this shift. Social media has taken on a central role in this. For example, social media platforms such as Twitter thoroughly criticized megachurch pastor Emmanuel Makandiwa for his sentiments regarding vaccinations. This and other factors led him to backtrack on his expressed views on inoculation. However, social media is not as available in rural areas. There, the influence of the religion is stronger than elsewhere in the country. Therefore investments must be made in educating people about the roles of the church and the confines of its authority. This will be instrumental in giving people the courage to cut against the very rough grain of religious dogma. Presently, few such educational opportunities exist. To spark this much-needed change, it will be useful to have incentivizing opportunities for dialogue in religious sects.
More than anything else, the people for whom and through whom the church exists must drive any shift in the church’s role. The people of Tunisia stripped President Zine El Abidine Ben Ali of his authority during the Jasmine Revolution of January 2011. The women of Iran continue to tear at the walls that surround the extremist Islamic Republic. In just the same way, the people of Zimbabwe have the power to disrobe the church of the veil of righteousness that protects it from criticism and accountability.
In anticipation of the upcoming election, the critical issues emerging necessitate this excoriation even more. This will open up political spaces for Zimbabweans to consider a wider pool of contentious issues when they take to the polls in a few months. Above all, the people of Zimbabwe must start viewing the church for what it is: an institution, just like any other, with vested interests in the country’s affairs. As with any other institution, we must begin to challenge, question, and criticize the church for its own good and for the good of the people of Zimbabwe.
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.
Pattern of Life and Death: Camp Simba and the US War on Terror
The US has become addicted to private military contractors mainly because they provide “plausible deniability” in the so-called war on terror.
Though it claimed the lives of three Americans, not 2,403, some liken the January 2020 al-Shabaab attack at Manda Bay, Kenya, to Pearl Harbour. The US would go on to unleash massive airstrikes against al-Shabaab in Somalia.
“We Americans hate being caught out,” a spy-plane pilot and contractor recently told me. “We should have killed them before they even planned it.”
Both the Manda Bay and Pearl Harbour attacks revealed the vulnerability of US personnel and forces. One brought the US into the Second World War. The other has brought Kenya into the global–and seemingly endless–War on Terror.
Months before launching the assault, members of the Al Qaeda-linked faction bivouacked in mangrove swamp and scrubland along this stretch of the northeast Kenyan coast. Unseen, they observed the base and Magagoni airfield. The airfield was poorly secured to begin with. They managed not to trip the sensors and made their way past the guard towers and the “kill zone” without being noticed.
At 5.20 a.m. on 5 January, pilots and contractors for L3Harris Technologies, which conducts airborne intelligence, surveillance and reconnaissance (ISR) for the Pentagon, were about to take off from the airfield in a Beechcraft King Air b350. The twin engine plane was laden with sensors, cameras, and other high tech video equipment. Seeing thermal images of what they thought were hyenas scurrying across the runway, the pilots eased back on the engines. By the time they realized that a force of committed, disciplined and well-armed al-Shabaab fighters had breached Magagoni’s perimeter, past the guard towers, it was too late.
Simultaneously, a mile away, other al-Shabaab fighters attacked Camp Simba, an annex to Manda Bay where US forces and contractors are housed. Al-Shabaab fired into the camp to distract personnel and delay the US response to the targeted attack at the airfield.
Back at the Magagoni airfield, al-Shabaab fighters launched a rocket-propelled grenade at the King Air. “They took it right in the schnauzer,” an aircraft mechanic at Camp Simba who survived the attack recently recalled to me. Hit in the nose, the plane burst into flames. Pilots Bruce Triplett, 64, and Dustin Harrison, 47, both contractors employed by L3Harris, died instantly. The L3Harris contractor working the surveillance and reconnaissance equipment aft managed to crawl out, badly burned. US Army Specialist Henry J Mayfield, 23, who was in a truck clearing the tarmac, was also killed.
The attack on Camp Simba was not the first al-Shabaab action carried out in Kenya. But it was the first in the country to target US personnel. And it was wildly successful.
AFRICOM initially reported that six contractor-operated civilian aircraft had been damaged. However, drone footage released by al-Shabaab’s media wing showed that within a few minutes, the fighters had destroyed six surveillance aircraft, medical evacuation helicopters on the ground, several vehicles, and a fuel storage area. US and Kenyan forces engaged al-Shabaab for “several hours”.
