Africa’s ‘lawless third’: duty of care
Swathes of the continent are home to people whose efforts at self-rule or traditional ways of life have challenged state attempts to deal with COVID-19
The lack of access to healthcare during the COVID-19 pandemic experienced by millions of Africans as a result of living in ungoverned, under-serviced, rebel-controlled, or poorly supported alternatively administered regions, raises a unique set of problems for governments, donor agencies, and healthcare professionals combating the novel coronavirus. The sheer scale and persistence of this problem has caused many decision makers at country and international levels to turn a blind eye to it – with the unfortunate result being the avoidance of the duty of care in this troublesome so-called “lawless third” of the continent, about 34% of the continental land mass incorporating all of Libya, half of Algeria, much of the Sahara and Sahel, northern Nigeria, the Horn and a crescent of the African Forest Belt.
However, the people living in these zones deserve equitable access to universal healthcare including adequate COVID-19 testing and treatment. These conditions are far more widespread in Africa than is usually acknowledged by the authorities, though concentrated in the Sahara, Sahel, and Forest Belt regions. As such, they are deeply marked by traditional modes of nomadic livelihood that clash directly with state attempts to curb the spread of the coronavirus. Nevertheless, there have been a variety of responses to the challenge posed by the pandemic in these regions, some of them remarkably positive. Regions that fall entirely outside the ambit of governments’ abilities to respond to the virus largely embrace those that fall under the control of separatist groups or rebels.
Regions that are under-serviced fall into three, sometimes interlinked, categories: those difficult to reach because of their remoteness or rugged terrain; poor rural areas, which under-resourced governments battle to serve, even under normal conditions; and those from which state services, including healthcare, are deliberately withheld or restricted because their populations are viewed as hostile to the central state. However, notable cases of viable alternative healthcare administrations are those of two states with contested legitimacy: the Sahrawi Arab Democratic Republic (SADR), which occupies the eastern third of the Moroccan-ruled territory of Western Sahara, and Somaliland, a Horn of Africa republic that seceded from the north of Somalia.
Governments direct few resources, including healthcare, to remote and rural provinces because of their sparse and nomadic populations. But very low average population densities should not be taken as an indication that people do not gather, socialise and interact in significant numbers in certain zones of the Sahara and Sahel. Notably, people cluster and move around bodies of water like Lake Chad (two million people within a 100 km radius of the lake’s centre, and 13 million within a 300 km radius) and along the Nile River (a density of up to 1,165 people/km² along the river’s lower course through Egypt), as well as along the ancient trade routes that traverse the region. Of relevance to COVID-19 is the potential for viral transmission at these points and along these routes.
Also, some rural population distributions are counter-intuitive: for example, the Ouargla province of Algeria and the Tombouctou province of Mali – both remote Saharan desert regions – have high focal population distributions, meaning their rural populations are densely clustered in small settlements, ideal for COVID-19 transmission given that these settlements are linked by poorly monitored/controlled nomadic travel. The African Forest Belt – home to many rebel groups – though mostly sparsely populated, also boasts zones of dense population.
Examples include the strife-torn Lake Kivu basin in eastern Democratic Republic of Congo, which has a density of over 400 people/km²: while government only controls half of the North Kivu province bordering the lake’s western shore, the rest is controlled by a patchwork of numerous guerrilla groups. Sparseness of law enforcement, resource allocation, and healthcare access has enabled rebel groups to operate with relative impunity and gives them an opportunity to legitimise themselves by offering the populace alternative services, including healthcare. But this is a rarity: insurgencies usually disrupt and overstress already fragile healthcare infrastructure. An example is northeastern Nigeria, which already had inadequate clinics and too few healthcare workers before the jihadist Boko Haram insurgency began in 2009.
