ECONOMIST: Protecting displaced Africans

Good piece (as usual) from The Economist on Internally Displaced Persons (IDPs), of which there are some two million in the Congo.


Protecting displaced Africans

Oct 29th 2009 | NAIROBI

A new treaty promises much, but will not help those who need help most urgently

AFRICA contains half of the world’s Internally Displaced Persons (IDPs)—those who have fled their homes but continue to live in their own countries. Sudan alone has over 4m of them, about the same number as the whole of Asia. Congo has another 2m or so, Somalia at least 1.3m. A score of other countries including Uganda, Zimbabwe and Kenya have hundreds of thousands more. In sum, there are about 12m IDPs across the continent.

On top of that, Africa has 3m refugees, who, by crossing an international border, have rights and can expect assistance from the United Nations High Commissioner for Refugees (UNHCR). IDPs, however, are not so fortunate. No binding agreements protect them. UNHCR will help out, but generally they have to rely on the generosity of foreign-aid organisations and, occasionally, the goodwill of their own governments. Sometimes though, as in the Darfur region of Sudan, those very same governments have driven the IDPs from their homes in the first place.

An African Union convention on IDPs, signed in the Ugandan capital Kampala on October 23rd, aims to change that. Under the convention, African governments will have to look after their displaced citizens. Politicians who chase civilians out of their homes will be liable for prosecution by their domestic courts. The convention takes a strong stand against armed rebel groups, which can now also be held responsible for uprooting civilians. It calls for more assistance for women and other vulnerable people.

Some campaigners are bitter that the convention was signed in Uganda. They charge that the Ugandan president, Yoweri Museveni, himself failed to protect the 2m or so of his people displaced by the Lord’s Resistance Army, a ragtag but monstrous militia from northern Uganda that continues to mutilate and burn civilians out of their homes in Congo, Sudan and the Central African Republic. Cynics think the convention may even have been a ruse by some old-timer African leaders to avoid signing a pesky African charter on democracy and elections. Zimbabwe’s Robert Mugabe was among the handful of African leaders who travelled to Kampala.

Mr Museveni brushed aside criticism. A piece of paper would not bring immediate relief to displaced women in Darfur, he said, but it was a start. The Sudanese government, indeed, has not signed the convention and so far shown no inclination to prosecute its own over the killing and rape of IDPs in Darfur. But insiders reckon that enough of Africa’s governments will sign the convention to make it stick. The harder part will be getting laws on the books and providing money to look after IDPs. A coalition of aid groups thinks the UNHCR should take more of a lead in looking after IDPs and be given the money and mandate to do so. There are other questions too. Should IDPs stay in rural areas or be resettled in towns? Providing the right amount of assistance is tricky as well. Too much, and an African government risks turning camps into subsidised slums. Too little, and people die.

The most significant bit of the convention is the recognition accorded to climate-change migrants. According to the Norwegian Refugee Council and other groups, the number of Africans displaced by conflict is falling, but the number displaced by climate change is climbing fast. The International Organisation for Migration thinks most of the world’s 200m predicted climate-change migrants will be Africans. The UN points out that rain-fed agriculture in Africa may be cut in half by 2020 because of shifting rainfall. Its head of emergency relief, John Holmes, argues that 700,000 Africans were displaced by climate change in 2008. More will follow.

Employees must wash hands before returning to work

Believe it or not, October 15 was "Global Handwashing Day". There really is a day (or week or month) for everything, but despite the silliness of designating a "Global Handwashing Day" (and yes, yes, it provides a focal point for awareness raising activities), handwashing (or not) is an activity that can help save (or not) millions of children's lives every year.

According to the Global Handwashing Day website: "Of the approximately 120 million children born in the developing world each year, half will live in households without access to improved sanitation, at grave risk to their survival and development. Poor hygiene and lack of access to sanitation together contribute to about 88% of deaths from diarrheal diseases, accounting for 1.5 million diarrhea-related under-five deaths each year. Children suffer disproportionately from diarrheal and respiratory diseases and deaths." Children older than five suffer as well: diarrheal and respiratory diseases kill around 3.5 million children a year worldwide.

Handwashing with soap is one of the most cost-effective means of preventing infection in developing countries, but a recent study of behavior in 11 countries found that on average, only 17% of child caretakers wash hands with soap after visiting the toilet. Of the 11 countries (Ghana, India, Madagascar, Kyrgyzstan, Senegal, Peru, China, Tanzania, Uganda, Vietnam and Kenya), Indians washed their hands with soap most frequently (42%) after visiting the toilet, while Ghanaians and Madagascaris washed least frequently (3% and 4% respectively). Chinese washed their hands 12-13% of the time, and Kenyans 29% of the time.

