Mobilising on all fronts against a common enemy

Youth: Fighting COVID-19 their way

Africa’s young people are using resourcefulness and new technologies to engage and make a difference in the battle against the virus

Ndlovu Youth Choir “America’s Got Talent” Season 14 Live Show Red Carpet at Dolby Theatre on September 17, 2019 in Hollywood, California. Photo: Frazer Harrison/Getty Images/AFP

As Africa continues to battle COVID-19, the continent’s youth are not sitting idly by waiting for the worst to come. Across the continent, young people are hard at work, in partnership with governments and diverse partners, providing solutions to help reduce the spread of the virus and ways to address the socioeconomic impact of the pandemic, through engagements and innovation. In Egypt, Mohamed Elkholy, 25, is using new technologies to engage young people, fight misinformation about COVID-19 and spread the right messages about the virus. Mohamed, the leader of youth network Y-Peer Egypt, has been hosting a youth-to-youth podcast programme to create awareness among young people. In a country like Egypt, where youth constitute some 60% of the population, finding effective ways to engage young people and empower them is important in the battle against the pandemic.

Gwendolyn Myers, a 29-year-old peace activist, is co-chairing the National Youth Taskforce Against COVID-19 in Liberia. The task force was set up under the auspices of Liberia’s Ministry of Youth and Sports, bringing together five youth-led organisations. It was established to mobilise and build young people, empowering them to to lead campaigns against the pandemic in local communities. The task force, for example, uses young people at grassroots levels to ensure food is distributed to vulnerable sectors of the population, and to distribute essential sanitary material in high-risk virus hotspots such as slum communities and informal settlements with large populations and a limited supply of social services. In East Africa, Kibra Green is a youth organisation in Kenya’s largest slum, Kibera, in the capital Nairobi. The group is passionate about the localised implementation of the United Nations Sustainable Development Goals (SDGs), including SDG 3 on health and wellbeing.

The group has been engaged in several initiatives to mitigate and reduce the spread of COVID-19. Alfred Otieno, a leading member of Kibra Green, believes that youth have a critical role to play in the fight against the virus. In their case, the group, in partnership with UN-Habitat and Médecins Sans Frontières (Doctors without Borders), has set up hand-washing stations for residents, enabling them to sanitise. The group has also handed out masks, disseminated relevant information about COVID-19 and prevention, as well distributed food and other essential items to vulnerable families, including sanitary pads to needy girls. Kennedy Odede, the CEO and founder of Shining Hope for Communities (SHOFCO), a grassroots organisation that offers support to several hundred thousand slum residents in Nairobi, argues that youth are in the majority on the continent and yet most of the time young people find themselves marginalised. “We can’t win this COVID-19 war if the youth are not involved,” Odede says.

Mohammed Elkholy spreads the right messages about COVID-19. Photo: Raphael Obonyo

“We have a new youth in Africa who will not follow orders. This new youth want to be listened to, not told what to do. They believe they have the solutions. Now let’s tap on them to fight COVID-19.” In Democratic Republic of Congo (DRC), Christella Kiakuba, 26, an orphan of military parents and co-founder of community organisation Telema Mwana Ya Mapinga, is helping women and orphans protect themselves from the coronavirus. She is distributing face masks and showing people how to use them, and how to sanitise. She and her organisation deliver food and provide legal help to widows and orphans. In Cameroon, Achaleke Christian, the national coordinator of civil society organisation Local Youth Corner, launched a “One Person, One Sanitiser” campaign in April to prevent the spread of coronavirus, especially among the poor.

He and members of the youth group have produced homemade hand sanitisers using World Health Organization standards and distributed them for free, teaming up with a coalition of youth civil society organisations, medical doctors, pharmacists and a laboratory scientist in the process. In South Africa, young people have been at the forefront of government and community efforts to educate people about the basic preventive measures to help curb the spread of COVID-19. One example is 750Amped, a national campaign launched in May by South Africa’s National Department of Health and the Health and Welfare Sector Education and Training Authority (HWSETA). The initiative, which involved the initial training of 750 learners, was established as “a proactive intervention that leverages the power of youth to inspire changes in social behaviour through training, education, and awareness around COVID-19”, according to the 750Amped website.

