When Hospitals Become Jails

The Kenyatta National Hospital is east Africa’s biggest medical institution, home to more than a dozen donor-funded projects with international partners — a “Center of Excellence,” says the U.S. Centers for Disease Control and Prevention. The hospital’s website proudly proclaims its motto — “We Listen ... We Care”.

Robert Wanyonyi, is not allowed to leave the hospital because he cannot pay his bill of nearly 4 million Kenyan shillings ($39,570). At Kenyatta National Hospital and at an astonishing number of other hospitals around the world, if you don’t pay up, you don’t go home. 

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Mothers and babies are sometimes separated. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say. During several August visits to Kenyatta National Hospital, The Associated Press witnessed armed guards in military fatigues standing watch over patients, and saw where detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler. All despite a court ruling years ago that found the detentions were illegal. At many Kenyan hospitals, including Kenyatta, officials armed with rifles patrol the hallways and guard the hospital’s gates. Patients must show hospital guards a discharge form to prove they’re allowed to leave and even visitors must sometimes surrender their identification cards before seeing patients.

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, who was not involved in the British research. “It’s probably hundreds of thousands if not millions of people that this affects worldwide. It is not something that is only happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.” The problem has also surfaced in wealthier countries, with patients being detained in hospitals in countries including India, Thailand, China and Iran.

In Congo’s second city of Lubumbashi, the AP visited more than 20 hospitals and clinics and found that all but one routinely detained patients who failed to pay, even though the practice is illegal there.

“It’s the dirty underbelly of global health that nobody wants to talk about,” said Sophie Harman, a health academic at Queen Mary University of London.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go.”

 In some hospitals in Cameroon and elsewhere, for example, the problem of patient imprisonment was solved by some institutions by simply demanding payment upfront. Unlike many hospitals in developed countries, African hospitals don’t always provide food, clothing or bedding for patients, so holding onto them does not necessarily incur a significant cost. Detained patients typically rely on relatives to bring them food while those without obliging family members resort to begging for help from staff or other patients.

Dr. Festus Njuguna, a pediatric oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly holds children with cancer who have finished their treatment, but whose parents cannot pay. The children are typically left on the wards for weeks and months at a time, long after their treatment has ended.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

In its 2016 financial report, Kenyatta’s auditor-general said the hospital lost more than $470,000 in fees from patients who “absconded” without paying. That year, the hospital reported total revenue of more than $115 million. Kenya’s Human Rights Commission attempted to conduct an audit of Kenyatta, but officials refused to cooperate and have ignored all requests for information about detained patients.

In January, demonstrators called for an investigation into allegations of rape and sexual harassment of patients at the hospital. 

“This is something that hospital authorities have been trying to keep under wraps,” said George Morara, vice chairperson of the country’s national commission on human rights. He said the number of Kenyans imprisoned in hospitals is “disturbingly high” and that the practice is “ubiquitous in public and private hospitals.” He said patients have been held at Kenyatta for up to two years, and it was reasonable to suspect that hundreds of patients could be detained there at any time.

After she was elected to Kenya’s Parliament, Esther Passaris visited Kenyatta last December to check on supporters who were injured in election violence. She was stunned to find that patients were incarcerated.

“There was one lady I met in the corridor and she was crying, ‘please let me go home,’” Passaris said. The woman had hurt her back and hip. She had been medically cleared to leave, but wasn’t allowed to go home because she hadn’t paid her bill. “I just thought, ‘Oh my goodness, it’s almost Christmas, how can these people not go back to their families?’”

Passaris started an online campaign to have the patients released. Just before the holidays, Kenyatta let more than 450 leave — a victory, Passaris says, though the problem remains.

“Unfortunately,” she said, “you can’t get water from a rock, so some of these patients stay for a year because they don’t have the money.”

“Aid money becomes ineffective and useless in an environment where people are terrified they’re going to be locked up,” said Robert Yates, a health policy expert at Chatham House, the British think tank that reported on imprisoned patients. “It’s very embarrassing for the global health community that these detentions have become so embedded into countries that they seem normal, and so the whistle needs blowing on all of us.”

Dr. Carey Farquhar, director of the university’s Kenya Research and Training Center, said she didn’t recall seeing any detained patients at Kenyatta, though was not surprised that it happened — she knew of no hospitals there that did not detain patients. “It does make me uncomfortable,” she said.

Dr. Agnes Soucat of WHO said the U.N. agency was aware of hospital detentions and confirmed they happened “quite frequently.”

“We do not support this in any way, but the problem has been documenting where it happens,” said Soucat, director of WHO’s department of health systems, financing and governance. To date, WHO has made no attempt to collect data on hospital detentions and says such information is hard to find.

Researchers for the Center for Reproductive Rights, which acts to support women’s health around the world, were conducting a study of maternal health care in Kenya in early 2012 when they learned of the cases of Maimuna Awuor Omuya and Margaret Oliele.

Unable to pay her bill at Pumwani Maternity Hospital after the delivery of her sixth child, Omuya and her baby were imprisoned along with more than 60 other women in a damp ward, in September 2010. She often slept on the wet ground next to a flooded toilet. Mother and child were released after nearly a month, but only when one of Omuya’s friends appealed to the mayor to intervene.

Two months later, Oliele arrived at Pumwani. During a botched cesarean section, doctors left a pair of surgical scissors inside Oliele’s stomach; a second surgery was needed to remove the scissors and she later suffered a ruptured bladder and a blood infection. When she couldn’t pay her hospital fees, Oliele was taken to a detention ward.