Included in the destroyed aircraft was a secretive US Special Operations Command (SOCOM) military de Havilland Dash-8 twin-engine turboprop configured for intelligence, surveillance, and reconnaissance missions. A report released by United States Africa Command (AFRICOM) in March 2022 acknowledges that the attackers “achieved a degree of success in their plan.”
Teams working for another air-surveillance company survived the attack because their aircraft were in the air, preparing to land at Magagoni. Seeing what was happening on the ground, the crew diverted to Mombasa and subsequently to Entebbe, Uganda, where they stayed for months while Manda Bay underwent measures for force protection.
I had the chance to meet some of the contractors from that ISR flight. Occasionally, these guys—some call themselves paramilitary contractors—escape Camp Simba to hang out at various watering holes in and around Lamu, the coastal town where I live. On one recent afternoon, they commandeered a bar’s sound system, replacing Kenyan easy listening with boisterous Southern rock from the States.
Sweet home Alabama!
An ISR operator and I struck up an acquaintance. Black-eyed, thickly built, he’s also a self-confessed borderline sociopath. My own guess would be more an on-the-spectrum disorder. Formerly an operator with Delta Force, he was a “door kicker” and would often—in counter-terror parlance—“fix and finish” terror suspects. Abundant ink on his solid arms immortalizes scenes of battle from Iraq and Afghanistan. In his fifties, with a puffy white beard, he’s now an ISR contractor, an “eye in the sky”. His workday is spent “finding and fixing” targets for the Pentagon.
Occasionally, these guys—some call themselves paramilitary contractors—escape Camp Simba to hang out at various watering holes in and around Lamu.
He tells me about his missions—ten hours in a King Air, most of that time above Somalia, draped over cameras and video equipment. He gathers sensitive data for “pattern of life” analysis. He tells me that on the morning of the attack he was in the King Air about to land at the Magagoni airstrip.
We talked about a lot of things but when I probed him about “pattern of life” intel, the ISR operator told me not a lot except that al-Shabaab had been observing Camp Simba and the airstrip for a pattern of life study.
What I could learn online is that a pattern of life study is the documentation of the habits of an individual subject or of the population of an area. Generally done without the consent of the subject, it is carried out for purposes including security, profit, scientific research, regular censuses, and traffic analysis. So, pattern-of-life analysis is a fancy term for spying on people en masse. Seemingly boring.
Less so as applied to the forever war on terror. The operator pointed out the irony of how the mile or so of scrubland between the base and the Indian Ocean coastline had been crawling with militant spies in the months preceding the attack at Camp Simba. Typically, the ISR specialist says, his job is to find an al-Shabaab suspect and study his daily behaviours—his “pattern of life.”
ISR and Pattern of Life are inextricably linked
King Airs perform specialized missions; the planes are equipped with cameras and communications equipment suitable for military surveillance. Radar systems gaze through foliage, rain, darkness, dust storms or atmospheric haze to provide real time, high quality tactical ground imagery anytime it is needed, day or night. What my operator acquaintance collects goes to the Pentagon where it is analysed to determine whether anything observed is “actionable”. In many instances, action that proceeds includes airstrikes. But as a private military contractor ISR operator cannot “pull the trigger”.
In the six weeks following the attack at Magagoni and Camp Simba, AFRICOM launched 13 airstrikes against al-Shabaab’s network. That was a high share of the total of 42 carried out in 2020.
Airstrikes spiked under the Trump administration, totalling more than 275 reported, compared with 60 over the eight years of the Barack Obama administration. It is no great mystery that the Manda Bay-Magagoni attack occurred during Trump’s time in office.
Typically, the ISR specialist says, his job is to find an al-Shabaab suspect and study his daily behaviours—his “pattern of life.”
Several al-Shabaab leaders behind the attack are believed to have been killed in such airstrikes. The US first launched airstrikes against al-Shabab in Somalia in 2007 and increased them in 2016, according to data collected and analysed by UK-based non-profit Airwars.
Controversy arises from the fact that, as precise as these strikes are thought to be, there are always civilian casualties.