Including people who rinsed their hands with water but did not use soap, the numbers were much higher, leaping to 39% in Ghana and 57% in Kenya. The India study did not report "no soap" handwashing statistics, and bizarrely, the two China studies, done in Sichuan and Shaanxi (and admittedly featuring small data samples), which produced nearly identical "handwashing with soap" results, returned extraordinarily different results on the question of handwashing without soap (Sichuanese rinsed 87% of the time and Shaanxi only 14% of the time).

Hygiene is in great part a function of culture and convenience (if you had to collect all of your washing and cooking water every day, and had no water facilities in your toilet, which you were sharing with hundreds of others, how good a handwasher would you be?), but poor hygiene is not exclusive to developing countries. A study in the U.K. found that only 43% of mothers washed their hands with soap after changing a dirty diaper/nappy. That's five points ahead of Kenya (38%).

Of course, you don't have to be a health and sanitation researcher to know that poor hygiene knows no economic or national boundaries. The next time you visit the toilet in a luxury hotel or posh restaurant, pause for a moment (trying not to get arrested for loitering with intent to solicit) and see what percentage of people wash their hands with soap. No matter how exclusive the venue, a sizable minority (or majority!) of people will head straight out the door without even a glance at the sink.

I included a couple of photos above, The first shows a handwashing cistern at a Medecins Sans Frontieres hospital in Gety, Ituri province. These cisterns frequently have a piece of soap nearby, but although this one doesn't, the water contains antiseptic. The second photograph shows a toilet in a camp in North Kivu for internally displaced refugees (IDPs). The toilets are scattered around the camp and segregated by sex (though I imagine that in the middle of the night most people head for the nearest). They're drop toilets and probably needless to say, they don't feature sinks and running water. If you want to wash your hands, you do so after returning to your hut.

War is hell. On Schoolchildren.

War is hell on schoolchildren. The decade-plus of war that has killed nearly six million citizens of the Democratic Republic of the Congo and destroyed the country's industry and infrastructure has also destroyed the hopes of a generation of children that they might get an education and with it, an opportunity to help their country break its cycle of poverty and self-destruction.

In 2005 it was estimated that 4.6 million Congolese children were not being educated, either because their parents could not afford school fees and supplies, or because armed conflict had caused the suspension of educational services in their towns and villages. Data compiled in 2007 estimated that 3% of D.R.C. citizens receive a university education, 30% a secondary school education, 46% only a primary school education, and 21% no education at all.

Travel around the D.R.C. and you see children everywhere. In the IDP (internally displaced person) camps, you are followed everywhere by a crowd of kids. In part this is curiosity; how strange the mzungu are! In part it is hope; can the mzungu help us? In part it's boredom; doing anything is better than doing nothing.

Of course, children also work to support their families. They collect water and they help their parents in the fields in times peaceful enough to permit people to cultivate their fields. The above photographs taken in and around IDP camps near Rutshuru in North Kivu show children collecting water and observing the mzungu photographer.

I brought my "A" game and was, I'm sure, at least as entertaining as usual, but I can't claim my visit was an adequate substitute for a good education.

Congo/Women

If you're interested in the Congo, and in the plight of its people, the Congo/Women exhibition is well worth a look.Photographs taken by Lynsey Addario, Marcus Bleasdale, Ron Haviv and James Nachtwey tell the story of daily life in the Congo – political, economic, cultural, medical and personal – and essays provide deeper background with which to understand the photographs' context.

You can read more about the exhibition at the New York Times's excellent "Lens" blog.

Movie Night in the Congo

One morning on my way back from the hospital in the North Kivu town of Rutshuru, I passed the above-pictured cinema and wondered what was playing and how movies are shown. [Regrettably, the scene had passed from my mind by the time I walked to the Medicins Sans Frontieres residential compound where I was staying and could have asked. Also regrettably, there was no chance at all for me to go to the movies while in the Congo; MSF operations everywhere I stayed outside of Kinshasa and Bunia (in Ituri province), where there is a large United Nations peacekeeping force headquartered on the outskirts of town, observe a curfew from nightfall for security reasons.]

It's almost impossible to imagine that there's a film projector involved; far more likely is that the cinema owners possess some sort of projection television (if reasonably wealthy), or even simply show DVD movies on a medium-sized (by developed country standards) CRT television.