“I tried to escape, but when I got to the main gate, I was taken by the security guards,” Oliele told AP. “I had no clothes on and still had the catheter in my stomach. The guards then forcefully took me back to the hospital where they handcuffed me to a bed, while claiming that I had gone mad.” She was held for six days.

Center for Reproductive Rights lawyers resolved to take up the cause of detained patients, bringing suit on behalf of Omuya and Oliele.

“These were two very appalling cases and their treatment was very degrading,” said Evelyne Opondo, a senior regional director at the center who oversaw the case.

They won. In September 2015, Kenya’s High Court ruled the women’s detention violated numerous human rights enshrined in the constitution and was therefore illegal. The High Court described the women’s detention as “cruel, inhuman and degrading.” The court further ordered the Kenyan government to “take the necessary steps to protect all patients from arbitrary detention in health care facilities.”

But three years later, it appears little has changed. “People are still being detained,” Oliele said. “They should stop treating people like animals and treat them as fellow human beings.”

Opondo said detentions continue because nobody has asked hospitals “to provide answers, because they’ve not been held accountable.” She estimated there could be many thousands of people across the country detained, based on information received by the center and news reports.

https://www.apnews.com/daf47512c8f74e869b722782299b4a0e

The real cost of disease

 The Ebola outbreak that ravaged Sierra Leone, Guinea and Liberia in 2014 cost economies an estimated $53 billion, according to a study in this month's Journal of Infectious Diseases.

The outbreak ran from 2013 to 2016 and killed at least 11,300 people, more than all other known Ebola outbreaks combined. 

The report's authors, Caroline Huber, Lyn Finelli, and Warren Stevens, put the economic costs at $14 billion and said the human cost was even greater, based on the people affected and a dollar figure that reflects the value of each human life.

The total is far higher than previous estimates. In October 2014, the World Bank said the Ebola epidemic could cost $32.6 billion by the end of 2015 in a worst case scenario, but by November 2014 it dialled back that forecast to $3-4 billion. In 2016 the World Bank estimate of economic loss was $2.8 billion.

The new Ebola study factored in the impact on health workers, long-term conditions suffered by 17,000 Ebola survivors, and costs of treatment, infection control, screening and deployment of personnel beyond West Africa. The biggest cost not previously accounted for was deaths from other diseases, as Ebola tied up healthcare resources and hospital admissions fell dramatically, adding $18.8 billion to the total bill.

During the outbreak, there were 10,623 additional deaths from HIV/AIDS, tuberculosis and malaria, with 3.5 million additional untreated malaria cases. Measles caused 2,000-16,000 extra deaths as 1 million children missed being vaccinated for measles, and 600,000-700,000 missed other vaccines. The authors added that they had limited information on the cost of deploying international health staff and military personnel, and they were obliged to place a value on human life, a widely accepted economic measurement.

Although the "value of a statistical life" (VSL) in North America and Europe is estimated at $7 - 9 million, the authors said, they took a figure from the only study in a West African context, with a VSL of $577,000 in Sierra Leone.

http://news.trust.org/item/20181024164518-78sjj/

Nigeria's child mortality

• A report on inequality by Oxfam International said one in 10 children in Nigeria died before the age of five.
• UN data puts Nigeria’s under-five mortality rate at 100 per 1,000 children – or one in 10. Nigerian data points to an even higher rate.

Was It Worth It? (1961)

From the November 1961 issue of the Socialist Standard

The following letter has been received from a sympathiser and we think it will be of interest to our readers.

On September 4 dockworkers and railwaymen at Takoradi and Kumasi in Ghana went on strike against a deliberate attempt by the government to decrease the workers' share of what they produce. The austerity budget introduced in July provided for measures which would lead to an all-round rise in prices. In addition a compulsory savings scheme was introduced and a wage freeze announced.

The strikers were told that they didn’t really want to strike but that they were being forced to; if anyone wished to return to work the government would gladly provide protection. Very few workers took up this offer and President Nkrumah from a holiday resort on the Black Sea coast of Russia ordered his Ministers at home to get tough with the strikers. All those who refused to return to work were threatened with dismissal and troops were moved into Takoradi. The strike was, of course, unofficial since the leadership of the trade unions supports Nkrumah. The general secretary of the T.U.C. hurried back from the neutral's conference in Belgrade, quickly got to know the facts and did not hesitate to call the strike a “counter-revolution" and to denounce it as illegal.

This is not the first time that Ghanian workers have protested. Last year they were demanding wage increases. The opposition newspaper Ashanti Pioneer supported these demands and in September the legal daily minimum wage for unskilled workers was raised from 5s. 6d. to 6s. 6d. The austerity budget will make the workers worse off than they were before September last. Not surprisingly, then, they have gone on strike. The reasons given for last year's trouble are interesting:

  T.U.C. spokesmen blamed the workers’ dissatisfaction on the remnants of a capitalist, imperialist, colonialist system which still darkened the economic and social horizon. The minority and the Ashanti Pioneer, felt that the workers were dissatisfied because they saw top trade union officials and Government Ministers becoming wealthier while the workers suffered. (Observer, 28/8/60.)

