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Reflections on Medical Ethics in the Era of COVID-19

11 min read.

The intense centralisation of health services has killed the doctor-patient relationship while hospitals have now become centres for gathering detailed patient information that is exploited by pharmaceutical companies.

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Reflections on Medical Ethics in the Era of COVID-19
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According to William Ruddick, the wide field usually referred to as “medical ethics” comprises a range of disciplines, including medical ethics (primarily, medical doctor-centred), and healthcare ethics (including nurses and other healthcare providers), clinical ethics (focused on hospital case decisions with the aid of diverse committees and consultants), and bioethics (including general issues of reproduction, fair distribution of organs and other scarce life-saving resources, and protection of the biosphere). All discussions of medical ethics proceed from the assumption that all things being equal, all patients have moral status. As Matjaž Zwitter observes in a chapter on “Moral Status”, “There should be no doubt that all of us with a capability of deciding about ourselves have moral status.” Zwitter further points out that only beings with moral status can be meaningfully said to have rights.

However, in our time, the misconception is widespread that science, of which medicine is a part, is all about “objective” observation of facts without any consideration of values (standards by which we judge some things to be good or bad, right or wrong, beautiful or ugly, and so on). Nevertheless, we human beings cannot live without values, because it is they that make life truly human by enabling us to choose our goals and the appropriate means of attaining them. Thus, in the introduction to his Medical Ethics: A Very Short Introduction, psychiatrist Tony Hope writes, “As my clinical experience grew so I became increasingly aware that ethical values lie at the heart of medicine. Much emphasis during my training was put on the importance of using scientific evidence in clinical decision-making. Little thought was given to justifying, or even noticing, the ethical assumptions that lay behind the decisions. So I moved increasingly towards medical ethics, wanting medical practice, and patients, to benefit from ethical reasoning.” In what follows, I examine the viability of the doctor-patient relationship, undergirded by medical ethics, in the era of COVID-19.

Principles of medical ethics in the era of COVID-19

One of the best-known texts associated with medical ethics is the Hippocratic Oath authored in ancient Greece about 2400 years ago. It required a person being admitted to the position of a medical doctor to swear by a number of healing gods to uphold certain ethical standards. The oath established several principles of medical ethics that are still considered crucial to the conduct of a medical doctor today. At the heart of medical ethics are questions regarding what is morally acceptable or morally unacceptable for a doctor to do in the course of caring for the sick. Three of the key issues in medical ethics are commitment on the part of the doctor to do only good to the patient, to respect the patient’s right to accept or decline a medical procedure, and to conduct medical research in line with sound ethical principles.

Doing only good to the patient

According to William Ruddick, the Hippocratic injunction “Strive to help, but above all, do no harm” is the ruling moral maxim in the doctor-patient relationship. In current discussion, this maxim has been codified in oft-cited principles of beneficence (action to promote the good/welfare) and non-maleficence (refraining from doing evil). For the doctor to achieve these noble goals, he or she must utilize their medical knowledge in a free atmosphere in which their only concern is their patient’s well-being, without having to worry about demands from an elaborate medical care bureaucracy. Yet in the era of COVID-19, the doctor has been turned into a functionary of just such a bureaucracy, receiving instructions from local and global health authorities, and being stopped from using certain medications, even if he/she and his/her patient would have liked to use them.

Respecting informed consent

The principle of informed consent stipulates that the patient has a right to accept or decline a medical procedure after being duly furnished with information about what it entails and the possible positive and negative impacts arising from it. As I indicated in COVID-19 Vaccine Mandates in the Light of Public Health Ethics, the medical ethical principle of informed consent is based on the conviction that each and every human being is endowed with intrinsic infinite worth (dignity) and human agency (the capacity of the person to act out of his/her own uniquely human viewpoint). Underlying the two considerations is the assumption that the human person is a ‘know-er’, since it is impossible to adequately enjoy human dignity and human agency without knowledge. All this implies the idea of human rights—certain entitlements due to every person by virtue of his/her humanity.

