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  • Rethinking mental health in Africa

    As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

    Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries' agendas than other health issues.

    "Everyone is putting their money in HIV, reproductive health, malaria," says Sheila Ndyanabangi, director of mental health at Uganda's Ministry of Health. "They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest."

    Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

    In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world's biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

    "Mental health hasn't found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond," Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. "Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets."

    The post-MDG era

    According to a May report from the UN Secretary-General's High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

    "Mental health hasn't found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond"

    Yet it also acknowledges that they have done little to reach the world's most vulnerable. The report says the MDGs were "silent on the devastating effects of conflict and violence on development" and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world's most vulnerable will only be trapped in that cycle.

    "The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention," said Minas. "We've gone beyond that, and now understand we're dealing with complex systems, where all of the important issues are very closely interrelated."

    Poverty and mental illness

    In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

    "The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term," say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

    In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda - which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords' Resistance Army - monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

    "We need to be mentally healthy to get out of poverty," Ethel Mpungu, the study's lead researcher, told IRIN.

    The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

    "It really is around issues of development and economics - those things can no longer be ignored," says Minas. "They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes."

    Putting mental health on the agenda

    As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

    Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME - the programme for improving mental health care - was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

    Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

    Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

    "Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria," said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. "But if people don't care whether they live or die, they're not going to be able to take advantage of these things that are offered."

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  • African governments still underfunding health

    Twelve years after African governments pledged in the Abuja Declaration to allocate at least 15 percent of their annual budgets to healthcare by 2015, just six countries have met this goal.

    Liberia, Madagascar, Malawi, Rwanda, Togo and Zambia have met the target, and five other countries are spending at least 13 percent of their annual budgets on health, according to data compiled by the UN World Health Organization (WHO).

    While on aggregate spending on health has increased - up to 10.6 percent from 8.8 - about a quarter of African Union (AU) member-states have regressed and are now spending less on health than they were in 2001, adds the WHO data.

    Recently, the AU held another special summit on HIV/AIDS, tuberculosis (TB) and malaria in Abuja, Nigeria, dubbed Abuja +12, which provided an opportunity for African governments and other stakeholders to review progress made and to discuss what should be done to ensure health funding targets are met before 2015.

    The HIV/AIDS experience

    “A renewed and bold commitment here in Abuja is essential as, drawing from experiences in the AIDS response, we know that smart investments will save lives, create jobs, reinvigorate communities and further boost economic growth in Africa,” said Michel Sidibé, the executive director of UNAIDS, in a press statement.

    At present, funding for healthcare remains short of requirements and is very unevenly spread across countries. According to UNAIDS, an additional US$31 billion per year will be needed to meet the continent’s 15 percent health funding targets.

    As of 2011, at least 69 percent of the world’s 34 million people estimated to be living with HIV/AIDS were in sub-Saharan Africa.

    But there are encouraging signs. The number of new HIV infections fell by 25 percent in 2011 compared to a decade earlier.

    “The main challenge in the fight against HIV and AIDS globally is how to ensure universal access to prevention, treatment, care and support, and… ensuring zero transmission of new HIV infections in children,” wrote Ghanaian President John Dramani Mahama in a blog article in May.

    Among 21 priority countries in Africa, the number of children newly infected with HIV has fallen by 38 percent since 2009, according to a joint AU-UNAIDS report launched at Abuja +12.

    Malaria and TB burden

    Africa is also lagging behind in reducing cases of - and deaths from - TB and malaria.

    Globally, Africa is the only region not on track towards halving TB deaths by 2015, and it accounts for almost a quarter of the global caseload, according to WHO.

    Inadequate TB detection and drug-resistant strains of the disease, which can be 100 times more expensive to treat, pose significant challenges in Africa. About 40 percent of TB cases in Africa go undetected, adds WHO.

    Malaria is also a serious health problem. Eighty percent of the world’s cases and 90 percent of malaria-related deaths occur in Africa.

    “We are at a turning point for making historical gains in Liberia's health sector - where no child dies of malaria and every mother living with HIV can give birth to HIV-negative children while living healthy lives themselves,” wrote Liberian President Ellen Johnson-Sirleaf, in a statement to the Global Fund.

    Liberia allocates 18.9 percent of its annual budget to healthcare, the second highest proportion in Africa; Rwanda spends 23.7 percent.