For daring to make such observations on the development of capitalism in Ghana and for supporting the demands for wage increases the Ashanti Pioneer found that in future it would be subject to censorship. The Ghana T.U.C. spokesmen are right in attributing the cause of the trouble to Capitalism. But it is not the remnants but the beginning of Capitalism that is responsible. Ghana is just entering a period of capitalist development despite all the talk about "Ghana's way to Socialism." As Capitalism develops and more workers are needed to operate the new machinery the tribes are broken up: simultaneously classes begin to appear among the urban inhabitants. Already Ghana has a wealthy upper class:

  Ghana's first gambling casino will open shortly—but only for foreigners and certain classes of wealthy Ghanians. A company set up to run the casino announced today that in conformity with casino licensing laws passed last year, Ghanians will not be admitted to membership unless they have a yearly income of more than £1.500 and are not members of the armed forces, judiciary, police force or public service departments. (Guardian, 9/6/60.)

Very few workers in this country, let alone Ghana, get £1,500 a year. As it is, with the legal minimum wage at 6s. 6d. a day these Ghanian capitalists get about ten times as much a year as an ordinary worker.

Little wonder, then, that the workers are beginning to feel that perhaps they have no interests in common with all classes of wealthy Ghanaians including the Nkrumah ruling clique. Many must be asking themselves as they survey the part they played in the struggle for independence: “Was it worth it? ” Socialists have said all along that national independence movements merely end in the setting up of capitalist nation-states and are therefore not worth supporting. The leaders of nationalist parties once in power are faced with the harsh realities of running and expanding Capitalism in their countries, and Capitalism can never be made to run in the interests of the workers. If we look outside Ghana we see the same sort of thing happening: men like Lee Kuan Yew of Singapore and Julius Nyerere of Tanganyika with more regard for democracy than Nkrumah have been forced to act against the workers in their countries, as the following report from Tanganyika shows:

  Relations between Mr. Nyerere, Tanganyika’s Chief Minister, and the territories’ trade union leaders are sharpening. The strike at the Williamson diamond mine which Mr. Nyere firmly ended after 12 days, brought this division into the public eye. After Tanganyika obtained an elected majority in the legislative council in September, trade unionists expected quick action to improve wage levels. But Mr. Nyerere has to be pushed into rash promises or actions. Working closely with Sir Arthur Vasey, his Finance Minister, he is endeavouring to maintain the climate of quiet confidence for foreign investment. (Daily Telegraph, 29/12/60.)

Dr. Banda, after his sweeping victory in the Nyasaland elections, seems to be planning similar actions to those of Nkrumah. The Sunday Express (17/9/61) reports that Suzgo Msiska, leader of one of the two rival trade union congresses in Nyasaland "has lost a great deal of prestige in the eyes of Banda and his colleagues. No sooner had Malawi emerged victorious at the polls than Msiska brought 800 workers out on strike for more pay. Now Banda urges: ‘Msiska must go.’ ’’

In the Congo politicians like Lumumba were elected to power on promises of wage increases which the workers didn’t get. So they went on strike. At first, Lumumba called out troops against them but eventually gave in and granted the wage increases, but not before he had devalued the Congolese franc. So that the workers merely received an increase in money wages.

The plain fact of the matter is that independence merely brings a change of masters for the workers—and their new masters are more often than not their former leaders. Socialists see no reason why they should help such men to power. Even the elementary democratic rights of “one man, one vote ” and freedom of political activity that independence may bring are not secure as in events in Ghana in particular show. To those Ghanian and other workers who ask if the struggle for independence was worth it, Socialists reply that it was. not. We do not, of course, expect colonial workers to suffer colonisation forever. We are just pointing out that independence is not the solution to their problems. Indeed, in many cases, it is just the beginning. Socialism is the only solution to the problems of the workers throughout the world.

Adam Buick

Nkrumah Strikes (1961)

Dr. Nkrumah has made a habit of disappointing some of the well-meaning asses who supported him because they thought that he wanted to set up a democratic state in Ghana.

These people fall so readily and so persistently for any small-time nationalist who breezes along that it is fair to assume they are able to ignore any evidence which points out the error of their ways.

But surely even they were unsettled by Nkrumah's recent arrest of his political opponents, and by the propaganda which accompanied it?

When the Ghana government roped in the fifty politicians, the official statement justified the arrests by referring to “. . . acts of violence, secret meetings . . . strikes, sabotage, lockouts . . . conduct destructive and subversive, against the Constitution and other legal institutions of the State.”

Now this rings a bell. It is just the sort of vague accusations which colonial powers use to excuse the suppression of a rising nationalist movement.

To read it takes us back to the early nineteen-fifties, when Nkrumah was in gaol. The asses were braying, then, for his release, because he was supposed to be leading Ghana to freedom. Are they surprised that he has turned out to be no better than the rulers he replaced?

We know our asses too well. Even if they drop the dictator in Accra, they will soon be taking up the cause of some other Nkrumah of the future

Female Empowerment

High fertility rates can be seen in much of Africa with four or more births per woman. Countries with high fertility have faster population growth, which poses challenges for governments already struggling to make progress to provide education, healthcare, and employment opportunities.

Generally, these countries are poorer with limited access to quality healthcare and contraception.

UNFPA found that over 20 percent of women in the region want to avoid a pregnancy but have an unmet need for family planning.

At the same time, almost 20 million—or 38 percent—of the region’s pregnancies each year are unintended.

Practices such as early marriage, which is associated to an early start to child bearing, is also common.

In sub-Saharan Africa, approximately 38 percent of women are married by the age of 18. In Niger, 76 percent of girls marry by the age of 18. Child marriage, which is accompanied with the end of education and the lack of opportunities for employment and thus reduced earnings in adulthood, denies girls’ decision-making power and their right to choose.

“The gap between desired and actual family size suggests that women and men are not fully able to realise their reproductive rights,” the report states.