“The US uses pattern of life, in part, to identify ways to reduce the risk of innocent civilian casualties (CIVCAS) (when/where are targets by themselves or with family) whereas obviously Shabaab does not distinguish as such and uses it for different purposes,” a Department of Defense official familiar with the matter of drone operations told me.
The Biden administration resumed airstrikes in Somalia in August 2021. AFRICOM claimed it killed 13 al-Shabaab militants and that no civilians were killed.
According to Secretary of State Anthony Blinken, Mustaf ‘Ato is a senior Amniyat official responsible for coordinating and conducting al-Shabaab attacks in Somalia and Kenya and has helped plan attacks on Kenyan targets and US military compounds in Kenya. It is not clear, however, if this target has been fixed and killed.
A few days after the second anniversary of the Manda Bay attack, the US offered a US$10 million bounty.
The American public know very little about private military contractors. Yet the US has become addicted to contractors mainly because they provide “plausible deniability”. “Americans don’t care about contractors coming home in body bags,” says Sean McFate, a defense and national security analyst.
These airstrikes, targeted with the help of the operators and pilots in the King Airs flying out of Magagoni, would furnish a strong motive for al-Shabaab’s move on 5 January 2020.
The Pentagon carried out 15 air strikes in 2022 on the al-Qaeda-linked group, according to the Long War Journal tracker. Africom said the strikes killed at least 107 al-Shabaab fighters. There are no armed drones as such based at Camp Simba but armed gray-coloured single-engine Pilatus aircraft called Draco (Latin for “Dragon”) are sometimes used to kill targets in Somalia, a well-placed source told me.
The US has become addicted to contractors mainly because they provide “plausible deniability”.
The contractor I got to know somewhat brushes off the why of the attack. It is all too contextual for public consumption, and probably part of army indoctrination not to encourage meaningful discussion. He had, however, made the dry observation about the al-Shabaab affiliates out in the bush near the airfield, doing “pattern of life” reconnaissance.
The strike on Magagoni was closely timed and fully coordinated. And it appears that the primary aim was to take out ISR planes and their crews. It was private contractors, not US soldiers, in those planes. I pointed out to the operator that those targets would serve al-Shabaab’s aims both of vengeance and deterrence or prevention. His response: “Who cares why they attacked us? Al-Shabaab are booger-eaters.”
With that he cranks up the sound, singing along off-key:
And this bird, you cannot change
Lord help me, I can’t change….
Won’t you fly high, free bird, yeah.
Breaking the Chains of Indifference
The significance of ending the ongoing war in Sudan cannot be overstated, and represents more than just an end to violence. It provides a critical moment for the international community to follow the lead of the Sudanese people.
They say that the only thing necessary for the triumph of evil is for good men to do nothing.
As someone from the diaspora, every time I visited Sudan, I noticed that many of the houses had small problems like broken door knobs, cracked mirrors or crooked toilet seats that never seemed to get fixed over the years. Around Khartoum, you saw bumps and manholes on sand-covered, uneven roads. You saw buildings standing for years like unfinished skeletons. They had tons of building material in front of them: homeless families asleep in their shade, lying there, motionless, like collateral damage. This has always been the norm. Still, it is a microcosm of a much broader reality. Inadequate healthcare, a crumbling educational system, and a lack of essential services also became the norm for the Sudanese people.
This would be different, of course, if the ruling party owned the facility you were in, with the paved roads leading up to their meticulously maintained mansions. This stark contrast fuelled resentment among the people, leading them to label the government and its associates as “them.” These houses were symbols of the vast divide between the ruling elite and the everyday citizens longing for change. As the stark divide between “them” and “us” deepened, people yearned to change everything at once, to rid themselves of the oppressive grip of “them.”
Over the years, I understood why a pervasive sense of indifference had taken hold. The people of Sudan grew indifferent towards a government that remained unchanged. It showed no willingness to address the needs of its citizens unless it directly benefited those in power. For three decades, drastic change eluded the Sudanese people. They woke up each day to a different price for the dollar and a different cost for survival. The weight of this enduring status quo bore down upon them, rendering them mere spectators of their own lives. However, as it always does, a moment of reckoning finally arrived—the revolution.