Kibra Green is a youth organisation engaged in initiatives to mitigate the spread of COVID-19 in Kibera, Nairobi. Photo: Raphael Obonyo

Young South Africans have also used the power of music to encourage their communities to practise preventative measures against the virus. The Ndlovu Youth Choir, which was originally formed in 2008 by a Dutch doctor, working in South Africa’s largely rural Limpopo province to help orphans and the children of Aids patients, became a global phenomenon when they reached the finals of the TV show America’s Got Talent. They were forced to cancel an international tour when COVID-19 swept the world, but since then a video of a new song, in isiZulu with English subtitles, that demonstrates how to practise basic preventative measures, has gone viral. North of the border, in Zimbabwe, Bridget Mutsinze, 25, is among a group of youth volunteers working with development organisation Voluntary Service Overseas (VOS), using social media to fight coronavirus misinformation.

They have taken to Twitter, WhatsApp, Facebook and radio to comb through online comments, to identify and correct COVID-19 misinformation. In Côte d’Ivoire, Ibrahima Diabate and the Youth Peace and Security Network recorded a series of awareness-raising videos in different local languages to disseminate the much-needed information about coronavirus. The videos went viral on social media platforms. The use of local languages, and the cultural translation of the messages in ways that make sense to the communities they target, have enhanced their accessibility. And telling the stories of life under COVID-19, in this case among poor and marginalised communities in southern Africa, are dynamic young journalists like the team at Tazama World Media in Kenya, led by James Smart and Kizito Gamba in Kenya, who are dedicated to community-based journalism using smart phones and social media.

As South Africa’s Sport, Arts and Culture Minister Nathi Mthethwa said when he launched youth month 2020 on 2 June, recalling the role of young people in fighting the country’s apartheid regime: “The youth of 2020 have been called upon to fight a much more silent war, the coronavirus pandemic, and to help rebuild a society post COVID-19.” As Mthethwa correctly noted in his address, young people have a major role to play in the fight against the coronavirus – because youth are Africa’s greatest asset and the future of the continent depends on them.

Dying to give birth

Maternal mortality

Postpartum haemorrhage and obstetric fistula are two avoidable conditions that continue to kill and maim women in sub-Saharan Africa every year

Nigerien women suffering from obstetric fistula wait for a chance to be examined and eventually get surgery on July 16, 2008 at the Maradi hospital, southern Niger, as doctors from Turkish help association Deniz Feneri and Doctors Worldwide visit Niger to help some of the 200,000 fistula illness effected women in the country. Obstetric fistula, or vaginal fistula, is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available. The World Health Organization estimates that approximately 2 million women in Africa, Asia and the Arab region are living with the condition, and some 50,000 to 100,000 new cases develop each year. AFP PHOTO / MUSTAFA OZER (Photo by MUSTAFA OZER / AFP)

Atim (not her real name), from Nigeria’s southern state of Akwa Ibom, was barely a teenager when she was married off to a much older man. She would have preferred to have had a child when she was older, but that was completely out of her control and she found herself pregnant in the first year of her marriage. Her delivery was prolonged and difficult, which was further complicated by the fact that her hearing and speech are impaired. After attempting to cope with the distressing after effects of the difficult birth and with little understanding of what was causing them, Atim ended up at the Family Life and VVF (Vesicovaginal fistula) Hospital Mbribit Itam, in Akwa Ibom’s capital, Uyo. She had developed obstetric fistula. International NGO, the Fistula Foundation, describes an obstetric fistula as occurring when: “a mother has a prolonged, obstructed labour, but doesn’t have access to emergency medical care, such as a C-section.