“Choice can be a reality everywhere. This is something that governments should prioritise,” UNFPA’s Washington D.C. director Sarah Craven told IPS. Craven expressed concern over any policy that restricts individuals to access information and services, and highlighted the importance of reproductive choice.

In high fertility countries, there is a need for education on reproductive rights and employment opportunities for rural women while low fertility countries should implement family-friendly policies such as child care services and parental leave.

UNFPA’s executive director Natalia Kanem said “The way forward is the full realisation of reproductive rights, for every individual and couple, no matter where or how they live, or how much they earn…the real measure of progress is people themselves: especially the well-being of women and girls, their enjoyment of their rights and full equality, and the life choices that they are free to make.”

A Rush to Freedom

300 people rushed a border fence between Morocco and Spain's North African enclave Melilla, Spanish authorities said. One man died and nineteen other people were being treated for fractures or cuts sustained while scaling the fences . 

The border between Morocco and Spain's Melilla is cordoned off by two fences over six meters (20 feet) high and topped with barbed wire. Despite the Spanish government's promise to remove barbed wire on top of the fence, it has not yet done so.

According to the latest United Nations figures, over 48,800 migrants and refugees have entered Spain so far this year — more than Italy and Greece. Over 4,000 have entered Spanish territory in 2018 by crossing the fence into Melilla.

https://www.dw.com/en/hundreds-of-migrants-scale-spanish-enclave-fence/a-45976287

ICC - A toothless court

At least 33 countries ignored International Criminal Court’s warrants for arrest of Sudan's president, Omar al-Bashir. 

He has been travelling freely around the world despite an eight-year-old international warrant for his arrest on charges of war crimes and genocide. In 2009 and 2010 Bashir was indicted by the Hague-based International Criminal Court on multiple counts of genocide, crimes against humanity and war crimes. Warrants for his arrest were issued on the basis of his “individual criminal responsibility” for those alleged crimes during the conflict that began in Darfur in 2003. However, despite these warrants, in the last decade he has made 150 trips to countries including China, South Africa, Saudi Arabia, Egypt, Jordan and Kenya, with many of these party to the statute that set up the ICC.

Bashir has made regular trips to countries that are not full members of the ICC, such as Saudi Arabia, Ethiopia and Qatar, but it is his visits to full members of the Rome statute, such as South Africa, Uganda and Jordan, that raise the most questions. This was highlighted when Jordan was referred to the UN security council by the ICC following its failure to arrest him during a March 2017 trip. Jordan’s response was that he was immune from arrest as a sitting head of state. Jordan said it subscribed to the need to punish those responsible for crimes within the court’s jurisdiction, but not at the “expense of fundamental rules and principles of international law aimed at securing peaceful relations among states”. South Africa was also admonished for similarly failing to arrest him, but the ICC decided not to refer it to the UN.

There are 123 countries signed up to the ICC, but the lack of a police force means it is reliant on countries implementing its decisions.

“How useful is the ICC when it can’t arrest those it wants to try for crimes they have allegedly committed?,” asked Windridge. “Bashir is consistently travelling to non-state parties, which is undoubtedly frustrating, but of more concern is that he is also consistently travelling to state parties, sometimes on multiple occasions,” he said. “And it does appear that one of the biggest weaknesses the ICC faces in this case and moving forward is arresting sitting heads of state, which is concerning, as eradicating immunity was one of the very reasons the ICC was created. It wasn’t created to try low-level perpetrators, it was created to try those most responsible for the worst crimes, when domestic prosecution could not take place. But those most responsible are often those leading countries, and we are having great difficulty actually prosecuting them.” He continued, “Is the reality that the ICC will only ever try former heads of state, those deposed from power? It’s possible, but many people would say that isn’t a good place to be, nor is it the ICC vision that so many worked hard for so many years to create. The idea was, and continues to be, that if a wanted person were to leave their country and go to an ICC member state, they would be arrested. So in a sense, at the very least, they would be pinned into their own country with very limited or no travel, becoming an international pariah. But what we are seeing with Bashir is quite the opposite and we are now seeing the realisation that arresting and trying sitting heads of state is a lot more complicated than perhaps first thought.”

https://www.theguardian.com/global-development/2018/oct/21/omar-bashir-travels-world-despite-war-crime-arrest-warrant

Mali's "WHITE GOLD"

Mali is West Africa's second-largest rice producer, but it still imports 18 percent of its rice annually. Imports prevent local production from reaching its full potential. Malian authorities are looking for ways to reduce imports and become self-sufficient in rice.

 When rice farmers started producing yields nine times larger than normal in the Malian desert it was the result of an engineering feat that has left experts in this impoverished nation in awe - but one that has yet to spread widely through Mali's farming community.

With hunger a constant menace, Malians are cautiously turning to a controversial farming technique, known as rice intensification, to adapt to the effects of climate change. The method has raised hopes that Mali's small-scale rice farmers might be able to increase their productivity to meet the country's gargantuan appetite for the grain.

Consumption of the staple stood at about 72 kg (163 lb) of rice per person in 2014, according to the latest data Mali's National Directorate of Statistics has made public - and demand is continuing to grow.

Dubbed the System of Rice Intensification (SRI), the new rice production method involves planting fewer seeds of traditional rice varieties and taking care of them following a strict regime. Seedlings are transplanted at a very young age and spaced widely. Soil is enriched with organic matter, and must be kept moist, though the system uses less water than traditional rice farming. Rice intensification uses up to 40 percent less water than traditional rice growing methods. Rice plants grown following the method live longer because, given more space, more oxygen and less water, their roots grow bigger and deeper, so they are more resilient to drought and don't deteriorate under flooding. 