Returning home after the 2019 revolution in Sudan, what stood out in contrast to the indifference was the hashtag #hanabnihu, which from Arabic translates to “we will build it.” #Hanabnihu echoed throughout Sudanese conversations taking place on and off the internet, symbolizing our determination to build our nation. To build our nation, we needed to commit to change beyond any single group’s fall, or any particular faction’s victory. Our spirits were high as everyone felt we had enough muscle memory to remember what happened in the region. We remembered how many of “them” came back to power. With the military still in power, the revolution was incomplete. Yet it still served as a rallying cry for the Sudanese people. It was a collective expression of their determination to no longer accept the unfinished state of their nation.
Many Sudanese people from the diaspora returned to Sudan. They helped the people of Suean create spaces of hope and resilience, everyone working tirelessly to build a new Sudan. They initiated remarkable projects and breathed life into the half-built houses they now prioritized to turn into homes. We had yearned for a time when broken door knobs and crooked toilet seats would be fixed, and for a time when the government would smooth out the bumps on the road. For four years following the revolution, people marched, protested, and fought for a Sudan they envisioned. They fought in opposition to the military, whose two factions thought that a massacre or even a coup might bring the people back to the state of indifference that they once lived in.
Remarkably, the protests became ingrained in the weekly schedule of the Sudanese people. It became part of their routine, a testament to their unwavering dedication and the persistence of their aspirations. But soon, the people found themselves normalized to these protests. This was partly due to the fact that it was organized by the only body fighting against the return of this indifference: the neighborhood’s resistance committees. These horizontally structured, self-organized member groups regularly convened to organize everything from planning the weekly protests and discussing economic policy to trash pickup, and the way corruption lowered the quality of the bread from the local bakery.
The international media celebrated the resistance committees for their innovation in resistance and commitment to nonviolence. But as we, the Sudanese, watched the news on our resistance fade, it was clear that the normalization of indifference extended beyond Sudan’s borders. The international community turned a blind eye to justice, equality, and progress in the celebrated principles of the peaceful 2019 revolution. In a desperate attempt to establish fake stability in Sudan, the international community continued their conversations with the military. Their international sponsors mentioned no retribution against the military for their actions.
During my recent visit to Sudan, the sense of anticipation was palpable. It was just two months before the outbreak of war between the army and the paramilitary group. The protests had intensified and the economy was faltering. The nation stood at the precipice as the activism continued and the tensions between “us” and “them” had begun to grow once again.
Now, as war engulfs the nation, many Sudanese find themselves torn. At the same time, they hope for the victory of the Sudanese Army. Despite the army’s flaws, Sudanese people hope the army will win against “them” while recognizing that this war remains primarily between different factions of “them.” We wake up every day with a little less hope. We watch them bomb Khartoum and the little infrastructure that existed turn to dust. We watch as the resistance committees continue to do the army’s job for them. They work fiercely to deliver medicine, evacuate people and collect the nameless bodies on the sides of the streets next to the burnt buildings that were almost starting to be completed.
Another battle takes place online. On Sudanese social media, people challenge the negative mood of the war. Sudanese architects and designers work from their rented flats in Cairo or Addis, posting juxtaposed images that place the grainy, rashly captured photos of the latest burnt-down building in Khartoum next to different rendered perspectives. These perspectives reimagine the same building in a rebuilt Sudan. They thus instantly force a glimpse of hope in what now looks like a far-fetched reality to most people.
Just as these young visionaries attempt to defy the odds, international intervention and support are pivotal to help Sudan escape the clutches of this devastating conflict. Let Sudan serve as a catalyst for the change that was meant to be. Diplomatic engagement, humanitarian aid, and assistance in facilitating peaceful negotiations can all contribute.
The significance of ending the ongoing war in Sudan cannot be overstated. It represents more than just a cessation of violence. It provides a critical moment for the international community to follow the lead of the Sudanese people. The international community should dismantle the prevailing state of indifference worldwide. The fight against indifference extends far beyond the borders of Sudan. It is a fight that demands our attention and commitment on a global scale of solidarity. We must challenge the systems that perpetuate indifference and inequality in our own societies. We must stand up against injustice and apathy wherever we find it.
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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