    Health for development

    According to the AU/UNAIDS Abuja +12 report, there is an economic case to be made for further investment in healthcare: For every year that life expectancy rises across the continent, it argues, GDP will increase by 4 percent. The average life expectancy in Africa is 54.4 years, the lowest globally.

    “A sick population cannot generate the productivity needed to maintain the acceleration of our economy,” said Ghana’s President Mahama.

    More funding for health could also mean more jobs within the health sector. In 2012 for example, the AU approved a business plan to increase the output of the local pharmaceutical industry.

    “Focusing on three things that Africa needs to do urgently - decrease dependency by growing African investments, deliver quality-assured drugs sooner to the people who need them, and leadership - the blueprint will help African countries to build long-term and sustainable solutions,” stated Mustapha Sidiki Kaloko, the AU Commissioner of Social Affairs, in a statement, ahead of the Abuja +12 summit. “Africa’s health and our prosperity are inextricably linked.”

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  • No consensus on implementation of cessation clause for Rwandan refugees

    The future of tens of thousands of Rwandan refugees living in Africa remains uncertain nearly two weeks after the 30 June deadline recommended by the UN Refugee Agency (UNHCR) for the discontinuation of their refugee status. 

    UNHCR has recommended countries invoke the “ceased circumstances” clause for Rwandans who fled their country between 1959 and 1998. The cessation clause forms part of the 1951 Refugee Convention and can be applied when fundamental and durable changes in a refugee’s country of origin, such that they no longer have a well-founded fear of persecution, remove the need for international protection. Both UNHCR and the Rwandan government have pointed out that since the end of the civil war and the 1994 genocide, Rwanda has been peaceful, and more than three million exiled Rwandans have returned home. 

    However, many of the estimated 100,000 Rwandans who continue to live outside the country - mainly in eastern, central and southern Africa - remain unwilling to repatriate, citing fear of persecution by the government. Refugee rights organizations have also warned that human rights abuses by the current government have caused a continued exodus of Rwandan asylum seekers.

    “We have been told time and again that Rwanda is safe and there might be some truth in that. However, one wonders why the call for cessation is happening while there are still people who are seeking asylum,” Dismas Nkunda, co-director of the International Refugee Rights Initiative, told IRIN.

    Differing views on protection

    So far only four countries in Africa - Malawi, the Republic of Congo, Zambia and Zimbabwe - have followed UNHCR’s recommendation to invoke the cessation clause, a fact that, according to Nkunda, “speaks volumes” about how different African countries view this group’s need for protection. 

    In an article in the July issue of a newsletter produced by the Fahamu Refugee Programme, a refugee legal aid group, John Cacharani and Guillaume Cliche-Rivard accused UNHCR of pressuring states to follow its recommendation, “holding hostage the fate of more than 100,000 Rwandan refugees who, of their own volition, have decided not to repatriate, yet continue to fear the end of their international protection.”

    "One wonders why the call for cessation is happening while there are still people who are seeking asylum"

    But in response to questions from IRIN, Clementine Nkweta-Salami, UNHCR regional representative for southern Africa, emphasized, “It is the responsibility and prerogative of states to declare the cessation of refugee status.” She said UNHCR’s role was only to make a recommendation based on its analysis of conditions in the country of origin and how they relate to the refugees’ reasons for flight. 

    That only four states had agreed to implement cessation as of 30 June did not in any way indicate that UNHCR’s recommendation was premature, she insisted. At an April 2013 meeting of host states held in Pretoria, “some states underscored that, for various legal, logistical, practical or other considerations, they are not in a position to apply the cessation clauses by 30 June 2013. Others have specified that, for the time being, they will concentrate on taking forward other components of the [comprehensive durable solutions] strategy, namely voluntary repatriation and local integration”.

    Preparing for returnees

    Meanwhile, Rwandan officials say the country is prepared to receive the refugees, and has developed a comprehensive plan to repatriate and reintegrate returnees. So far this year, an estimated 1,500 Rwandans have returned home following government-operated “go-and-see” programmes.

    “The conditions that forced them to flee no longer exist,” Rwandan High Commissioner to Uganda, Maj Gen Frank Mugambagye, told IRIN. “The government has established three transit centres which are well equipped with shelter, education and health services. These people will be given packages for three months. We have mobilized the local authorities to receive and help them reintegrate into the communities.”

    He added that for Rwandans seeking local integration in host countries rather than repatriation, the government will issue national identity cards and passports that will allow them to retain their nationality.