SRI is used on both irrigated and non-irrigated land, meaning it is possible to cultivate rice even in Mali's desert, pilots conducted by the U.S. Agency for International Development have shown.

Up to 20 million farmers now use rice intensification in 61 countries, including in nearby Sierra Leone, Senegal and Ivory Coast, said Norman Uphoff, a senior advisor at the SRI International Network and Resources Center at Cornell University in the United States.

 Because it competes with the improved hybrid and inbred rice varieties that agricultural corporations sell, Uphoff said by phone. "The new technique is "not good news for the brand breeders and the seed companies".

For Faliry Boly, who heads a rice-growing association, the prospect of rice becoming a "white gold" he method could increase yields while also offering a more environmentally-friendly alternative, including by replacing chemical fertilisers with organic ones, he said. What's more, rice intensification naturally lends itself to Mali's largely arid climate.

The cost of a rice transplanting machine - a key part of the system - is between $2,100 and $2,900, more than many farmers can afford.

http://news.trust.org/item/20181019050923-zzozt/

And Quiet Flows The Nile

Running through eleven countries for 6,853 kilometres, the Nile is a lifeline for nearly half a billion people. But the river itself has been a source of tension and even conflict for countries and territories that lie along it and there have been rumours of “possible war for the Nile” for years now. While to date there has been no outbreak of irreversible tension, experts say that because of increasing changes in the climate a shared agreement needs to be reached on the redistribution of water soon. All the cities that run along the river exist only because of these waters. For Egypt, this is particularly true: if the Nile wasn’t there, it would be just another part of the Sahara desert. Each year, rainfall in Ethiopia causes the Nile to flood its banks in Egypt. When the Nile flood recedes, the silt – a sediment rich in nutrients and minerals and carried by the river – remains behind, fertilising the soil and creating arable land. Natural fertility is actually the Nile’s biggest legacy for Egyptians.

“Right now I do not think there is a concrete and imminent risk of conflict between Egypt, Sudan and Ethiopia, given the internal difficulties and the unstable nearby area [Libya] of the first, the recent secession suffered by the second and the peace agreement achieved by the third with Eritrea,” Maurizio Simoncelli, vice president of the International Research Institute Archivio Disarmo, a think tank based in Rome, told IPS. “However, it is certain that if a shared agreement is not reached on the redistribution of water in a situation of increasing climatic changes, those areas remain at great risk,” he said.

Egypt and Sudan still regard two treaties from 1929 and 1959 as technically binding, while African upstream nations – after gaining independence – started to challenge these agreements, signed when they were under colonial rule.

The 1959 treaty allocates 75 percent of the river’s waters to Egypt, leaving the remainder to Sudan. Egypt has always justified this hegemonic position on the basis of geographic motivations and economic development, as it is an arid country that could not survive without the Nile’s waters, while upstream countries receive enough rainfall to develop pluvial agriculture without resorting to irrigation.

 "...Cairo has no alternative water resources. Without the Nile, Egypt would die,” Matteo Colombo, associate research fellow in the MENA Programme at the Italian Institute for International Political Studies (ISPI) told IPS.

 Ethiopia could need more water to produce more electricity, which could in turn diminish the amount of flow towards Cairo. Indeed, Ethiopia’s Grand Ethiopian Renaissance Dam, which is currently under construction, will be the biggest dam on the African continent and could diminish the amount of water flowing to Egypt.

The Nile Basin Initiative (NBI), created in 1999 with the aim to “take care of and jointly use the shared Nile Basin water and related resources”, could be an example of regional multilateralism to resolve disputes but it remains relegated to discussions about water management. Institutionally, the NBI is not a commission. It is “in transition”, awaiting an agreement on Nile water usage, so it has no legal standing beyond its headquarters agreement with Uganda, where the secretariat is settled. The NBI has focused on technical, relatively apolitical projects. This ends up weakening the organisation since Egypt sees technical and political tracks as inseparable. Therefore, Cairo suspended its participation in most NBI activities, effectively depleting the organisation’s political weight.

The Nubian population are among these affected people. The Nubians, an ethnic group originating in southern Egypt and northern Sudan, have lived along the Nile for thousands of years. In 1899, during the construction of the Aswan Low Dam, they were forced to move and relocate to the west bank of the Nile in Aswan. During the construction of the Aswan High Dam in the 1960s, over 120,000 Nubians were forced to move for a second time. Their new home proved far from satisfactory: not a single resettlement village was by the river. And to date, the socio-economic and political conditions of the Nubians have not appeared to have improved.

“I think we are passing through one of the worst moments for us Nubians. Every time we tried to claim some rights in the last few years, the government did not want to listen to us and many of our activists were recently arrested,” Mohamed Azmy, president of the General Nubian Union, a movement that actively promotes the right to return of the Nubian community to their ancestral land, told IPS.

Lorri Pottinger of International Rivers expained that Africa’s large dams have not reversed poverty, or dramatically increased electricity rates, or even improved water supply for people living near them.

“What they have done is help create a small industrial economy that tends to be  companies from Europe and elsewhere. And so these benefits are really, really concentrated in a very small elite,” she had said.

Who gains from female circumcision? (1999)

From the October 1999 issue of the SocialistStandard

Female circumcision, like male circumcision, is a practice that dates back to the remotest of times in history. Today, however, the former has come under fire by feminists and other concerned groups and individuals. Why male circumcision is not touched is not clear. Perhaps the whole issue is still part of the male chauvinistic nature of contemporary society since it may not be plausible to claim that male circumcision is harmful as there are no statistics regarding the casualties the practice has caused or how it has affected fertility.