She often labours in excruciating pain for days. Tragically, her baby usually dies.” For the women who survive this trauma, most of them from impoverished communities and often married young, the physical damage is extensive. Says the Fistula Foundation, “the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone become compressed, restricting the normal flow of blood”. The damage leaves holes – fistulae – between the woman’s vagina, bladder and rectum, causing lifelong chronic incontinence unless surgically repaired. Fortunately for Atim, she was saved by the intervention and experience of Dr Sunday Lengmang, who was on a routine visit to the hospital from Jos, in northern Nigeria. Lengmang, a renowned fistula care expert, carried out a two-stage surgery that relieved her of incontinence. Atim is one of the lucky ones; she is not only able to live a normal life thanks to Dr Lengmang, she also avoided becoming a statistic, among the more than 600,000 maternal deaths that occurred in Nigeria between 2005 and 2015, according to a 2019 World Health Organization (WHO) report.

Although there have been reductions in global maternal mortality rates, with a 38% drop per 100,000 live births between 2000 and 2017, the WHO worries that it is still unacceptably high, with “about 295,000 women (dying) during and following pregnancy and childbirth in 2017”. Most of these deaths (94%) occur in poorly-resourced countries, and most of them were avoidable. According to the WHO, sub-Saharan Africa and southern Asia accounted for approximately 86% of the estimated global maternal deaths in 2017. Two-thirds (196, 000) of these deaths were in sub-Saharan Africa alone, with Nigeria accounting for “nearly 20% of all global maternal deaths”, with “no less than 900,000 maternal near-miss cases occurring in the country”. Postpartum haemorrhage (PPH) is the leading cause of maternal deaths and accounts for about 35% of them. Annually, about 14 million women around the world suffer from PPH, with 99% of the deaths occurring in low- and middle-income countries like Nigeria, as opposed to just 1% in high-income countries.

Patients wait in a ward prio to undergo obstetric fistula repair surgery at the Mulago Hospital in Kampala on October 31, 2014. Millions of women in developing countries suffer from the obstetric fistula, a hole in the vagina or rectum caused by prolonged labour without treatment which means they leak urine uncontrollably, and also endure the social stigma arising as a result of it. More than about 200,000 Uganda women live with fistula, but there are 1,900 new cases annually — this is just above the 1,850 women who were treated surgically in 2013, according to a report by the United Nations Population Fund, which funds the majority of repairs through the Campaign to End Fistula. AFP PHOTO/ Isaac Kasamani (Photo by Isaac KASAMANI / AFP)

The late Humihani Yahaya, from Kogi State in Nigeria’s middle belt region, called her husband on 17 March, 2020 to let him know that she had successfully given birth to a baby girl. Shortly after that, he received a call telling him his wife had begun to bleed uncontrollably. Rather than taking her to the dysfunctional primary healthcare centre a few blocks from her home, her family struggled to get a vehicle to take her to a more functioning hospital, where she died on arrival. In Bwari, a satellite town in Nigeria’s federal capital territory, Nkechi Okonya, 32, the breadwinner of her family, who supported her husband and two children by petty trading, gave birth to premature triplets on 20 April 2018. But after delivering the first baby at the Bwari Primary Healthcare Centre, her labour stalled. “For hours, they kept telling her to push, thinking the baby left inside her was just one, but nothing came out so they referred her to Bwari General hospital,” her cousin, Chinwendu Ekwunife, told journalists.

After delivering the first baby at 9am, it was only at 5pm that day that she was wheeled into theatre. “She delivered the remaining two children, but was bleeding heavily,” Ekwunife said. “She took four pints of blood in less than 15 minutes.” Okonya died shortly afterwards. For many impoverished women like Atim, who do survive an obstructed labour, the price they pay is a life of constant incontinence, shame, social segregation and health problems. In 2018, the WHO estimated that more than two million young women were living with untreated obstetric fistula in Asia and sub-Saharan Africa. This is a situation that experts like Dr Henry Uro-Chukwu attribute to malfunctioning health systems. Uro- Chukwu is the Director: Training, Research and Mobilisation at the National Obstetric Fistula Centre (NOFIC), in Abakaliki, Ebonyi State, in Nigeria’s south-east region. He told Africa in Fact that the underlying cause is “the state of the health system; fistula is a reflection of a bad health system”.