    IRIN spoke to government officials and UNHCR representatives in several of the African countries that are hosting significant numbers of Rwandan refugees to find out how they are handling the cessation clause.

    Countries invoking the clause

    Malawi 

    Although Malawi is among the countries said to be invoking the cessation clause, the process is still in its early stages. According to George Kuchio, UNCHR representative for Malawi, the first step of informing the 660 refugees covered by the clause of their right to apply for exemption has just been completed, and the government has yet to decide what options it will offer for local integration. 

    “If there are people who still have compelling reasons for not returning, they’ll be given the opportunity to have their say,” Kuchio told IRIN. 

    However, the principal secretary in the Ministry of Foreign Affairs and International Cooperation, Besten Chisamile, was quoted in the local media as saying, “The situation in Rwanda stabilized long ago, and there is every reason for the remaining ones [refugees] to return to their home. We are working with UNHCR on ensuring we repatriate them.”

    Malawi is host to a further 500 Rwandan asylum seekers whose refugee status has yet to be determined but who are unlikely to be covered by the cessation clause.

    Republic of Congo

    In June, the Republic of Congo announced that it would invoke the cessation clause for the 8,404 Rwandan refugees it hosts. They will now have to choose between voluntary repatriation, naturalization or applying for exemption.

    "Those who fail to choose one of these options will be subject to the laws pertaining to foreigners' entry, residence and departure," said Chantal Itoua Apoyolo, director of multilateral affairs in the Ministry of Foreign Affairs and Cooperation.

    Juvenal Turatsinzé, 49, who is among 2,500 Rwandan refugees living in Loukolela, in the northern Cuvette region, said: "We've been worried since hearing about the loss of our status. We'd love to go back to Rwanda, but the conditions that would allow us to do that willingly are not yet in place.

    "There are often arbitrary arrests in Rwanda. There is no freedom of expression, no democracy. We don’t think the time is right for voluntary repatriation... There are no security guarantees there."

    He added, "I have already put in my request for naturalization as a Congolese citizen.”

    Zambia 

    Zambia hosts 6,000 Rwandan refugees, about 4,000 of whom are covered by the cessation clause. According to Peter Janssen, a senior protection officer with UNHCR, the majority of these have applied for exemption, but most have been rejected. “Officially their refugee status has ceased, but the government has made it known that there will be a possibility for people to acquire an alternative status,” said Janssen. 

    “That still needs to be fine-tuned, but it is positive because, until a while ago, it looked like people would be left without a status and have to return to Rwanda.”

    Zimbabwe 

    Zimbabwe, which is also following the recommendation to invoke the cessation clause, is further along with the process.

    Prior to 30 June, 72 cases comprising over 200 individuals who left their country before 1999 were identified as falling within the scope of the clause, out of about 800 Rwandan refugee and asylum seekers living in the country. Those unwilling to repatriate who qualify for local integration, either through marriage to a local or through employment in certain professions, such as lawyers, doctors and teachers, have been encouraged to apply for permanent residence or work permits. However, they cannot be issued permits until they are in possession of Rwandan passports, which the Rwandan government have yet to issue. 

    The majority who do not qualify for local integration but do not want to return home have already applied for exemption from the cessation clause. According to Ray Chikwanda, a national protection officer with UNHCR in Zimbabwe, only six out of the 60 cases that applied were successful. Those who were rejected have been encouraged to appeal.

    “Our reading of the situation is that until there is a political consensus in the region [about invoking the cessation clause], these appeal decisions are unlikely to be released,” said Chikwanda. 

    Countries not invoking the clause

    Democratic Republic of Congo 

    The government of the Democratic Republic of Congo (DRC) has said it will not immediately invoke the cessation clause for the estimated 47,500 Rwandan refugees it hosts, but will instead adopt a phased approach. 

    Rwandan refugees will first be identified, registered and asked if they want to return. Following a meeting in October, a repatriation plan will be drawn up. Julien Paluku, governor of North Kivu Province, where most of the Rwandan refugees have settled, told the Associated Press that refugees who do not want to return home will be allowed to apply either for a residence permit or for Congolese nationality, which may be granted on a case-by-case basis.

    UNHCR has helped some 8,000 Rwandans return home from DRC since 2012 and says it will continue to assist with repatriation.