This general picture of lawlessness or fragmented authority imposes some unique circumstances under which the COVID-19 pandemic has been faced across many parts of Africa, but there are instances of stable yet alternate (and thus often unrecognised) territorial authorities with aspirations to formal government and state status. At either extremity of this supposedly “stateless” third of the continent lie the Sahrawi Arab Democratic Republic (administered by a government recognised by 40 out of 193 UN member states, 20 of which are AU members) and Somaliland (administered by a government recognised by only three UN member states, two of them AU members).
Regardless of whether the international community recognises these states, in reality they are only “unadministered” in the view of the central governments in Rabat and Mogadishu which lay claim to them; in most other respects, they fall under conventional functioning administrations, which provide healthcare to their citizens. Where diplomatic recognition does count, however, is whether these contested territories are able to access adequate COVID-19 testing, and donor or funding partner healthcare support. Pandemic statistics reported by the Africa Centres for Disease Control and Prevention (Africa CDC) derive from recognised governments only.
In addition, the World Health Organization (WHO) has no official coverage of either territory by its Regional Office for Africa (AFRO). Within SADR’s zone, on 19 March, the Sahrawi government announced its implementation of COVID-19 countermeasures, including the closure of borders with friendly neighbours Algeria and Mauritania. It also created quarantine areas, and the imposition of a “stay-in-your-tent” lockdown policy. On the one hand, this indicates a seriousness by the Sahrawi authorities to exercise their duty of care, but the remoteness and relative poverty of their territory meant that when these measures were implemented, healthcare workers had “just 600 pairs of gloves and 2,000 masks for a population of between 180,000 and 200,000 people”, according to a Euronews report on 20 April.
The only reliable reporting appears to be by the UN mission in the region, MINURSO, which “maintains constant liaison with the Moroccan government, POLISARIO and Algerian government to share information and coordinate action”. Its last report, dated 5 June 2020, states: “There have been no new cases in the Tindouf Governorate (of Algeria) since 10 May and still no cases to date in the Sahrawi refugee camps or in the Territory East of the Berm”, the embankment that marks the border with Algeria. “The lone death from COVID-19 in Tindouf Governorate remains the only fatal case in MINURSO’s area of operations.” The report, however, gave no number of positive cases for the SADR-occupied portion of Western Sahara.
On the extreme east of the continent, the widely unrecognised state of Somaliland, which in 1991 broke away from Somalia – itself without a fully functional or authoritative government and state since then – has likewise posed a problem for tracking the progress of the virus, and for attempts to combat it. The internationally recognised government of Somalia in Mogadishu announced the first positive COVID-19 case on 16 March and suspended international flights in response, later followed by the suspension of domestic flights. It also tried to prevent the importation of khat (the leaf chewed for its mildly narcotic effects) as a means to limit socialising amongst people.
But Mogadishu’s grip on authority is tenuous at best. By mid- August last year it could only claim to control the capital and some of the larger cities of the south. The result has been that the official government is unable to enforce any travel restrictions by road. Also, the situation is bedevilled by drought, locust storms, flash floods, traditional contestation between six major clans, and some 2,6 million people internally displaced due to conflict. Somaliland reported its first two positive novel coronavirus cases on 31 March 2020, six days after closing its land borders and ordering incoming airline crews and passengers to be quarantined for two weeks. On 26 March, it had diverted all developmental funding into combating the pandemic.
*Accountability International is aware that the statistics that are presented to the Africa CDC or other regional/continental/global organisations on which we base our scorecard grading (for COVID-19) are not without some problems and can thus not always be taken at face value. Firstly, on a country-by- country basis, we need to have an understanding of the robustness of each country’s reporting mechanisms (are they adequately funded, comprehensive, and statistically sound?). Next, we need to recognise that in rare cases, the temptation of governments to improve their public image by under-reporting the impact of the pandemic may prove too strong: this is clearly the case with Tanzania that dangerously ceased reporting on 9 May 2020, but there may be other less obvious examples that involve under-reporting rather than a total refusal to provide data. Lastly, a pre-existing lack of data, particularly on key populations, undermines an adequate understanding of the impact of the pandemic on the most vulnerable and marginalised.*
Khat establishments were closed, mosques issued with social distancing guidelines, social gatherings outlawed, and 574 prisoners pardoned and released, but the crucial lifeline of flights to Ethiopia was maintained. To date, the Africa CDC’s figures have not differentiated between separatist Somaliland and Somalia (including Puntland), with 2,860 positive cases of whom 90 had died as of 25 June 2020, although it appears Mogadishu is counting Somaliland in its reporting to the Africa CDC and WHO. Somaliland separately reported on the same date a total of 681 cases of whom 28 had died. On 15 July, Somalia reported 3,083 cases of whom 93 had died, with Somaliland the following day reporting 807 cases of whom 29 had died.