In addressing the condition in Ebonyi, support first came from the United States Agency for International Development’s (USAID) Fistula Work Project, followed by the federal government’s interest in making the facility the first national VVF centre in Nigeria. The centre now receives patients on a regular basis from 17 states across Nigeria as well as some from neighbouring countries like Cameroon. Referring to a study conducted in Ebonyi State, Uro-Chukwu says there is another factor to be considered: poorly performed caesarean sections. The situation is similar in Kenya. Galgallo Golicha, project officer of the Safe Motherhood Project, Amref Health Africa in Kenya, told Africa in Fact that some of the new cases of obstetric fistula presenting for treatment at hospitals are the result of “the doctors accidentally puncturing the bladder and/or uterus” during caesarean sections or other pelvic surgeries. It is also impossible to ignore the cultural influences that raise the risk of fistula and PPH, adding to maternal mortality across sub-Saharan Africa.

These include a form of female genital mutilation, commonly called yankan gishiri in northern Nigeria, and which is also practised in Niger, early marriage and childbearing, and birthing in churches and homes. Other traditional practices that put women at risk include: the belief that surgical delivery by C-section and birthing in hospital are signs of the woman’s weakness; the culture of delivering the first child in the mother’s house; the belief that the husband has the sole right of consent for his wife to undergo any surgical procedure; and a preference or insistence that female personnel attend the birth. Ogochukwu Mbamalu, a senior medical officer at NOFIC, says that while fistula is rarely fatal in itself, the longterm consequences are devastating for patients. She points out that cultural practices, ostracisation and the stigma attached to fistula lead patients to suffer depression, and in some cases they become suicidal. She advocates that more attention be paid to helping patients with their mental health as part of their recovery process.

Salamatou Traore, founder of the DIMOL (Dignity) non-governmental organisation, speaks about obstetric fistula at the NGO’s health centre in Niamey on February 19, 2016. – Niger is in a fight against fistula — a medical condition that affects girls married too young. (Photo by ISSOUF SANOGO / AFP)

Meanwhile in Kenya, Golicha identifies the lack of fistula surgeons as the biggest obstacle to remedying the situation. Although Kenya is “navigating this by organising fistula repair camps at least twice a year in each region,” he says this is a very expensive approach, and unsustainable. African governments, and Nigeria in particular, have signed into various international conventions, but these all seem to be nine-day wonders. The governments appear to be doing little regarding implementation, said Lengmang, who strongly advocates that gender equality policies, universal education and universal health coverage are issues that could help in fighting and preventing these health challenges for women, thus assisting in reducing the maternal mortality rate.

Vanessa Offiong is a journalist in Nigeria, with experience in investigative, science and development journalism. Vanessa is Executive Director of The Black Banana Media & Development Initiative and a Health Systems Global fellow. She has won awards and has been published by the British Medical Journal’s Global Health Blog.

The cracks in Cameroon’s health system

Abuja Declaration: a bridge too far

Pressure from the coronavirus is  exacerbating old weaknesses in healthcare delivery in public health institutions, leaving mental patients compromised

Jamot Hospital in Yaounde, Cameroon Photo: Amindah Blaise Atabong

In 2001, African heads of state and government signed the Abuja Declaration, pledging to allocate at least 15% of their annual budgets to the improvement of their health systems. This historic commitment was undertaken to make available resources to respond to health challenges, especially HIV/AIDS, tuberculosis and other related infectious diseases. It was aimed at getting the continent’s health systems prepared for outbreaks such as the coronavirus. Some policy experts have found the Abuja Declaration wanting, and have instead pushed for a per capita model of funding. But even at that, close to two decades after the Abuja Declaration, nothing seems to have changed in many African countries; their health systems remain poor and fragile.

Cameroon is one of those countries which are yet to meet the funding target. A 2016 World Health Organization report titled ‘Public Financing for Health in Africa: from Abuja to the SDGs (sustainable development goals)’ shows that Cameroon’s health spending was 4% of the national budget, far below the continental average of 10%, in 2014. Cameroon’s health system had perennial cracks even before the outbreak of the coronavirus. It wasn’t tailored to handle a pandemic of such complexity and severity. Prior to the outbreak of COVID-19, the citizenry in Cameroon had difficulties in accessing healthcare services. Between 2016 and 2018, 27% of the population went without medical care many times, while a further 38% didn’t get medical care even once, according to Afrobarometer in 2020. Close to 50% of the population which had contact with a public health facility had difficulties obtaining the care they needed.