Discovering this photograph yesterday among the thousands I shot in the Congo, I was prompted to wonder about the typical Congolese (i.e. ex-Kinshasa) moviegoing experience. [If any readers of this blog have first-hand knowledge, I'd be very happy to hear it.] How much does it cost to go to this cinema, I wonder (around $0.10-0.25 is my guess)? What movies are shown? French movies, I presume, dominate, and probably the major Hollywood blockbusters, subtitled in French, are shown as well. [Cost aside, language would be a bar to moviegoing for the average Congolese, who speaks little French and no English.]

What about locally produced movies? After all, Nigeria has a thriving video production industry; what about the Congo?

Well, I did some research, and it seems the 12 years of war that have killed nearly six million people has also dampened enthusiasm for producing films in the country. There are a few well-known (to cineastes) Congolese directors, but they live and work overseas.

In any event, the history of film production in the Congo is brief. During the Belgian colonial period (until 1960), Congolese were not permitted to watch foreign films at all, ostensibly because they were unable to differentiate between fact and fiction and therefore might develop mental problems (reminding me that China banned "Babe", a live action film about a talking pig, on the grounds that because pigs can't talk, people might become confused), but in fact to limit exposure to (and questions about) the more egalitarian ex-colonial world. The Belgian colonial administration did, however, see the utility of the film medium as a communications tool, and it established a Film and Photo Bureau to produce educational and propaganda films for the local population. And inevitably, in training locals to assist with the production process, the seeds of a local film industry were sown.

Not until 1987, however, was the first Congolese feature film produced, Mwenze Ngangura's "La Vie Est Belle". Although I haven't see either that or his "Pieces d'Identite", which won several awards, Ngangura remains the Congo's best-recognized film director.

Readers who live in the New York City area may be interested to learn that the Maysles Cinema is screening a "Congo in Harlem Film Festival" this month until October 24. On the schedule is Ngangura's "La Vie Est Belle" (October 23); the documentary "Reporter", chronicling New York Times correspondent Nicholas Kristof's efforts to raise global awareness about the war in the Congo; and "Pygmy Thrills" (October 20), a 10-minute short (shown with another film) filmed in the 1930s by Eugene Castle and a film Werner Herzog cites as his impetus for embarking on a film career. Unfortunately, you've missed Raoul Peck's "Lumumba", which was shown on October 2.

Venture Capital Wanted for 'Green Laundry' Business

Remember that British kid who set up a web page and sold "ads" at $1 a pixel, trying to raise $1 million to fund his university education (and ensure he had beer money while he was there)? Stupidest idea in Internet history, right? His final tally was $1,037,100. No word on whether or not he bothered to go to university in the end.

Bringing me to my point.

Are you looking for somewhere smart to put the millions you pulled out of tech companies just before the last dotcom crash? Or a safe (and remunerative) haven for the proceeds from the Dubai and Singapore condominiums you managed to sell early last year, just before those markets went into cardiac arrest?

Yes? Do I have a business for you!

First off, it's a green business, meaning it's "eco-friendly", "sustainable", blah blah blah. The words that get people very, very excited these days (so excited they sometimes don't even ask to see cash flow projections, in case you're thinking of flipping your stake within 6-12 months).

Second, it's a business that will help support people in a developing country, a business that doesn't involve hiring retired Spetsnaz officers with fleets of Antonov cargo planes to extract conflict gold, diamonds and cellphone minerals from jungle airstrips at the business end of an AK-47.

The business? Hand-laundered, sun-dried eco-laundry. If you're reading this from a developed country that is not Japan (where mostly, laundry - including mine - is still air dried), chances are you clean your clothes in a washing machine and dry them in a clothes dryer. You probably throw some "fresh scent" fabric softener into either the washing machine or dryer, and you feel pretty good about yourself (or at least, about the way your clothes feel and smell). Good, that is, until you pause to consider the armageddon-inducing damage you're inflicting on the environment.

The ladies in the photos above work in a small Medecins Sans Frontieres-operated hospital in Kabizo, North Kivu, and take care of all the laundry for a medical facility that had 45 resident patients when I visited, and can accommodate more. The water they use (you can see the taps in the first photo) is purified in a nearby MSF-built water sanitation facility and pumped to a 15,000-liter storage bladder on the hospital grounds.

So many things that are automated or mechanized in our world, are done by hand in their world. Nearly everything, in fact.

Want to build a building? First, buy the wood, and a man will cut down a tree in the forest, rough cut it where it falls, truck it to your site, and cut it into lumber. All by hand, with two-man saws, hand saws, adzes and planes.