    Uganda

    Out of 14,811 Rwandan refugees living in Uganda, about 4,100 individuals fall within the scope of the cessation clause. However, the government has not invoked cessation because ambiguities in the country’s Immigration Act and Constitution would hinder local integration - an alternative to voluntary repatriation that host states are supposed to make available as part of the comprehensive solutions strategy. 

    For example, Article 12 of the Constitution bars the children of refugees from qualifying for citizenship, while sections of the Immigration Act effectively preclude refugees from qualifying for permanent residence or work permits.

    “The government of Uganda has declared that, pending the resolution of the [legal] ambiguities and the charting of a way forward towards implementing local integration and alternative legal status, they will not be invoking the ceased circumstances clause,” Esther Kiragu, UNHCR assistant representative for protection, told IRIN. “They will, however, announce a date for invocation in due course once the road map is clearly drawn.” 

    South Africa 

    At a ministerial meeting convened by UNHCR in Pretoria in April 2013, South Africa’s Minister of Home Affairs Naledi Pandor said, “The position of the UNHCR in relation to Rwanda has created anguish and uncertainty among the refugee community in South Africa”, suggesting that much work remained to be done to clearly articulate the reasons for the clause being invoked. 

    The South African government has since informed UNHCR that it will conduct its own research into existing conditions in Rwanda and consult extensively with the local Rwandan community before making a decision on invoking the cessation clause. 

    A local Rwandan refugee leader, who did not wish to be named, commended South Africa’s Department of Home Affairs for “welcoming Rwandan refugee leaders, listening to their concerns and fears of being returned to Rwanda, and sharing with refugees the government of South Africa’s position around the cessation clause”. 

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  • Countering Africa’s green revolution

    Civil society groups are taking on the policies of the Alliance for a Green Revolution in Africa (AGRA), which promotes the use of genetically modified (GM) crops and Green Revolution technologies.

    They argue that GM and Green Revolution practices - those aimed at increasing developing countries’ crop yields through specific innovations - will, in the long run, be detrimental to ecosystems across the continent. Earlier this month, a coalition of almost 60 civil society groups across Africa came out to protest AGRA ahead of the G8 Summit in London.

    “Green Revolution technologies benefit relatively few farmers, often at the expense of the majority. These technologies produce concentration of land ownership, increasing economies of scale (production has to be at a large scale to get into and stay in markets), and a declining number of food-producing households in a context of limited other livelihood options,” they said in a letter sent to AGRA’s president, Jane Karuku.

    They also believe that the intellectual property of many plant types may be transferred to large multinational corporations as part of Green Revolution practices.

    “Private ownership of knowledge and material resources (for example, seed and genetic materials) means the flow of royalties out of Africa into the hands of multinational corporations,” they said.

    Technology for the needy

    AGRA was founded in 2006 through a partnership between the Rockefeller Foundation and the Bill and Melinda Gates Foundation. It works with smallholder farmers across the continent by giving them microfinance loans, hybrid seeds and fertilizers to increase their crop yields. In this way, AGRA hopes to alleviate hunger and poverty across the continent.

    The Green Revolution
    A period from the 1940s until the 1970s when, through the use of new technologies such as irrigation, improved seed, fertilizers and pesticides, as well as an economic environment that supported industrial agriculture, a massive increase in agriculture output in developing countries (particularly in Asia) occurred. Norman Borlaug, who won the 1970 Nobel Peace Prize for improving agricultural technologies, is widely considered as the “Father of the Green Revolution”, and is often credited with saving a billion lives through his innovations.

    “There are millions of skilled farmers in Africa who simply need the tools,” said Sir Gordon Conway, a scientist and author of One Billion Hungry: Can We Feed the World?, speaking by video message at an agriculture conference in Nairobi. In his book, he argues that both microcredits - to help smallholder farmers - and macro-investment are needed for farmers to benefit from Green Revolution technologies.

    He believes traditionally marginalized groups - such as women, youth and ethnic minorities - will benefit from the use of new agricultural technologies targeted at smallholders, and that the total number of hungry will be drastically reduced. For example, Conway calculates that by ensuring female farmers have access to the same productive resources as men, the number of undernourished people globally could be reduced by 100 to 150 million.

    “If we are going to feed some 9 billion people by 2050 and do that in environmentally sustainable ways and in the face of climate change, then we are going to need access to the very best that modern science can offer,” said Peter Hazell, a leading agriculture expert who has worked with the World Bank and International Food Policy Research Institute. “All technologies have risks (e.g., cell phones may cause brain cancer) but as these things go, GM crops seem to be doing rather well.”