The study also shows that the country’s health system is characterised by long waits to obtain services, lack of nearby facilities and the payment of bribes. Cameroon doesn’t feature on the list of African countries that provide free and universal healthcare. Instead, the country’s public resources allocated to healthcare have continuously been among the lowest on the continent in terms of GDP. A World Bank study found that of the $61 per Cameroonian spent on healthcare in 2010, the government contributed only $17, that is, 28% – of which $8 was provided by international donors. By implication, Cameroonians largely pay for their own healthcare. The COVID-19 pandemic has greatly affected an already pressurised and weak healthcare sector, according to Dr Kibu Odette, senior health policy analyst at the Nkafu Policy Institute, an independent think tank at the Denis and Lenora Foretia Foundation.

Odette told Africa in Fact the country has far less than the number of physicians recommended by the World Health Organization (WHO), with just 1.1 doctors per 100,000 of the population. “It had less than 500 critical beds. Very few ventilators are available to take care of COVID-19 patients. These, among other factors, have greatly affected the way patients are managed. As such, curbing the pandemic has been a challenge to Cameroon,” Odette said. To flatten the curve of the contagion, the government has ramped up its efforts to mobilise resources for the response. Besides initiating a national solidarity fund and seeking debt relief, it has sought loans from the IMF, AfDB and other financing partners – all directed at COVID-19. In so doing, however, other health challenges in regular times such as mental disorders and HIV/ AIDS have been neglected by acts of either omission or commission.

Mental health is an issue in Cameroon, both unrelated to the pandemic and caused by Covid-19. According to WHO, neuropsychiatric disorders are estimated to contribute to 6.1% of the total disease burden in the country. Yet, Cameroon has no mental health policy in place and a simplified guide on the handling of mental cases was only introduced in 2017. Mental health is only mentioned in the general health policy. People who suffer from mental health problems in Cameroon are usually looked at with scorn. Mental health problems are not culturally acknowledged, and people are sceptical of scientific explanations. So, many do not regard it as an illness but some sort of curse, witchcraft, or sign of ill omen and that the patient should be avoided. At policy level, there are only two tertiary public hospitals in the country – Jamot Hospital Yaounde and Laquintinie Hospital Douala – that handle mental health problems.

Kidney patients stage a protest outside the Yaounde University Teaching Hospital, Cameroon, August 2020
Photo: Amindah Blaise Atabong

But these facilities lack adequate qualified personnel and resources. A visit to Jamot Hospital in Yaounde on 18 August 2020 confirmed an existing reality – a gap in the provision of mental healthcare. Officials at the facility declined to comment. However, a caretaker of one of the patients, who gave her name as Mama Christabel, said things had turned upside down since the onset of the pandemic. “It has been a difficult moment for us with patients here. All attention has been shifted to COVID-19,” she said. Jean Pierre, a mental health patient, told Africa in Fact that with the COVID-19 situation, they have encountered problems while attempting to meet their respective doctors. “It is not easy at all. A few patients with whom I was following up treatment have died and I think it is because of fear. So much attention is on the pandemic and it makes it scary.” The government has not been keen to address mental health issues resulting from the pandemic.

It managed to put a mental health call line – 1511 – in place, but it has not been effective, according to Agbor Matelot, a Yaounde-based psycho-social counsellor. “The practice of counselling is not rooted in the culture of Cameroon,” he said. Matelot and other volunteers are running their own COVID-19 mental health call centre as the government response falters. “Through our We-Connect project, people have been able to reach us for assistance. We have handled hundreds of cases related to COVID-19 and the ongoing armed conflict in the Anglophone regions,” Matelot told Africa in Fact . In the past few months, Matelot has stepped up to fill the gap, offering individual and group counselling services in schools and organisations, amongst others.