Human dignity, human agency and human rights presume the autonomy of the individual. In his On Liberty, John Stuart Mill asserted the autonomy of the individual as follows:

“The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

In a chapter on “Autonomy and Its Limitations”, Matjaž Zwitter highlights at least five characteristics of individual autonomy. Understood as the right to self-determination, autonomy includes the right to information and protection of privacy. In an ideal situation, a patient with full autonomy participates in all essential medical decisions, and consents to every invasive procedure. Nevertheless, even patients with full capacity have the right to transfer their autonomy to others such as family members, friends, or to their physicians. In cases where patients are unable to decide for themselves and therefore with limited autonomy, surrogate decision-making is justified. Nevertheless, a doctor is not morally obliged to respect a directive by a surrogate decision-maker if this directive is clearly against the patient’s interests. Some persons make advance directives, to be followed in case of their future incapacity to participate in decisions regarding their treatment. While such written or oral directives are helpful, their validity may be re-considered in situations that the person could not have foreseen at the time of making the advance directive.

In the era of COVID-19, the doctor has been turned into a functionary of just such a bureaucracy, receiving instructions from local and global health authorities.

Thus, in “COVID-19 Vaccine Mandates in the Light of Public Health Ethics”, I pointed out that in the light of the notions of human dignity, human agency and human rights manifesting in medical care as informed consent, any measures imposed on the patient in the name of containing COVID-19 is paternalism, that is, the treating of adults as though they were children. This is equally true in medical care where the doctor-patient relationship is in operation, as in public health policy where health authorities institute measures for the welfare of populations.

Research ethics in medicine

Progress in the medical field rides on research, but therein also lies the danger of the violation of the moral principles that ought to govern the doctor-patient relationship. Consequently, as Adebayo A. Ogungbure notes, the aim of medical research ethics is to ensure that research projects involving human subjects are carried out without causing harm to the subjects involved.

One of the most outrageous violations of medical research ethics was the “Tuskegee Study of Untreated Syphilis in the Negro Male”  of which Ogungbure writes:

“The Tuskegee Study of Untreated Syphilis in the African American Male was the longest experiment on human beings in the history of medicine and public health. Conducted under the auspices of the US Public Health Service (USPHS), the study was originally projected to last six months but ended up spanning forty years, from 1932 to 1972. The men used as subjects in the study were never told that they had the sexually transmitted disease. The term “bad blood” was coined to falsely depict their medical condition. The men were told that they were ill and promised free care. Offered therapy “on a golden platter”, they became willing subjects. The USPHS did not tell the men that they were participants in an experiment; . . .

Though the study was organised and managed from Washington, the participants dealt with a black nurse named Eunice Rivers, who helped with transportation to the clinic, free meals, even burials. The project did not stop until Peter Buxtun, a former PHS venereal disease investigator, shared the truth about the study’s unethical methods with an Associated Press reporter.”

As Ogungbure further explains, the health authorities went to great lengths to ensure that the men in the “Tuskegee Study” were denied treatment, even after penicillin had become the standard cure for syphilis in the mid-1940s. He points out that the ignominious study only came to an end when the Associated Press published a well-researched article about it by whistle-blowing reporter Jean Heller. As a result, writes Ogungbure, congressional hearings about the Study took place in 1973, and the following year the United States Congress passed legislation creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research. Apologising for the Tuskegee Syphilis Study on 16 May 1997, President Bill Clinton described it as “deeply, profoundly, and morally wrong”.

Yet in the early years during which African Americans in Alabama were being ravaged by the Tuskegee Syphilis Study, Adolf Hitler’s regime in Germany was busy conducting grossly unethical research on segments of the population that he considered to be inferior to his mythical Aryan race in the name of eugenics (a set of beliefs and practices that aim to improve the genetic quality of a human population by excluding people and groups judged to be inferior or promoting those judged to be superior). Ogunbure explains that one of the consequences of the atrocities committed by Nazi Germany was the drafting of the Nuremberg Code by an international panel of experts on medical research, human rights and ethics, which served as the initial model for those few public and private research and professional organisations that voluntarily chose to adopt guidelines or rules for research involving human subjects.

Progress in the medical field rides on research, but therein also lies the danger of the violation of the moral principles that ought to govern the doctor-patient relationship.