    Debt and expense

    But civil society groups disagree. “AGRA aims to move farmers in exactly the wrong direction, by encouraging them to take on debt in order to use more agrochemicals and corporate hybrid seeds,” Teresa Anderson of the Gaia Foundation told IRIN.

    “For many years, NGOs across Africa have worked with farmers to encourage them to stop using fertilizers and pesticides, and to improve their soil health, their ecosystems, their seed diversity and their food sovereignty. AGRA is undoing a decade of agro-ecological progress in Africa by getting farmers into debt and back on the agribusiness treadmill,” she said.

    "World over, the same companies that own the seeds also own the chemicals; it is a mafia-like cartel that has proven to be ruthless towards poor small-scale farmers"

    Genetically modified crops are allowed to be used commercially in only three countries in Africa - Egypt, Burkina Faso and South Africa - according to Gareth Jones of the African Centre for Biosafety. Of these countries, only South Africa uses them extensively. Jones believes it is a mistake to think their model could be replicated elsewhere across the continent.

    “The legacies of colonialism and then apartheid left South Africa with a well-resourced and supported white commercial farming sector, many of whom (including maize, cotton and soya farmers) cultivate on large pieces of land, using modern inputs,” he told IRIN via email. “Projects to get smallholder farmers in South Africa to grow GM seed such as in the Makhathini Flats, though much heralded by the biotechnology industry at the time, have been largely unsuccessful.”

    The Makhathini Flats project, which started to grow cotton in 2002, ended after just five years. High loan repayments on the seed and poor climate meant that smallholders were unable to afford to grow the crop. “There is no reason to believe that the introduction of GM seeds would have different results in the rest of the continent,” Jones said. He accuses initiatives such as AGRA of spurring the push for greater use of genetically modified crops on the continent.

    In September 2012, over 350 civil society organizations wrote a statement protesting AGRA’s agricultural approaches.

    “We are concerned that as a result of the AGRA seed program, the rich pool of African indigenous seed varieties will become the property of corporate seed companies, displacing and reducing farmers’ access to indigenous varieties, and locking them into an expensive high-input agricultural system,” they said. Signatories included the African Biodiversity Network, the African Centre for Biosafety, Kenya Biotechnology Coalition, Participatory Ecological Land Use Management, and ActionAid Tanzania and Uganda.

    These groups cite a 2009 study by the International Assessment of Agricultural Knowledge, Science and Technology for Development, conducted with the UN Food and Agriculture Organization (FAO), UN Environmental Programme, World Bank and others, which concluded that industrial agriculture is not likely to be majorly beneficial in mitigating hunger and poverty.

    Patents or people?

    In 2009, the three largest seed companies controlled more than a third of the global seeds market, according to a 2011 study commissioned by the Commission on Genetic Modification.

    Under most current legal frameworks, farmers growing patented seeds are not allowed to use the seeds naturally produced from their crops.  Large firms such as Monsanto routinely sue farmers who propagate their patented crops.

    “World over, the same companies that own the seeds also own the chemicals; it is a mafia-like cartel that has proven to be ruthless towards poor small-scale farmers,” Ruth Nyambura of the African Biodiversity Network told IRIN.

    But Karuku, AGRA’s president, insists the organization tries to collaborate with local partners to develop new breeds of seed. In Kenya, she said, they work with the Kenya Agricultural Research Institute, which then owns the patents to the seeds, not large multinational corporations.

    She also pointed to growing populations and said that scarcity of land meant that African farmers needed to increase the productivity of their crops. With 239 million undernourished people in Africa, according to the FAO’s State of Food Insecurity in the World 2012, she said there is a need for strong action. “If we don’t do anything, it will be way more than that,” she said. “We should be worried.”

    “Nobody forces farmers to grow GM crops, so if they prove less profitable than the alternatives, farmers will simply stop growing them,” noted Hazell. “Farmers have been able to reduce the use of pesticides on many GM crops with significant environmental and health benefits.”

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  • Planning for non-surgical male circumcision

    In May, the UN World Health Organization (WHO) announced the prequalification of PrePex, the first non-surgical device for adult male circumcision. Compared to surgical circumcision, the device has fewer complications and is easier and quicker to use, allowing lower-cadre medical workers to be trained to perform the procedure.