Lacking its own testing facilities, the breakaway state has been sending abroad to get test results. COVID-19 aid is being sent via Mogadishu – which politically and practically undermines Hargeisa (the Somaliland capital): in late April, the European Union (EU) donated €27 million to Somalia, of which €10 million was officially earmarked for Somaliland. Yet it was subsequently reported that Somaliland had been entirely cut out of the aid. On 23 June, Hargeisa announced the lifting of all anti-COVID-19 measures – though social distancing and the quarantining of virus-positive people entering the country remained in force.
The government did not give reasons for reopening the country, but it is likely that it could no longer bear an economic shutdown without external aid. Lastly, we must deal with the fact that some regions in many African countries are deliberately under serviced by central governments because of their perceived hostility to the incumbent political leadership. Such pre-existing ethnicised healthcare access inequalities are only amplified under COVID-19. For example, in Burundi, the aftermath of the genocidal civil war between a Tutsi-dominated army and Hutu rebel groups from 1993-2005 has seen the authorities enforce 60% Hutu/40% Tutsi ethnic quotas on the staffing of foreign NGOs, including in the healthcare sector.
Human Rights Watch noted: “On 1 October 2018, authorities suspended the activities of foreign non-governmental organisations (NGOs) for three months to force them to re-register, including new documentation stating the ethnicity of their Burundian employees.” The disruption put many healthcare projects months behind schedule, while some NGOs, wary of how the ethnicity data might be misused, exited the country entirely – all of which has undermined Burundi’s COVID-19 response. On 12 May 2020, the Burundian government declared persona non grata the WHO’s country director and some of its health experts who were critical of underreporting of data on the pandemic.
On 10 June, President Pierre Nkurunziza, who had refused to take strong measures against COIVID-19, died of a heart attack rumoured to have been brought on by the virus. Denial of healthcare in remote borderlands is most often practised against migrants, refugees and other non-citizens, even under COVID-19 quarantine. An example of this is from Ethiopia, where a Reliefweb update on the pandemic warned that “Internally Displaced persons (IDPs) living in congested and unsanitary collective centres, spontaneous and planned sites, rental accommodations or shared shelters with relatives in host communities are particularly vulnerable to COVID-19.”
Complicating the issue is that most undocumented migrants, including asylum seekers, cross international borders often knowing nothing about the COVID-19 pandemic. For example, the UN’s International Organisation for Migration (IOM) reported that just over half of all migrants attempting the dangerous crossing into the Gulf states from Somalia via war-torn Yemen had not heard of COVID-19. An urgent starting point is for all armed groups – state or rebel – to allow international healthcare agencies to do their work in remote and conflict torn areas unhindered. In addition, the international community needs to immediately put human lives above diplomatic considerations and provide direct assistance to SADR, Somaliland, and any other contested regions where the rulers of which, regardless of their official status, have demonstrated their administrative capacity and resolve to fight the pandemic.
Lastly, African administrations and their international supporters must pay significant attention to the most vulnerable population groups languishing in poor, remote, and under-serviced areas across the continent, key populations most threatened by the novel coronavirus. Only by adhering to universal healthcare commitments can we advance equitable access to all, establishing a legacy of robust care well after the current crisis is over.
This is an edited version of an original paper authored by Michael Schmidt (Hammerl Arts Rights Transfer), with graphics conceptualisation by Phillipa Tucker (Accountability International), and graphics by Thomas Heap (HokaHey!). Republished with the kind permission of Accountability International and Hammerl Arts Rights Transfer.