The following are the ten basic principles of the Nuremberg Code: Seek the voluntary consent of the human subject; conduct only an experiment that is necessary, and whose results will promote the good of society; an experiment on humans ought to only follow experiments on animals; an experiment ought to avoid all unnecessary physical and mental suffering and injury; no experiments likely to cause death or disabling injury should be undertaken; the humanitarian importance of the problem to be solved by the experiment ought to exceed the degree of risk involved; the experimental subject should be protected against even remote possibilities of injury, disability or death; an experiment ought to be conducted only by scientifically qualified persons; the human subjects should be at liberty to opt out of an experiment at any stage; the scientist in charge must be prepared to terminate an experiment at any stage if he/she has any reason to believe that its continuation is likely to result in injury, disability or death.

Several other documents on medical research ethics have been issued since the Nuremberg Code, including the World Medical Association’s Declaration of Helsinki of 1964 which has been revised several times since, and Canada’s Belmont Report of 1979.

Centralisation killing the doctor-patient relationship 

One of the dominant trends in our day is the centralisation of services. Those of us who are older recall a time when the branch bank manager had considerable freedom to make decisions. Then, due to digitisation, came the motto “Every Branch is Your Branch”, because every branch was now directly link to the head office. What we were not told was that the branch manager would henceforth be a mere functionary who had to wait for decisions on every minor detail from the head office. We have witnessed similar developments in the university system, with the Commission for University Education (CUE) now having massive control over the operations of universities in Kenya, so that although there are over forty public universities in the country, CUE requires all of them to operate along the same lines, leaving very little room for lecturers to exercise the time-honoured academic freedom.

Similarly, as hospitals have grown in physical size as well as in the number of personnel, so have their centralizing bureaucratic procedures (“red tape”). Doctors have to comply with elaborate protocols put in place by hospital management to avoid or reduce the number of court cases filed against the hospitals. Similarly, the elaborate chains of command pile pressure on doctors to comply with the policies of the hospitals even when those policies are contrary to patients’ interests. For example, one leading hospital chain in Kenya requires doctors to “request” three different tests on every patient suspected of having malaria, significantly raising the patients’ bills. If the results show that patients do have malaria, doctors in the hospital chain are again duty-bound to administer only a specific set of drugs. In short, doctors have very little say in that whole process.

Furthermore, hospitals have now become centres for gathering detailed information about patients for purposes other than the patients’ welfare. Many of my Kenyan readers have probably noticed that they can only purchase drugs or have tests done in private hospitals after giving their phone numbers to the personnel at the front desk. This enables the hospitals to access a patient’s personal records for the purpose of building a detailed history of all the drugs and tests that he/she has procured from that hospital over the years. This is precisely the kind of information which large pharmaceutical companies are eager to buy from the hospitals for a handsome price. In the era of the Fourth Industrial Revolution, the pharmaceuticals use artificial intelligence to analyse the massive information (“big data”) to get a  very clear picture of trends in the health of individuals and populations, thereby enabling them to design business plans that bring them massive profits.

As hospitals have grown in physical size as well as in the number of personnel, so have their centralizing bureaucratic procedures.

The death of the doctor-patient relationship on the back of intense centralisation has already taken a huge toll on the quality of health in hospitals in Kenya. According to the “Kenya Patient Safety Survey” conducted by the Ministry of Health in 2013, a patient’s safety could not be guaranteed in a majority of medical facilities in the country: only 13 hospitals out of 493 public and private health facilities in 29 counties surveyed achieved a score greater than one on an ascending scale of 0-3. The report stated, “Overall safety compliance was relatively poor, with less than one per cent of public facilities and only about two per cent of private facilities achieving a score greater than one in all five areas of risks assessed.” For instance, less than 10 per cent achieved a score greater than one in providing safe clinical care to patients. Of the 13 that scored more than one, 11 were private facilities, while only two were public. Furthermore, less than six per cent of public hospitals achieved a score greater than one in having a competent workforce. According to the report, this state of affairs had in some instances resulted in death.

Besides, in mid-2015, twenty-eight children in Busia County became partially paralysed due to medical malpractice. According to The Standard, the children had partial paralysis arising from injections given in the six months between December 2014 and June 2015, although those with severe paralysis reported initial complaints after treatment in 2013. The Standard quoted then Cabinet Secretary James Macharia as stating, “Our initial investigations point towards medical malpractice from inappropriate injection techniques as the primary cause of partial paralysis in all the 28 children.”