Want your laundry done? If you're a Congolese farmer or IDP refugee, you don't do laundry, or at least don't do it very often (and when you do, you're doing it in an unclean river or stream). If you have greater resources (as we do), you figure out how to get clean water (for MSF that means building a water sanitation facility, and almost certainly sharing it with the local community), and you do it by hand (more likely, you hire people to do it by hand for you).

Handcut lumber is already being exported from the Congo, almost certainly for the most part exploitatively rather than sustainably, but I reckon eco-laundry is The Next Big Thing.

Send money first, bags of laundry later.

Eight Minutes

Actress Sienna Miller traveled to Democratic Republic of the Congo in early 2009 to document the problem of rape, used there as a military weapon to terrorize the civilian population. The title of Miller's short documentary, "Eight Minutes" (click title or here to go to site), refers to the frequency with which a woman is raped in the Congo ... it happens every eight minutes.

The problem of peacekeeping in a country where there's no peace

The United Nations currently maintains a force of nearly 20,000 peacekeepers in the Democratic Republic of the Congo, comprising nearly 17,000 soldiers, 700 military observers and more than 1,000 police officers, as well as several thousand civilian personnel. The mission, known by its French acronym as MONUC, was deployed following a U.N. Security Council resolution in February 2000 to monitor the implementation and investigate violations of a ceasefire among the armies of Angola, the Democratic Republic of the Congo, Namibia, Rwanda, Uganda, Zambia, and Zimbabwe, as well as about 25 armed groups.

Since the deployment of an initial force numbering just over 5,000 soldiers, MONUC's mission has expanded to include support for the conduct of elections, protection of civilians and humanitarian aid workers, and disarmament and demobilization of armed groups operating within the D.R.C. And in the 19 years MONUC has been operating, 94 soldiers, 10 military observers, six policemen and 39 civilian staff members have been killed. During that same time, over five million civilians have died as a direct and indirect (disease and starvation) result of conflict in the Congo.

There are obvious problems with sending peacekeeping missions into countries that are not at peace. Although it is the U.N.'s largest peacekeeping operation, MONUC is pitifully undermanned in the context of the size of the D.R.C., the inaccessibility of much of its territory, and the continuing levels of military activity by both rebels and foreign governments.

Most critically, most U.N. peacekeepers, though fabulously paid by Congolese standards, would probably not consider themselves well paid enough to die for a country that is not theirs. And that, to my mind, is the problem with soldiering for hire, which is what U.N. peacekeepers do.

U.N. member states are paid for contributing peacekeepers, at a rate of around $1,000 a day per soldier. More for specialists, plus allowances for gears and weaponry. A nation, e.g. Fiji, Guatemala (the soldiers in the photos above are part of a Guatemalan special forces unit) contributing 1,000 peacekeepers to MONUC receives $1 million a day in compensation. Not an insignificant sum for a small nation that isn't Monaco or Luxembourg.

Most nations add a bump to the soldiers' pay, but it's nowhere near the $1,000 a day being received from the U.N. So imagine you're getting an extra $200 a month to be a peacekeeper in the Congo. If you're a Pakistani enlisted man, that's not a small amount on top of your regular pay, but is it worth getting killed over? Definitely not, and as a result, how well you do your job depends on how seriously you take your responsibilities as a soldier and a United Nations peacekeeper.

Late last year, during a handover from Indian to Uruguayan forces in the North Kivu town of Kiwanja, near Rutshuru where I was not long ago, rebel forces attacked Kiwanja and Rutshuru, killing civilians and taking control of both towns while MONUC peacekeepers (who had armored vehicles) bunkered down in their base, at one point even coming under fire from Congolese army soldiers whom MONUC theoretically supports. The Indians defended their (in)actions by saying they were unaware of the attacks on civilians occurring just down the road from their base, but not helpfully from an intelligence gathering perspective, the English-speaking Indian forces had no translators on duty in French-speaking Congo.

This is not to cast aspersions on the abilities of Indian peacekeepers alone. There are plenty of other examples (Rwanda, Bosnia, Somalia, Haiti) of catastrophic U.N. peacekeeping failures, reinforcing the fundamental problem: that few people, even professional soldiers, are motivated by a few (and it really is just a few) extra dollars to die for someone else's country.

Essential Drugs

Doctors who work for MSF are pretty much guaranteed they will face pathologies they would not have had to deal with in their home countries, even if their home countries are developing nations with significant health care problems. MSF's mandate is (for the most part) emergency response, and doctors respond to outbreaks of cholera, malaria and meningitis, treat victims of armed conflict, and set up treatment programs for HIV/AIDS sufferers.