    Randomized, controlled trials in 2006 found that male circumcision reduced a man's risk of contracting HIV through vaginal intercourse by as much as 60 percent.

    Fourteen African countries in eastern and southern Africa plan on circumcising a total of 20 million men by 2016 in an effort to curb the transmission of HIV. A number of these countries are lagging behind on their targets, and feel the PrePex device will give their programmes a much-needed boost, while others are more cautious.

    Studies continue

    Malawi's Ministry of Health plans to adopt and roll out the PrePex device once it has completed safety and acceptability studies targeting 2,000 clients in the districts of Nsanje, Lilongwe and Mulanje. The studies are due for completion in August.

    "We hope that the results will assist us to scale-up the services, because already more males have been asking for this device," said Henry Chimbali, health promotion and communications officer for HIV prevention and behaviour change at the Ministry of Health. "It is also most likely going to reduce costs of providing VMMC [voluntary medical male circumcision], because currently we use VMMC disposable kits, as well as costs of human resource and also perhaps adverse events."

    As of March 2013, a total of 42,700 Malawian men had been circumcised since the October 2011 start of the programme - an estimated 350,000 adult males were circumcised prior to the programme. The ministry aims to reach some 1.8 million adult males by 2015.

    In Kenya, the Male Circumcision Consortium (MCC), in collaboration with the National AIDS and STIs (sexually transmitted infections) Control Programme (NASCOP) and the Nyanza Reproductive Health Society (NRHS), welcomed the approval of PrePex, but called for more studies to assess its acceptability and safety in local healthcare settings. The organizations are currently conducting the second phase of study to assess the efficacy of PrePex-assisted male circumcision among 425 men in routine health-care settings in western Kenya's districts of Kisumu and Rachuonyo; results are expected by September.

    "The outcome will provide the government with information and recommendations on the adoption of this device,” MCC project manager Mathews Onyango told IRIN. "There are some issues that have not been addressed by the WHO prequalification, such as cost, acceptability... These might vary from country to country and, thus, like in Kenya, our study will address its safety and acceptability, especially within a larger population."

    "Different countries have varying needs and they would need to ensure that they introduce the non-surgical devices to fit within their context," he added.

    The first phase of the Kenyan study assessed 50 men to ascertain the safety of the device in Kisumu. The committee of independent experts reviewed the results, found no safety concerns, and recommended that the study proceed to the second phase.

    Kenya's programme aims to reach 80 percent of men between 15 and 49 years old - some 860,000 men. Since the programme was launched in 2008, it has reached more than 420,000 men.

    In Rwanda, the government plans to roll out the device and scale it up to health facilities, following its successful trials at Nyamata and Kanombe military hospitals. Officials say it saves both time and money. Following the research, Rwanda announced in 2011 that it would be rolling out its VMMC programme using PrePex.

    "We believe that the PrePex is the only circumcision method that will allow us to meet the goal of [circumcising] over 1.5 million men in two years," Vincent Mutabazi, lead investigator in the Rwandan PrePex studies. "Several campaigns and numerous training[s] of new PrePex healthcare providers have taken place. Some 5,000 men were circumcised outside of [the] clinical environment in Rwanda since [February 2012]... In the upcoming months, more than 200,0000 procedures are expected."

    “Safer, faster and reduces discomfort”

    In Botswana, the health ministry, in collaboration with the US Embassy, the African Comprehensive HIV/AIDS Partnership (ACHAP) and Jhpiego, an affiliate of the US's Johns Hopkins University, are carrying out pilot research at Nkoyaphiri Clinic, Mogoditshane and Block 8 Clinic in the capital, Gaborone. The study targets 1,000 HIV-negative men aged 18 to 49 to evaluate the effectiveness and safety of PrePex; so far 330 adults have been circumcised in the study, which ends in September.

    "The results of this study will determine its roll out in the country. There is no doubt that the PrePex and any other acceptable and safe circumcision device will boost circumcision not only in Botswana but in all countries involved in the programme," said Benjamin Binagwa, VMMC programme manager at ACHAP. "The advantage of having these devices is that they can be used by other health staff other than doctors."

    He continued: "Any device that makes a surgical procedure safer, faster and reduces discomfort or pain is always a welcome component of the health service. From current experiences with the PrePex, the device provides the aforementioned to a great extent. Therefore its incorporation in the Safe Male Circumcision programme... is a welcome development."