This is precisely the kind of inforamation which large pharmaceutical companies are eager to buy from the hospitals for a handsome price.

Yet in the era of COVID-19, the heavy centralisation of hospital operations that is stifling the traditional doctor-patient relationship has moved to an unprecedented high level. COVID-19 testing and treatment are heavily centralised and meticulously directed from the highest health authorities in each country. In many countries, doctors are strictly forbidden to use COVID-19 vaccines and therapies that have not yet been approved by the World Health Organisation (WHO) and adopted by their own top health authorities. Besides, countries are required to share their data on COVID-19 infections, hospitalisations, vaccinations and deaths with the WHO. Many health authorities at country level run online COVID-19 databases through which citizens can request for vaccination, download their vaccination certificates, and show proof of vaccination. Various governments also have arrangements among themselves to verify the authenticity of international travellers’ vaccination certificates/passports.

Furthermore, David Ngira and John Harrington inform us that generally, WHO recommendations are used as a form of quality control by domestic regulators who view them as a guarantee of safety and effectiveness. Ngira and Harrington also point out that many African states have relied wholly on the WHO Global Advisory Committee on Vaccine Safety given their weak national drug regulators and the limited capacity of the Africa Centre for Disease Control (CDC). The Africa CDC itself deems vaccines safe for use by member states on the basis of WHO recommendations. This means that the doctor no longer has the latitude to give his/her patient guidance strictly on the basis of his/her medical training and experience, but rather on the basis of protocols formulated by local and global health authorities.

Thus in the face of intense centralisation of medical care in the era of COVID-19, time-honoured principles of medical ethics such as the single-minded promotion of the good of the patient, confidentiality, respect for the patient’s right to informed consent, and the imperative for moral integrity in medical research, all of which held the doctor personally responsible for what he/she did in the course of his/her work, are inconceivable in a situation in which a doctor only acts on “orders from above”. The loser in this undesirable paradigm shift is the patient, and the winner the wealthy who have turned medical care into a business. I recently heard a senior Israeli medical professor state that when politics is mixed with science, all that remains is politics. To which I add that when medical care is mixed with business, all that remains is business.

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Dr. Reginald M.J. Oduor is Senior Lecturer in Philosophy at the University of Nairobi. He is the first person with total visual disability to be appointed to a substantive teaching position in a public university in Kenya. He was the founding Editor-in-Chief of the New Series of Thought and Practice: A Journal of the Philosophical Association of Kenya from 2009 to 2015. With Drs. Oriare Nyarwath and Francis E.A. Owakah, he edited OderaOruka in the Twenty-First Century. He is also Co-founder and current Chair of the Society of Professionals with Visual Disabilities (SOPVID). Email: rmjoduor@gmail.com. Blog: http://kenyancrossroads.blogspot.co.ke

Politics

‘Crush and Grind Them Like Lice’: Harare Old Guard Feeling Threatened

With the launch of the Citizens Coalition for Change, Zimbabwe’s political landscape has undergone a significant shift, with a younger activist generation increasingly impatient with the unfulfilled promises of liberation.

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‘Crush and Grind Them Like Lice’: Harare Old Guard Feeling Threatened
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On the 26th of February 2022, Zimbabwe’s Vice President delivered a chilling threat to the opposition. In a speech the “retired” army general Constantino Chiwenga, the chief architect of the November of 2017 putsch that removed Robert Mugabe, threatened that the opposition will be “crushed and ground on a rock like lice”. The General claimed that the ruling party was a “Goliath”; the Biblical imagery of the diminutive David “slaying” the giant Goliath was entirely lost on the Vice President. Here are his words:

“Down with CCC. You see when you crush lice with a rock, you put it on a flat stone and then you grind it to the extent that even flies will not eat it… But we are as big as Goliath we will see it [the opposition] when the time comes”.

The following day violent mayhem broke out in Kwekwe, the very town where the fiery speech was made. By the time the chaos ended, the opposition reported that 16 of their supporters had been hospitalised and it was recorded that a young man was sadistically speared to death. The supporters of the ruling party had taken the threat to “crush” and “grind” the opposition seriously. Details emerged—from the police—that the suspects were from the ruling party and had tried to hide in a property owned by a former minister of intelligence.