COVID-19: an African overview
African countries have reacted in different ways to the pandemic, from outright denial to some of the most stringent lockdown rules in the world
When retired star footballer Musa Otieno went public on 30 June 2020 after contracting COVID-19, Kenyans sat up and listened. It was a sobering moment for the country, especially among the naysayers who still believed that the disease was nothing but a scaremongering tactic by the government. Otieno was a long-serving captain of the national team apart from playing professional football for the Cape Town based Santos FC, which won the South African League when he was there in the 2001/02 season. Before news of Otieno’s illness had sunk in, the country was numbed by the death from COVID-19 of popular TV and stage actor Charles Bukeko, who gained world fame when he appeared in an advert for Coca Cola, which aired globally just before the 2010 World Cup.
Finally, celebrated TV news anchor Jeff Koinange also went public on 20 July 2020 after testing positive. The former CNN journalist advised Kenyans to take the disease seriously. These three cases proved to be a godsend for a government that was trying hard to contain the spread of the virus amidst widespread public scepticism. Ever since the first case was reported in Kenya in early March, the numbers have kept rising, a situation that prompted President Uhuru Kenyatta to announce a nationwide curfew as well as lockdown of the capital Nairobi, the port city of Mombasa and Mandera, bordering Somalia and Ethiopia.
The first of the raft of measures were announced by President Kenyatta on 26 March 2020 with a 7 pm to 5 am curfew exempting those providing essential services, and a ban on all gatherings, including places of worship and sporting activities. Weddings and funerals were allowed but with the caveat that only 15 people attend while adhering to all the safety protocols laid out by the Ministry of Health. President Kenyatta, at the time of writing, has been reviewing these measures monthly and in his latest address on 28 August 2020, he extended the curfew and ban on bars and entertainment operations for a further 30 days.
Churches and mosques have since been allowed to open but with a strict one and a half hours service with attendants limited to 100 people maximum. The first partial lifting of the tough conditions that allowed the sale of alcohol in restaurants, but with the caveat that alcohol could only be sold if patrons also ordered food, was announced by the head of state in his June address. But nothing can separate Kenyans from their drink, it seems, and soon afterwards Health Minister Mutahi Kagwe lamented that people were breaking the rule with impunity. According to the former newspaper executive, wily Kenyans were going to restaurants, ordering a sausage or two, then engaging in binge drinking.
Restaurant goers referred to this as “Mutahi Kagwe Special”, (“special” here being borrowed from eateries parlance where people order special meals), the minister said. And the beer ban busting was not entirely limited to the common folk. Towards the end of July, the Senator for Nairobi Johnson Sakaja, a close ally of President Kenyatta, was caught by policemen as he hosted a party at a high-end hotel long after the permitted hours of 5 to 7 pm. His case was all the more interesting because he was the chairman of the Senate ad hoc committee on COVID-19. A contrite Sakaja addressed a press conference the next day where he not only apologised but resigned from his committee position.
He was fined Kshs 15,000 (about $150) by a Nairobi court, a punishment Kenyans dismissed as a slap on the wrist, considering that senators earn as much as Kshs 1 million per month. Like many countries in the world, Kenya is struggling to combat the disease that has all but brought the country to a standstill. In late July, the Ministry of Health ordered 100,000 body bags to dispose of the corpses of coronavirus victims, while most of the county governments have announced they are purchasing land to be used as public cemeteries to bury the COVID-19 dead. But by the end of August, there was not a single county that had started burials at the newly acquired cemeteries.
Meanwhile, schools remain closed, with the government saying some of the institutions will be turned into temporary hospitals if the situation deteriorates. As at July 28, Kenya had recorded 33,016 cases, 564 deaths and 19,296 recoveries. It was against this background that President Kenyatta in his address to the nation on July 3 asked for more caution from the public in fighting the pandemic. The head of state admitted that he was walking a tight rope, trying to balance containing the scourge while ensuring that the economy did not go into meltdown. Kenyatta’s dilemma mirrors that of his fellow African heads of state as they try to deal with a new enemy that respects no borders.