    "Training of both nurses and doctors on use of the PrePex device is less technically demanding since it does not involve use of injections to prevent pain, there is no cutting of live tissues and thus no need to control bleeding, and no need for stitches," Adrian M Musiige, safe male circumcision programme manager for Jhpiego, told IRIN. "The same technical properties of the device also address some important barriers to male circumcision for some men who still associate conventional male circumcision surgery [with] pain because of the involvement of injections, surgical blades, some bleeding and stitches."

    A total of 75,604 men aged 13 to 49 years have been circumcised in Botswana since the campaign was launched in 2009; the national target is 385,000 men by 2016.

    Operational challenges

    In Tanzania, where some 415,000 people out of the targeted 2.8 million had been circumcised as of March 2013, participants in one ongoing study in the country's central-western region of Tabora are already showing high levels of acceptability. But rolling out the procedure using PrePex may face operational challenges.

    "I am definitely sure that the use of device in Tanzania will be approved," said Jackson Lija, head of biomedical prevention in Tanzania's Clinical STI, HIV and Circumcision Services. "Our main problem to scale it up will be funding. We are struggling. Currently, we have a funding problem that is affecting the conventional male circumcision. PrePex is likely also to be affected with the same."

    In South Africa, the health department plans to have "formal talks" with traditional leaders about the possibility of introducing a Prepex device to circumcision ceremonies, Thobile Mbengashe, national HIV director, told the Mail & Guardian.

    He said the country was behind on its male circumcision targets - 4.3 million men by 2016 - and was "unlikely to achieve its goals if additional modalities that can help to scale up the medical circumcision process are not introduced".

    Ugandan officials say WHO prequalification of PrePex was anxiously awaited and will boost the country's programme, which has, since 2010, reached 380,000 men - a fraction of the 4.2 million men it aims to have circumcised by 2015.

    "The National Task Force [on safe male circumcision] and the ACP [AIDS Control Programme] welcomes the approval and will go through the process of including its use in the guidelines," said Alex Ario, programme manager for the ACP. "The device will definitely lead to increased access and acceptability of safe male circumcision among young males."

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    Planning non-surgical circumcision
  • Digital jobs offer skills, promise to Africa's unemployed youth

    Although Africa’s economy has expanded rapidly in recent years, it has not kept pace with the growth of its youth population or their need for jobs. 

    With almost 200 million people between 15 and 24 years old - a figure that is set to double by 2045, according to the African Economic Outlook’s (AEO) 2012 report - the continent has the youngest population in the world. Yet despite the increasing percentage of Africa’s young people with secondary and tertiary educations, many find themselves unemployed or underemployed in the informal economy. Part of the problem, according to the AEO study, is a mismatch between the skills young jobs seekers have to offer and those that employers need. 

    The world’s increasingly digitalized economy needs workers with the skills to capture and manage the vast amounts of data it generates. With appropriate training, such tasks can be performed anywhere in the world. Data generated by a high-tech company in Silicon Valley, for example, can be processed by youth with smartphones or tablets living in a slum in Nairobi, Kenya. This means that digital work could potentially alleviate the unemployment and poverty hampering development in many African countries.

    Both the private and humanitarian sectors are starting to recognize this potential and find ways to harness it.

    Skills for the future

    The Rockefeller Foundation recently launched Digital Jobs Africa, a seven-year, US$83 million initiative to improve the lives of one million people in six African countries through digital job opportunities and skills training. 

    Eme Essien Lore, the foundation’s Nairobi-based senior associate director, explained that having identified youth unemployment as one of Africa’s most pressing problems, the organization was looking for ways to help young people on the continent gain sustainable, long-term job opportunities. 

    “The reason digital employment really rose to the top for us was because we saw the skills they get from these kinds of jobs as a springboard to other types of employment,” she told IRIN. “We know young people take time to figure out what they want to do. Also, we don’t know what the future labour market is going to look like. So we thought this was a very important sector because it develops skills they can use whether they stay in the digital economy or move into other sectors.” 

    The six focus countries - Egypt, Ghana, Kenya, Nigeria, Morocco and South Africa - share particularly high youth unemployment rates and have rapidly developing information and communications technology (ICT) infrastructures. Some, such as Nigeria and South Africa, have booming ICT sectors in need of labour, while others, such as Morocco, are well-placed to meet demand from Europe and the US, said Lore. 