COVID-19 disruption to essential health services has also been evident. Egbe Maggie-Lowells Ebot, a counsellor at the Presbyterian Hospital Kumba told Africa in Fact that some HIV/AIDS patients were cut off from essential antiretrovirals. “Restriction on movement has made it difficult for patients from remote areas to reach health facilities. And the government didn’t take this into account. Also, patients were scared of visiting health facilities, unsure of whether they will be forcefully tested and quarantined,” Ebot said. A government instruction to observe physical distancing during the pandemic also affected service delivery. Waiting times became even longer as health workers received one patient at a time. “Some got frustrated and left,” Ebot said. Moreover, from the onset of COVID-19, the government made the wearing of face masks in public mandatory. But at the time, face masks were scarce and unaffordable for many.

Those who couldn’t get a face mask were turned away from hospitals. As the government battles to contain the coronavirus, patients with kidney problems have accused it of indifference to their plight, claiming the “government is intentionally killing us”. On 14 August 2020, tens of kidney patients staged a public protest in the capital, Yaounde, in front of the Yaounde University Teaching Hospital. The leader of the patients, Apua Simon, told reporters that most of the dialysis machines had broken down and no efforts had been made to repair them, while dialysis kits were unavailable. “In the beginning, we had 12 machines that were functional and four years later, we are left with just three machines. Every passing day, patients keep on registering and we are over 100 patients now at CHU with just three machines,” he said.

With only three machines in good condition, running 24/7, Apua said they were often given appointments at odd hours like 2am and the cost per dialysis session remained high at FCFA 5,000 (about $9). All these lapses point to the fact that the government doesn’t see healthcare as a strategic priority. Also, as Odette points out, there is no holistic approach in the way government delivers healthcare. “WHO defines health as not just the absence of disease but looks at the overall wellbeing of an individual,” she said.

Amindeh Blaise Atabong is a Cameroonian print and multimedia journalist. His interests include gender, human rights, climate change, environment, tech, conflict, peace-building and global development. In 2019, he was a finalist in the inaugural True Story Award, and also won a prestigious Kurt Schork Award in International Journalism (local category). He works for independent regional and international outlets, including for Quartz, Thompson Reuters Foundation News, Deutsche Presse-Agentur, Jeune Afrique, Epoch Times, African Arguments and Equal Times.

What is behind the renewed violence in Central African Republic?

CAR will struggle to break the cycle of violence without international commitment to end it

Militiamen of the armed group coalition Coalition of Patriots for Change (CPC) in the village of Niakari, which marks the front line with Central African army and its allies, north of Bangassou. On January 3, 2021, the city of Bangassou was attacked by hundreds of CPC militiamen, causing tens of thousands of people to flee into the bush and neighbouring DR Congo. Since the end of December 2020, the rebel coalition has taken control of the main roads and several of the country’s major cities. Photo: Alexis Huguet/AFP

On January 4, the incumbent president of Central African Republic (CAR), Faustin-Archange Touadéra, was re-elected for a second term after the country’s electoral commission announced he defeated 16 other candidates and garnered 53.9 percent of the vote, enough to render a runoff unnecessary.

DThe elections have generated an upsurge in violence triggered following the Constitutional Court’s rejection of former President François Bozizé’s candidacy on December 3. The court cited his failure to meet the constitution’s “good morality” requirement due to an international warrant and UN sanctions against him for his alleged involvement in assassinations, torture and other crimes during his tenure.

Following the announcement, Bozizé joined a coalition of armed groups, the Coalition of Patriots for Change (CPC), some of whom were formerly part of the Séléka coalition which toppled him in 2013. They launched attacks on several towns outside of Bangui in an effort to force an election postponement and initiative a new round of peace talks.

Over the course of December, hundreds of civilians died, 30,000 were forced to flee into neighbouring Cameroon, Chad, and the Democratic Republic of the Congo, while another 185,000  were internally displaced. Three UN Multidimensional Integrated Stabilization Mission (MINUSCA) peacekeepers lost their lives in the violence.

To help quell the violence, CAR requested additional military assistance from Rwanda and Russia. Both sent troops and supplies in support of the Central African Armed Forces (FACA), while France carried out flyover missions in the days preceding elections. CAR prosecutors have launched an investigation into Bozizé, who is accused of plotting the alleged coup.