Even doctors who served their residencies in Detroit, and have therefore seen more than their share of gunshot victims, have probably not treated too many patients who had stepped on land mines. The same is true of African trypanosomiasis, also known as sleeping sickness. Not too many cases of that at Karolinska University Hospital in Stockholm, for example.

MSF frequently operates in countries and regions where the health care infrastructure has completely fallen apart – the Democratic Republic of the Congo is an excellent example – and in order to maximize the speed and efficiency with which newly arrived medical teams can start delivering care to patients, the organization has developed a number of specialized kits, each containing a wide range of supplies needed to treat a certain number of patients in a particular pathology. MSF has also published a number of guidelines and protocols that share information from doctors who may have been in similar circumstances.

The book pictured above is a manual intended for use in the field by physicians, pharmacists, nurses and other health care workers involved in the prescription, dispensation and management of medicines. This particular volume looked as though it had been well used.

Other volumes published by MSF boast intriguing titles such as "Obstetrics in Remote Situations", "Management of Epidemic Meningoccocal Meningitis", "Blood Transfusions in Remote Areas", "Refugee Health in Emergency Situations" and "Rapid Health Assessment of Refugee or Displaced Populations".

Those titles are far more straightforward, I think, than "Essential Drugs", which has possibly been purchased by mistake by more than a few substance-impaired undergraduate university students.

Augustin, Sign Maker

Sorting through some photographs the other day, I looked closely at these shots I took of department/ward signs in an MSF-run hospital in Bunia. On each of them you can see (click on the image to see in a larger size) the sign maker's signature, Augustin. [I've added another sign, by Pierrot the sign maker, which may or may not have been taken in the same hospital (I can't be bothered to figure it out from the shot timings).]

I love the purity of Augustin's marketing strategy, though I imagine that if he hired an agency they would recommend writing "Augustin" in the size he's written "Maternite".

"I could never do that."

How often have you heard people say, or said yourself, "Oh, I could never do that."

In the course of showing my photos of the Congo to friends, I've heard more than one person say those words, or words like them. My friends seem to think they could never survive being shot in the leg, or that they could never build and live in their own grass and reed hut, or collect water and food every day in order to prepare that day's meals.

My friends are wrong, of course. Hundreds of millions of people do those things every day, because if you have no choice ... you have no choice.

Are we in the developed world "soft"? Yes, most of us are. We worry about trivia, because we have nothing worse to worry about. We convince ourselves we can't do things, because, if the going gets too tough we can always climb back into our BMWs and Audis, turn up the heater (and CD player), pick up a coffee at Starbucks, and have a hot shower when we get home, before deciding between ordering Chinese or pizza for dinner.

When you have no choice, things are simpler. If you have to collect 20 liters of water per day per person in your family, you know you need to wake up early and get moving with that 5-liter jug. If your child is sick and the nearest health clinic or hospital is 20 kilometers away, and there are no buses or other transport, you know you need to start walking.

If you had to run out of your house right now because drugged and drunken gunmen were attacking your community, indiscriminately spraying automatic weapons fire, and you had to hide in the woods for three days without food, returning to find that your home had been burned to the ground and you'd been left with nothing but the clothes on your back, could you handle that? You probably could.

Wanted: _____ologists

Dr. Richard is a 38-year-old anaesthesiologist working at Rutshuru Hospital in North Kivu province, and he's the only anaesthesiologist on staff. The hospital's surgeons perform 10-20 operations a day, around the clock, and Dr. Richard is stretched.

He has three nurses working under him who have anaesthesiological training, but Dr. Richard, who is Congolese and was trained at the University of Kinshasa Medical School, bears responsibility for their work, and more often than not, he attends in person.

A shortage of doctors in the Democratic Republic of the Congo, combined with an overall very basic level of medical care, means the vast majority of the country's medical school graduates (not a huge number anyway) go straight into general practice rather than undertaking a specialist residency.

The money is better in general practice (though by the standards of almost every other country on earth it's not good), so why spend an extra few years learning to be a gynecologist or endocrinologist or otolaryngologist? Or anaesthesiologist?

Perhaps in order to work overseas, for a lot more money, in a country where you're unlikely to be shot and killed because you have a job and perhaps own a bicycle and are therefore "rich"? No one would blame you.

The D.R.C.'s "medical brain drain" is, like so many of the country's other problems, rooted in the decade of war that has thus far cost 5.5 million lives, and prevents Congolese from establishing a society in which they can live without fear and work toward realizing their dreams.

No one can blame those who have the opportunity for choosing to seek a better future overseas, but equally, few can be unimpressed by those like Dr. Richard who choose to stay, to work for little pay and often at great personal risk to reclaim their countries from the depths of anarchy and despair.