I am not holding any brief for this custom but some of those against it fail to situate the practice in its right perspective and thus fail to find the right solution. This myopic attitude is reminiscent of similar haughty attempts to characterise traditional African religion as “barbaric” and “uncivilised” (when in fact all religions are the same).

Like other customary practices, female circumcision is a tool in the control and manipulation of society by the elders and leaders who in traditional society were the owners of wealth. In the case of female circumcision, a group of individuals (including vocal and influential women) soon emerged who specialised in the art of operation. In many areas, these “doctors and paramedical staff” introduced mysticism into the act in order to gain a monopoly over their “profession”. As religion and spiritualism are part and parcel of their life, it is always easy to weave the supernatural element into anything that is done. This mystification is usually intensified if there are some material gains attached.

It is common knowledge that not all those who are involved in collecting girls for the ritual nor those who carry out the operation do so for a fee. Yet they get more than if they were charging fees. It is the same with traditional healers. They charge no fees but you give what you feel like giving—and the gift/payment is usually more than a mouthful.

Those who organise female circumcision get a lot of material gains from the parents, relatives and well-wishers of the girls. For instance, the food requirements, drinks, kola nuts, tobacco, etc., of both girls and organisers are provided for by the girls’ parents. And here we are talking about a period which could last as long as six months though these days the period may be just about two months in some areas. But the organisers actually make their money during the “passing out” of the circumcised girls. In most cases, each chief organiser (who is always an influential woman) becomes a social, political and spiritual “mother” to all girls circumcised under her authority—they all join her camp. Such women constitute the ideologues of the practice of female circumcision and they concoct all myths to perpetuate the custom. Those girls who do not go through it are stigmatised and derided and may even find it difficult getting a husband.

Perhaps started by men to control family property relations, female circumcision is strongly encouraged today by some females for the sake of material gains.

One other prominent feature in the whole affair is the intervention of non-governmental organisations. Needless to say, much credit goes to these NGOs for “sensitising the international community” to this “evil custom”. But it is equally important to point out that, far from helping solve problems, NGOs are themselves an offshoot of the profit system. In fact, the ideology of NGOs enhances the money system and perpetuates its evil practices through the half-baked and inadequate measures they put forward in solving the world’s problems.

I know very well that there are genuine individuals who are doing their best to ameliorate the deplorable state of mankind. However, I do not think they can make any meaningful headway by targeting isolated issues like discrimination against women or, to be specific, here female circumcision.

What I, therefore, put forth as a lasting solution to these undesired customary practices and to the gender problem is a holistic and all-round approach. This entails a complete rejection of the status quo. Production of goods and services should be organised for the sake of satisfying needs and not for profits. Therefore money in all its forms (cheques, treasury bills, tickets, etc) should go. But as this cannot be wished away, people will have to come together and through concerted effort push towards the realisation of the objective in a world socialist movement.

Suhuyibi Nbang-Ba (Gambia)

Life Expectancy

While citizens in Spain, Japan, Singapore, and Switzerland can expect to live above the age of 85, average life expectancy for Lesotho, Somalia, Zimbabwe and the Central African Republic will be almost 30 years lower.

Dr Christopher Murray, director of the Institute of Health Metrics and Evaluation (IHME) at Washington University, explained, “In a substantial number of countries, too many people will continue earning relatively low incomes, remain poorly educated, and die prematurely."

https://www.independent.co.uk/news/health/life-expectancy-uk-world-ranking-alzheimers-disease-obesity-smoking-spain-japan-a8587251.html

DRC - Hunger growing

Around 15 million people, including women and children, in the Democratic Republic of Congo are without food in 2018, up from 7.7 million last year.

“The deteriorating hunger situation is concentrated in the ten provinces most adversely affected by violence,” Norwegian Refugee Council said in a statement, citing a report by World Food Program, the Food and Agriculture Organization and DR Congo’s Ministry of Agriculture.

“There have also been reports of women and girls in North Kivu going into prostitution to make money to buy food, as well as some men and boys joining armed groups just to receive regular meals,” it said.

“We are witnessing emergency levels of hunger and malnutrition in every town and village where we respond,” said Ulrika Blom, the country director for Norwegian Refugee Council in DR Congo.

Blom said they have witnessed people eating the raw seeds they received for planting in an attempt to satisfy their hunger.

 Conflict-related displacement is cited as the reason people are unable to access food. The intensified conflict across Congo’s eastern provinces paints a bleak future for civilians.

“In towns like Beni we know of hundreds of farmers who are too paralyzed by fear of being killed by armed groups that they refuse to go to their fields to cultivate,” said Blom. “The violence in many areas is having a ripple effect on local economies, and causing people to resort to increasingly desperate coping mechanisms to feed themselves and their children.”

Food production in DR Congo has fallen fast over the last 12 months. Staple foods like maize, cassava and rice have seen an average decline of 39 per cent in production levels compared to the previous season.

Only 27 per cent of the funds requested to meet the humanitarian needs in DR Congo for 2018 has been received.

Facts and figures:

• 43 per cent of children under five years are suffering from malnutrition across Congo, according to UNICEF.
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• At least six provinces have malnutrition rates that are as high as 50 per cent, according to UNICEF.
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• The northeastern provinces of North Kivu and Ituri have recently seen some of the worst fighting in years, causing nearly 750,000 people to flee their homes in the first eight months of this year alone.