The continent’s leaders have had mixed reactions to the virus. Whereas President Kenyatta and his South African counterpart have opted to ban, ease, then re-ban the sale and consumption of alcohol, on the extreme side are the former Burundi head of state, Pierre Nkurunzisa, who famously declared that God himself had assured him that COVID-19 would not harm Burundians. Then he got ill and died on 8 June 2020. Although the government announced he had died from a heart attack, local news outlets claimed that he had succumbed to COVID-19. As Nkurunzisa lay dying in a rural hospital in his country, his wife, First Lady Denise Bucuma Nkurunzisa, was airlifted to Nairobi where she was treated and discharged in time for her husband’s burial.
Reports indicated that she was being treated for COVID-19, although the hospital, citing patient confidentiality, never responded to the media reports. Diplomatic sources were also quoted in sections of the Kenyan press, saying that President Kenyatta was under pressure to allow some top South Sudanese generals to get treated in Nairobi after they tested positive for COVID-19. South Sudan Vice President Riek Machar wrote to Kenya on 7 April, 2020 seeking to have a high-level person be allowed treatment in Kenya. However, the request appears to have been turned down.
In Tanzania, President John Magufuli has flatly rejected any suggestions that his country could be in danger, and suggested Tanzanians go about their lives as usual, with no masks, no tests and no infection or deaths reported. Magufuli, who holds a doctorate degree in chemistry, has run into diplomatic turbulence with Kenya over his standpoint. In his national address on 27 July 2020, and without directly naming Magufuli, President Kenyatta spoke of “others” who were stifling information about the virus. A day after Kenyatta’s address, a plane carrying a Kenyan delegation to the burial of former Tanzanian President Benjamin Mkapa was turned back to Nairobi immediately after entering Tanzanian airspace.
Authorities on both sides blamed mechanical problems with the aircraft and bad weather, although the plane later landed safely in Nairobi and other planes landed in Tanzania on that day. In a tweet that was retweeted many times, the digital editor at The Star newspaper, Oliver Mathenge, said, “President Magufuli appears to have hit back after his Kenyan counterpart, Uhuru Kenyatta, insinuated that Tanzania was not honest about its COVID-19 situation. A Kenyan delegation to attend the burial of former Tanzania President Mkapa was not allowed to land today.” In Madagascar, tensions were reported after health minister Ahmad Ahmad wrote to the international community on 22 July 2020 to help the country deal with COVID-19.
This was in stark contrast to the position taken by President Andry Rajoelina, who has been vocal in his promotion of a herbal concoction which he has stated can prevent and cure the disease. The two divergent positions by the president and his health minister led to squabbles that came to a head on 20 August 2020, when the head of state fired the minister in a cabinet reshuffle. Initially, African countries were sitting pretty, smug in the false belief that COVID-19 was generally affecting people of Caucasian origin. As European countries like Spain and Italy reported infections and deaths in large numbers, African borders remained relatively safe. The trend was bucked when the disease reached the United States with reports that the black population there was the hardest hit.
Nonetheless, and probably by some divine providence, the wiping out of Africans as earlier predicted has not happened. With run-down health systems and other infrastructure, most experts were agreed that Africa would be hardest hit. However, with 1,196,298 cases, 28,021 deaths and 16,385,382 recoveries at the time of writing in the last week of August, Africa is not that badly off . But there is no time for African leaders and its health experts to rest on their laurels. One silver lining for Africa is that unlike other diseases where the ruling elite and their henchmen seek medical treatment abroad, with COVID-19 there is no such luxury, and it behoves the leaders to upgrade health facilities in their respective countries.
The desert locust outbreak requires several levels of response from national and regional governance structures.