Violence has escalated further since the announcement of Touadéra’s victory, with most of the opposition calling for the election results to be annulled citing voting irregularities and the fact that instability prevented many from casting their ballot. On January 13, the CPC launched a coordinated attack on the outskirts of Bangui before being pushed back by MINUSCA in fighting which killed one Rwandan soldier and several CPC fighters.

The election, which is only the second in the country’s history, was supposed to be an important milestone. However, this new round of violence has laid bare the deep flaws in the peace process and threatens to undo the tentative progress made towards stability since the signing of the Political Agreement for Peace and Reconciliation in February 2019.

If urgent action is not taken by international and regional actors to both address flaws in the peace process as well as some of the country’s deep structural drivers of conflict, CAR could slip into civil war in the coming months.

A cycle of violence

Since gaining independence from France in 1960, CAR’s political history has been punctuated by military rule, rebellion, and multiple coups against a backdrop of state disintegration, deep interethnic cleavages, and high levels of inter-communal conflict. The violence which was seen before, during, and following the December election is not unique, it is instead merely the latest expression of this long-running conflict.

Former President Bozizé seized power in a 2003 coup before being removed in 2013 by the Séléka: a coalition of predominantly Muslim armed groups, at least some of whom represented communities in northern CAR, who have historically been politically and economically disenfranchised. Following the rebellion, an opposing association of local Christian and animist self-defence groups, the “Anti-balaka”, engaged in retaliatory attacks, which escalated to the ethnic cleansing of the Muslim population.

In the following years, the country was plagued by violence despite efforts to restore stability, including the deployment of a 12,800-strong UN peacekeeping force. After a two-year transition led by a temporary government, CAR returned to constitutional democracy with the election of Touadéra in February 2016.

The new president continued to engage in dialogue with former Séléka and Anti-balaka armed groups, who had by this time fragmented and reconfigured. In February 2019, the Political Agreement for Peace and Reconciliation was signed between the government and the country’s 14 main armed groups.

Despite the political agreement, as well as the deployment of MINUSCA peacekeeping forces, the conflict has continued. The 2020 UN Panel of Experts’ assessment of the political agreement reported hundreds of violations and noted the continued exchange of accusations of reneged commitments by both the government and armed groups.

Since 2013, it is estimated that of the country’s population of roughly five million, about one in five people have been internally or externally displaced, thus creating the world’s highest humanitarian caseload per capita.

Outsourcing governance

There are a number of structural issues that keep CAR trapped within a cycle of conflict and underdevelopment. Multiple peace agreements have failed to address these deeper realities, and some have, at times, contributed to incentivising those who benefit from instability.

As outlined by Louisa Lombard, professor of anthropology at Yale University, rather than develop local government administration, French colonial officials leased CAR’s territories to private companies to run at their own profit or loss and to strike deals with local tribes to provide labour and security.

This system has effectively continued post-independence, whereby political elites in Bangui with little capacity, experience, or interest in extending governance beyond the capital, grant mining concessions to a range of international actors who rely on private military companies (PMCs) to facilitate transport and security without building out local government or infrastructure.

Basic services are mostly outsourced to the UN, European Union, and international NGOs and due to multiple coups, and in particular, Bozizé’s efforts to reduce the army to a presidential guard] to ward against coups, the state does not have a monopoly on the use of force in most of its territory.

Security has been privatised in a chaotic way by local leaders, clans, and militias, leaving communities to essentially fend for themselves. It has also provided ample opportunity for non-state actors to develop criminal enterprises in order to exploit the country’s vast natural resources.

Today, armed groups control most territory outside of the capital and there is little in the way of a social contract between citizen and state.

Militarisation of politics and peacemaking

In a closed political system, comprised of a small political elite in Bangui, violence has become a tried and tested route to power. Rebel leaders cycle between armed groups, which serve both as a vehicle for illicit criminal activity as well as helping to guarantee them a place on the political chessboard when the incitement of enough chaos forces the government into a political dialogue.