The launch of the Citizens Coalition for Change (CCC) has galvanised the opposition. Going by the youthful excitement at the rallies, the violence flaring against its supporters, and the way the police has been clamping down on CCC rallies, the ruling elites have realised they face a serious political threat from what has been called the “yellow” movement.

Exit Mugabe and Tsvangirai: Shifts in opposition and ruling class politics

The death of opposition leader and former prime minister Morgan Tsvangirai in February 2018 came in the wake of the November 2017 coup and other significant political events that followed. The death was a big blow to the opposition; there had been no succession planning, which was rendered more complex by the existence of three vice presidents deputising Tsvangirai. The MDC Alliance succession debacle set in motion a tumultuous contest that splintered the opposition. Court applications followed, and the ruling elites took an active interest. When the court battles ended, the judiciary ensured a “win” for the faction favoured by the ruling class. That faction was formally recognised in parliament, given party assets and provided with financial resources by the Treasury that were meant for the opposition.

As for the ruling party, there has been a shift in the political contests along factional lines, accentuated following the death of Robert Gabriel Mugabe in September of 2019. There is high suspicion that the 2017 coup plotters (generals and commanders) now want their proverbial “pound of flesh”—the presidency. With the presidency as the bull fighter’s prize, the factions are now lining up either behind the president or the behind generals and this is cascading through the ruling party structures. The historical faction known as G40 (Generation 40) that hovered around the then first lady has been practically shut out of political power, with its anchors remaining holed up outside the country. Remnants of the G40 faction in Zimbabwe have been side-lined, with some of them subjected to the endless grind of court processes to ensure they keep their heads down.

Yet another element has emerged, that of a president who feels besieged and is re-building the party and executive positions in the image of his regional ethnic block, bringing into the matrix a potent powder keg waiting to explode in the future.

The ruling party has gone further to entice Morgan Tsvangirai’s political orphans in order to decimate the leadership ranks of the opposition. Patronage is generously dished out: an ambassadorial appointment here, a gender commissioner position there, a seat on the board of a state parastatal…, and so on. These appointments come with extreme state largesse—cars, drivers, state security, free fuel, housing, pensions and the list goes on. The patronage also includes lucrative gold mining claims and farms running into hundreds of acres that come with free agricultural inputs. The former opposition stalwarts must be “re-habilitated” by being taught “patriotism” at a Bolshevik-like ideological school and then paraded at rallies as defectors to ZANU-PF.

Yet another element has emerged, that of a president who feels besieged and is re-building the party and executive positions in the image of his regional ethnic block.

As these political shifts take place and the opposition divorces itself from the succession mess, there are also changes in Zimbabwe’s economy and this has a direct impact on the trajectory of politics in the country.

Transformed political economy: Informality, diaspora and agrarian change  

From about the end of the 1990s and stretching into the subsequent two decades up to 2022, Zimbabwe’s political economy has shifted significantly. Firstly, the fast-track land reform of the early 2000s altered land ownership from white settler “commercial” farmers to include more black people. The white-settler class power was removed as a factor in politics and in its place is a very unstable system of tenure for thousands of black farmers that have been married to the state for tenure security and stability.

Secondly, the follow-on effect of the land reform meant that Zimbabwe’s industrial base was altered, and this has resulted in a highly informalized economy or what others have called the “rubble”. An informal economy is now the new normal across the board for ordinary citizens and this has weakened organized labour as a voice in political contests. In 2020, the World Bank estimated extreme poverty at 49 per cent; this is infusing a sense of urgency for political change and is putting pressure on the political elites in Harare.

Thirdly, the exodus of Zimbabwe’s younger population into the diaspora has introduced another factor into the political matrix. According to official figures, the diaspora transferred about US$1.4 billion in 2021 alone, but this figure doesn’t capture remittances that are moved into Zimbabwe informally; the figure is much higher. The diaspora has actually used its cash to have a political voice, often via the opposition or independent “citizen initiatives”. It is proving to be a significant player in the political matrix to the extent that Nelson Chamisa has appointed a Secretary for Diaspora Affairs. For its part, the ruling party has blocked the diaspora vote.