Zambia's Debts

In a world of depleting mineral resources, industrialised countries, especially resource-dependent Europe, need Zambia's copper, uranium and cobalt - the latter is in high demand recently due to the booming electric vehicle industry. They are also interested in the landlocked country's strategic position at the heart of the African continent. Zambia has borders with eight countries and close ties with neighbouring conflict-ridden and resource-rich Democratic Republic of the Congo. Zambia is the 4th most unequal country in the world, and 74.3 percent of the population lives on less than $3.20 a day.

Zambia's public debt has increased significantly in recent years, and concerns over a possible crisis have lately attracted the attention of the media. UK, Ireland, Finland and Sweden froze its aid to Zambia following an investigation into large-scale corruption.  A British business intelligence outlet Africa Confidential warned of escalating debt caused by allegedly unsustainable Chinese loans.  China probably holds a quarter to a third of Zambia's external debt.  Critics point out that a large number of these loans might be unaccounted for in the government official figures. Either way, the government declared a staggering $9.4bn of external debt in June this year, or 34.7 percent of GDP, up from $1.9bn at the end of 2011, or 8.4 percent of GDP which includes borrowing US dollars through large bond sales (known as eurobonds) on international markets controlled by Western institutions. The government issued three eurobonds between 2012 and 2015 for a total of $3bn - this does not include interest repayments, which keep going up due to sinking investor confidence. The yields on these bonds reached 17 percent last month. The first 10-year eurobond was issued in 2012 with a 5.6 percent yield.

 A debt default would open up opportunities for vulture funds and international creditors to take over the country's rich mineral and land resources and the few remaining parastatals that survived two decades of aggressive privatisation and public spending cuts imposed by the IMF and the World Bank from the 1980s to the mid-2000s. Health, education and other public services have already been decimated and the mining sector, previously under state control, is now for the most part in foreign hands - as are most sectors of the formal economy. China is now being blamed by the West for allegedly doing exactly what the IMF has been doing for decades: providing unsustainable loans to countries in need to further plunge them into debt, weaken state capacity and open up national economies to international investors.

President Edgar Lungu and his entourage are now perceived as an open threat to Western hegemony due to their vocal support for Beijing. Lungu's blatant mismanagement of public finances and his increasingly authoritarian tendencies show that his stance is far from principled and is driven by desperation. 

China is understandably hiding details of its loans from IMF oversight. An eventual IMF bailout would come with hefty conditionalities, imposing further spending cuts and privatisations in an already downsized state. There is no evidence that suggests that an IMF programme would be better than a Chinese deal. The Saudi government is financing several projects in Zambia, including hospitals and roads. Western media have been largely silent about these developments. This is not surprising, given Saudi alignment with the US and UK administrations.

If the country was to defaultthe biggest losers will be the Zambian people. A default would also trigger a chain reaction and bring down other African economies that borrowed heavily through eurobonds and are struggling with debt repayments.

https://www.aljazeera.com/indepth/opinion/china-blame-zambia-debt-problems-181009140625090.html

Cobalt Slavery

Cobalt is found in every lithium-ion rechargeable battery on the planet – from smartphones to tablets to laptops to electric vehicles. It is also used to fashion superalloys to manufacture jet engines, gas turbines and magnetic steel. You cannot send an email, check social media, drive an electric car or fly home for the holidays without using this cobalt. It is smeared in misery and blood.

Elodie is 15. Her two-month-old son is wrapped tightly in a frayed cloth around her back. He inhales potentially lethal mineral dust every time he takes a breath. Toxicity assaults at every turn; earth and water are contaminated with industrial runoff, and the air is brown with noxious haze. Elodie is on her own here, orphaned by cobalt mines that took both her parents. She spends the entire day bent over, digging with a small shovel to gather enough cobalt-containing heterogenite stone to rinse at nearby Lake Malo to fill one sack. It will take her an entire day to do so, after which Chinese traders will pay her about $0.65 (50p). Hopeless though it may be, it is her and her child’s only means of survival.

More than 60% of the world’s supply of cobalt is mined in the “copper belt” of the south-eastern provinces of DRC. According to the government agency charged with oversight of the informal or “artisanal” mining sector, at least 20% of this supply is mined by locals like Elodie, called creseurs. There are more than 255,000 creseurs mining cobalt in DRC, at least 35,000 of whom are children, some as young as six.

Across the south-eastern provinces,  Chinese companies run many of the industrial mines in the region. The Chinese also appear to run most of the “buying houses” that purchase cobalt from children like Elodie. Chinese processors then mix cobalt from industrial and artisanal sources during a preliminary refining stage to produce crude cobalt hydroxide, which they drive to ports at Dar es Salaam and Durban for export to China. After additional refining in China, the cobalt is sold to major component manufacturers and consumer electronic companies across the world.

Such companies are collectively worth trillions of dollars. Yet according to Amnesty International in a report at the end of 2017, none of them are making sufficient efforts to ensure that their riches are not being built on the backs of the oppressed women, men and children of the Congo who toil in putrid conditions, endure pitiful wages, grave injury and risk death to mine their cobalt. While market prices of cobalt have spiked 300% in the past two years, none of that increase makes its way down to the creseurs. The companies that source cobalt from DRC are surely aware of the appalling conditions under which the mineral is mined in some sites in the country. Aside from the Amnesty reports, labour abuses linked to cobalt mining in the region have been widely documented by human rights groups and by media organisations across the world. Yet while major consumer electronic and automobile brands state they do not tolerate child labour in their supply chains, none have invested enough resources or time into ensuring that they can adequately address the human rights abuses that could be lurking in the products they sell to millions across the world. They have consistently shifted responsibility for human rights abuses in the Congo on to their Chinese suppliers.