We know that environmental disasters are a function of our disregard for the environment we have been entrusted to steward. The current desert locust plague is a timely reminder that the consequences of climate change enables environmental disasters beyond just extreme weather. The warming of the Indian Ocean, caused by anthropogenic heat, has helped increase the frequency and intensity of tropical cyclones, creating favourable conditions for desert locust breeding and mutation.
In 2019, the North Indian Ocean experienced its most active cyclone season ever recorded. This created ideal locust breeding and survival grounds across the Arabian Peninsula. Desert locusts (Schistocerca gregaria) occur in swarms due to a particular combination of weather, soil and vegetation conditions that complement their reproduction and mutation from an otherwise solitary creature into one that matures and develops into speedy swarms (gregarisation) of up to 150 million locusts. This mutation makes the desert locust one of the most destructive insect groups when met with cropland.
The very nature of a desert locust disaster calls for a policy approach that must intersect with many levels of governance. Disaster risk management (DRM) for desert locusts requires early reaction, efficient control and monitoring and, fundamentally, a prevention approach. What makes desert locusts such a devastating pest is their ability to rapidly develop into swarms, migrate across regions and states, quickly destroying cropland. A swarm the size of Paris can eat as much as half the population of France in one day.
East Africa is currently experiencing the worst desert locust outbreak in decades. The Food and Agriculture Organisation (FAO) estimates that over 42 million people are facing acute food insecurity in the ten affected countries.
Despite early warning by The Desert Locust Watch agency during the 2019 cyclone season, the invasion could not be stopped in time. Knowledge on the ecology of desert locusts has developed considerably over time, but without international policy and implementation cooperation, understanding the species is not enough. National governments must domesticate the procedures and strategies agreed upon at the regional level. In 1962, the Desert Locust Control Organisation for Eastern Africa (DLCO-EA) was established to unify cooperation between the governments of Ethiopia, Somalia, Tanzania, Kenya and Uganda. The DLCO-EA hoped to ensure cooperation in the control of desert locust plagues across the region. Despite having the necessary scientific understanding of how to deal with the locusts, the organisation has struggled to deal with the magnitude of the current outbreak.
The desert locust disaster is an example of the disconnect between the actions of regional organisations and the preparedness of national locust control units. Ria Sen, Disaster Risk Reduction expert with the World Food Programme, asserts that although quantitative risk modelling is an important aspect of preparedness, grasping the context-specific scenario within affected states will ultimately determine the success or failure of a disaster risk management plan.
In the case of Ethiopia, policies do exist to ensure preparedness and risk management planning for disasters affecting the country. The federal agency responsible for their implementation has lagged and only half of the districts across the country have obtained the DRM plans and profiling since 2009. Coupled with the current political disputes between the Tigray Region and the federal government, the ability of the Plant Protection Division and Crop Protection Departments to support the implementation of local-level systems is highly constrained. Ethiopia continues to battle the recent upsurge of swarms in the north. If tensions continue to escalate between Tigray and the national government, the impact of the locust invasion will worsen.
Like most other environmental disasters, the desert locust outbreak requires several levels of response from governance structures both regional and national. Transnational governance response to environmental issues cannot act as a substitute for strong state-based governance. Strong national environmental policies create incentives for state and non-state actors to cooperate. The DLCO-EA should be complemented by member state investment into national and local level locust control policies so that they can work in synergy.
- Countries and regional bodies must invest in further research and technology to improve the ability to predict and potentially prevent desert locust disasters.
- Improve the early warning communication pathway between regional bodies like the FAO’s Desert Locust Watch and the affected countries.
- Strengthen cooperation and engagement between the member states of the DLCO-EA, the Central Desert Locust Commission and the regional environmental centres.
- Enhance coordination and prioritisation at a local and national level of prevention and control actions.
- Increase resource allocation for disaster risk management bodies in advanced to avoid costly emergency response actions.
The implementation of these recommendations will help align existing regional and national governance structures to avoid prolonging the current outbreak and help prevent future related environmental disasters.
This article was first published in the UNDDR Prevention Web site here