Fourth, the national political economy has been “captured” by an unproductive crony class to the extent that researchers have estimated that as much as half of Zimbabwe’s GDP is being pilfered:

“It is estimated that Zimbabwe may lose up to half the value of its annual GDP of $21.4bn due to corrupt economic activity that, even if not directly the work of the cartels featured in the report, is the result of their suffocation of honest economic activity through collusion, price fixing and monopolies. Ironically, President Emmerson Mnangagwa, who has been a public critic of illicit financial transfers, is identified by the report as one of the cartel bosses whose patronage and protection keeps cartels operating.”

Fifthly, and often under-researched, is the substantial role of China across Zimbabwe’s political economy as Harare’s political elites have shifted to Beijing for a closer alliance. This has paid handsomely for China which has almost unrestrained access to Zimbabwe’s natural resources, and the political elites are “comrades in business” with—mostly—Chinese state corporations; China’s influence is pervasive and evident across the country. Put together, the factors above mean that the political economy structure has changed significantly and it is within this landscape that the Citizens Coalition for Change—dubbed the “yellow movement” — that has been launched by the opposition will have to operate and organise.

‘Yellow Movement’: Re-articulating the future beyond the ‘Harare Bubble’? 

Since its launch, the opposition movement has swept into the CCC’s ranks the younger demographic of activists together with some solid veterans who survived the brutal years of Robert Mugabe’s terror. Zimbabwe’s median age is reported to be about 18 years of age; if these young people can register, turn out to vote and defend their vote, there is a whirlwind coming for the old nationalists in Harare.

Some within the ruling party have noticed this reality, with a former minister and ruling party member stating that “Nelson Chamisa is gaining popularity because the ZANU PF old guard is fighting its own young men and women”. This admission is consistent with the words of Temba Mliswa, another “independent” member of parliament and a former leading activist in the ruling party, who stated that:

“The generational approach is like you trying to stop a wave of water with your open hands. You cannot ignore it. It’s a generational issue. You cannot ignore it. You need to look at it. You need to study it… There is no young person in ZANU PF who is as vibrant as Chamisa, who is as charismatic as Nelson Chamisa. Chamisa is going to go straight for ED (President Emmerson Mnangagwa)… There is no gate preventing this.’

These admissions are an indication that the CCC movement poses a serious threat to the ruling party. But beyond the contest of politics, of ideas, of policy platforms, the “yellow movement” will have to divorce itself from the “Harare Bubble”. The ruling nationalists polished a rigid centralised political system inherited from settler-colonialism, and have used this to build a crony network of robbery based in the capital city while impoverishing other regions. But they are not alone in this; even the opposition has often overlooked the fact that “all politics is local” and it has also created a “Harare Bubble” of yesterday’s heroes and gatekeepers who, armed with undynamic analyses, continue to cast their shadows into the arena long after their expiry date.

“Nelson Chamisa is gaining popularity because the ZANU PF old guard is fighting its own young men and women”.

The yellow movement will have to go local and divorce itself from the parochial legacy of previously progressive platforms that have now been cornered by an elite who have become careerist, corrupt, inward-looking and, like civil warlords, only loyal to imported 10-year-old whisky bottles and their kitambis—their visibly ballooning stomachs.

Yet there is no ignoring it; Zimbabwe’s youth have been emboldened by political change in Zambia and Malawi, and by the rise of younger leaders in South Africa. The winds are blowing heavily against the status quo. In the 2023 general election, the ruling nationalists will face a more tactful, daring and politically solid Nelson Chamisa who has strategically pushed back against “elite pacts”. Added to his eloquence, his speeches are getting more structured, substantially more polished, and he is projecting the CCC movement as a capable alternative government. With the indelible footprints of Morgan Tsvangirai in the background, the next general election, in 2023, will be an existential contest for Harare’s old nationalists—they are facing their Waterloo.

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Politics

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.

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The Dictatorship of the Church
Photo: Aaron Burden on Unsplash.
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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 servicesCritics 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.

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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.

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Pattern of Life and Death: Camp Simba and the US War on Terror
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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.

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