Arthur, a 16-year-old boy joined a group of young men who spent two months digging a tunnel 26m straight down before they hit a heterogenite vein. Now they descend into darkness each day, spending up to 24 hours at a time in narrow tunnels unable to stand, hacking away for cobalt. Every minute is suffused with dread, because many tunnels have collapsed in Kasulo, burying alive everyone inside. At the surface, the men from Arthur’s tunnel with several sacks of cobalt go to one of the dozens of Chinese buying houses nearby. The entire neighbourhood has in fact been walled off, in an effort to keep people from documenting the perilous conditions. The cobalt under Kolwezi is purer than at Elodie’s site, so the traders at the nearby buying house pay a higher rate for each kilogramme. It works out to roughly $1.80 a day in income for Arthur, but he is unlikely to get to keep all of it. Numerous local creseurs told me that children like Arthur are forced to pay bribes to the local government functionaries who are supposed to ensure there are no children working at sites like Kasulo.

No company should be able to jettison their responsibility for the vicious and unjust treatment of the people who mine cobalt and other minerals simply because they are separated from them by a few thousand miles, and a few layers in their supply chains. Any company sourcing cobalt from DRC must establish an independent, third-party system of verification that all mineral supply chains are cleansed of exploitation, cruelty, slavery, and child labour. They must invest whatever is needed to ensure the decent pay, safe and dignified working conditions, healthcare, education and general wellbeing of the people whose cheap labour they rely on.

https://www.theguardian.com/global-development/2018/oct/12/phone-misery-children-congo-cobalt-mines-drc

Senegal's Pastoralists

This week, the Intergovernmental Panel on Climate Change warned that an increase in global warming will adversely affect livestock and crop production, particularly in sub-Saharan Africa. But herders like Saidou have already seen increasingly unpredictable weather patterns, drought, floods, and land degradation threaten their way of life.

Six million people in the Sahel faced severe food shortages in a prolonged lean season between January and August this year; Senegal was one of the three worst affected countries in the region. It may get worse yet, as the UN’s Food and Agriculture Organization (FAO) estimates that 2.5 million livestock herders, or “pastoralists,” and those who raise both livestock and crops in the Sahel risk losing their income.

As soon as the rainy season ended last September, it became clear that erratic rainfall had led to diminished pasture across the Sahel. “If there was good rain, all of our problems would be solved,” says Saidou. This isn’t looking likely: in the Sahel, the gaps between the hardship years are getting smaller and weather conditions are becoming more extreme.

Seasonal migration - which helps over-grazed regions recover by temporarily shifting the burden to areas with more pasture - is the common way of life for the Fulani, one of the Sahel’s largest ethnic groups. But as the length of the migration period and the distance herders are forced to travel to find food and water for their livestock increases, their economic well-being and very way of life are at risk.

Life in pastoral communities revolves around their main source of financial capital: the herd. So when animals are placed under stress, the social fabric also suffers. “Food security is above all assured by the security of the herd,” says Aliou Samba Ba, president of the Senegalese branch of the Réseau Billital Maroobé (RBM), a network of pastoralist associations in West Africa.

On the road, children accompanying their herder parents miss school, while animals die because of the rise in diseases. At home, people are hungry and increasingly worried about the waning value of the little that they own.

Thousands of herders and their livestock spend the dry season in Ranerou every year. But this time was different. Saidou had to station the animals 10 kilometres out of town, where a meagre supply of grass could be found. But with the route between their camp and the town barren and devoid of vegetation, they could only make the journey to Ranerou’s borehole to drink every few days. The animals stopped producing milk, a key nutritional staple for the family.

In the last five years, some areas in Senegal have reported decreases of between 50 and 100 percent in crops and grazing areas. This led to a spike in the demand for manufactured animal feed this year, which sent prices skyrocketing. A 40 kg sack of feed that cost around 7,000 CFA ($12) in October 2017 had risen to 13,000 CFA ($23) by March. Herders had to sell off animals to buy feed to sustain the rest of their herds, leaving a severe dent in their wealth.

Meanwhile, a government fund set up in 2012 to subsidise animal feed was not sufficiently replenished. The last cash injection was in 2015, and since herders tapped the fund in 2016 and 2017, subsidies weren’t available at the same level this year. “The state did not have the means to put in place a livestock safeguarding operation,” says Abba Leye Sall, the head of Animal Sectors at the Ministry of Livestock.

In addition, livestock prices plummeted due to desperate herders bringing large numbers of animals to market. Cattle, sheep, and goats fetched half the price they had four months earlier; by March in Ranerou, a sack of feed cost more than a sheep.

It’s difficult to predict the conditions of the season ahead, and with donkey-drawn carts as the primary means of transport, carrying large stocks of feed presents logistical difficulties.

As the year went on, herds intermingled around scarce water supplies and the incidence of disease rose. Foot-and-mouth disease killed young animals and slowed the pace of already weak herds forced to hobble long distances in search of sustenance.

Children were among the first to suffer. Many accompanied their parents on the journey south to help with the herd or because no one was left at home to care for them. For those who ordinarily attended school, this meant missing an academic year. Healthcare was non-existent when they became ill camping under tarpaulin sheets. “Social services are not adapted to mobility,” observes Noël Marie Zagré, regional nutrition adviser at UNICEF, the UN’s agency for children.

Full report here

http://www.irinnews.org/special-report/2018/10/10/Senegal-climate-change-Fulani-herders-drought-Sahel