The state has a history of incentivising this behaviour by co-opting rebel leaders during political settlements in the interest of creating temporary peace, thereby rewarding those who make a living out of provoking insecurity. Most major peace agreements since 1997 have awarded government positions to rebel leaders.

The 2019 Political Agreement was no different. Like previous peace deals, it provided the leaders of signatory armed groups government posts. For example, three of them gained positions as “Special Military Advisors” to the prime minister to oversee the creation of Special Mixed Security Units (USMS) comprised of armed group combatants and Central African state forces.

After disagreements regarding the pay and titles of former combatants within the new USMS units, two of the three special military advisers – who are also leaders of the country’s two strongest armed groups – resigned, while the third used his status to continue the operations of his armed group and expand his territorial control.

Last month’s election was an attempt to move the country towards a more orderly political settlement, whereby leaders would represent a political base and have popular support to hold office. The armed groups can no longer be said to represent communities’ grievances and are widely despised by citizens. They are therefore reluctant to transform into legitimate political parties and by disrupting the elections, hope to return CAR to a state where, as political-military entrepreneurs, they can find themselves a seat at the table.

A playground for foreign actors

Adding complexity to finding a lasting political solution to the conflict in CAR are the large number of international and regional actors who have interests and influence in the country. Over the last 10 years, Chad, Angola, and most recently Sudan, have all played host to political negotiations between armed groups and the CAR government – each driven by their own geostrategic interests. The porous borders between the CAR and its neighbours have allowed for ethnic groups having strong cultural allegiance and economic ties outside of the country.

In recent years, Russia has stepped up efforts to support Touadéra’s government through the Wagner Group: a private security company closely connected to the Kremlin and often used by the Russian state as a proxy force when plausible deniability is necessary. The head of the Wagner Group in CAR was appointed national security adviser, affords President Touadéra personal protection services, and provides some training to FACA.

Russian interests in CAR seem to be both financial (acquiring access to diamonds, gold, and other mining contracts) and part of the country’s wider strategy in Africa, aimed at countering American influence and gaining greater African support for Russian initiatives at the UN.

France, which has historical ties with CAR, and contemporary economic and security interests in the country, continues to push back against Russian influence. Ahead of last month’s elections, rival French and Russian disinformation campaigns that sought to influence internet users in CAR emerged.

Facebook released a statement saying it had suspended over 100 accounts and pages for “coordinated inauthentic behaviour” linked to CAR. One network was linked to “individuals associated with French military”, while another two had connections to “individuals associated with past activity by the Russian Internet Research Agency” as well as Russian businessman Evgeny Prigozhin, head of the Wagner Group.

Charting a way forward

Escalating insecurity in CAR calls for a thorough review of the Political Agreement for Peace and Reconciliation in order to determine whether it remains a relevant road map for peace and stability. If armed groups continue to refuse to transform into legitimate actors and can simply instigate violence as a means of political manoeuvring with little repercussion, a negotiated political process seems unlikely to work in the long term.

At the very least, MINUSCA should be strengthened and their mandate revised so they can take a more aggressive posture against those armed groups that continue to act as spoilers to peace. A more concerted effort is also required to train, equip, and expand CAR’s armed forces to the point where state authority may be reinstalled across wider regions of the country.

The international community must also face the reality that without significant investment in the economic development of CAR, the country may not ever be able to rise out of the cycle of conflict and poverty. This will require international community and influential regional actors to raise the interests of CAR above their own and work together in a transparent manner to support sustainable peace efforts.

The African Union (AU) should use CAR’s recent election as a case study in developing a typology of online disinformation strategies and countermeasures, in order to counter future attempts by foreign actors to influence African elections through online disinformation campaigns.

The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.

Stephen is a security analyst with several years of experience working in both conflict and post-conflict settings in Africa, primarily on issues of peace and security; transitional justice and reconciliation; democratisation and governance; and preventing and countering violent extremism. He currently serves as head of the Human Security and Climate Change (HSCC) project at Good Governance Africa and is a co-editor of the Extremisms in Africa anthology series.Climate Change (HSCC) project at Good Governance Africa and is a co-editor of the Extremisms in Africa anthology series.
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