    Winnie Mwihaki, 24, is among 500 Kenyan youths from poor backgrounds recruited by one of the Rockefeller Foundation’s grantees - San Francisco-based non-profit Samasource. Globally, the company has connected an estimated 3,700 young people in nine countries to paying work and hopes to expand this number to 5,000 by the end of 2013. 

    Samasource secures data- and content-processing jobs from its US-based clients, and then uses its specially developed software to break these large digital projects down into small computer-based tasks it calls “microwork”. This work is then distributed to local partners that are responsible for recruiting, training and managing employees. 

    Unlike most companies in the business process outsourcing (BPO) and information technology outsourcing industry, Samasource only employs people living below the poverty line. Workers must also be between 18 and 30 years old, and preference is given to women, who are less likely to have access to formal employment. 

    "We can bring someone in with virtually no experience, and in a matter of weeks they can start doing small tasks on a computer"

    “Part of the criteria is that people need to be literate in English,” added Lauren Schulte, director of marketing and communications at Samasource. “They don’t have to have any computer skills. We can bring someone in with virtually no experience, and in a matter of weeks they can start doing small tasks on a computer.”

    With her monthly salary of 13,000 shillings [$149], Mwihaki is able to assist her mother, who had been struggling to care for their family of six. “Because of the money I earn from here, I am now able to help my mother [and] to also be a breadwinner in the family,” Mwihaki told IRIN.

    Mwihaki grew up in Korogocho, a sprawling slum in Nairobi, where crime is commonplace. She was unable to proceed to college after secondary school because her parents could not afford it.

    “Now I will use part of what I earn from this job to sponsor myself through college,” she said. 

    A new trajectory

    Samasource is not the only company targeting disadvantaged people in low-income areas with digital employment. Another Rockefeller Foundation grantee, Digital Divide Data, operates on a similar principle and employs more than 1,000 people in Cambodia, Kenya and Laos. Both companies are considered pioneers of impact sourcing, which the Rockefeller Foundation defines as “the socially responsible arm of the BPO and information technology outsourcing industry”.

    A relative newcomer to the sector, and another Rockefeller Foundation grantee, is the Impact Sourcing Academy (ISA) in Johannesburg, South Africa. ISA combines a training and job placement programme with a fully functional call centre that gives its students the opportunity to obtain practical work experience while earning enough money to help support their families. 

    “We’re not so much interested in just giving them a job as a call centre agent,” said ISA head Taddy Blecher. “We really want to make sure they’re doing part-time studies while they’re working, getting access to more knowledge and training so they can move into higher-level jobs.”

    Once graduates are fully employed and earning a decent salary, they are encouraged to fund another student from a similar background. Using this model, the academy is already about 65 percent self-funded and aims to be completely self-funded in the future.

    Blecher described the Rockefeller Foundation initiative as “a massive opportunity” for South Africa, given the need for skilled labour to work in its booming BPO sector and its 51 percent youth unemployment rate. “In a short period of time, you can bring a family out of poverty and put them on a whole new trajectory,” he told IRIN.

    Opening doors

    For now, evidence that impact sourcing really can lift families out of poverty is limited to the small studies the Rockefeller Foundation has conducted with Samasource and Digital Divide Data. “What we want to do next is really measure the impacts on a household level,” said Lore. “Anecdotally, we’re quite convinced, but we need to work on measuring over the next seven years.”

    The Rockefeller Foundation does not stipulate a minimum wage that its grantees must pay, and the line between a living wage and an exploitatively low wage can be a fine one. “This is a sector where companies’ first priority is really around cost savings,” acknowledged Lore. “If you take the example of someone living in a slum, [a job like this] won’t get them into a nicer neighbourhood. But it might be able to buy food for the family and get younger siblings into school,” she said.

    She added that the demand for young people with these skills is such that they are often poached by rival companies offering slightly higher salaries. “We’ve seen that when people move from these jobs, usually after about two years, they go on to better jobs. You rarely see people sitting in these types of jobs indefinitely.”

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    Digital jobs for Africa’s youth
  • Southern Africa cracks down on TB in mines

    South Africa's gold mines are estimated to have the highest number of new tuberculosis (TB) cases in the world, making the disease a leading export to neighbouring countries. IRIN takes a look at the declaration meant to change this situation.

    In August 2012, heads of state from the Southern African Development Community (SADC) agreed to sign the SADC Declaration on TB in the Mining Sector, following endorsements by their national ministers for health, labour and justice.

    According to Swaziland’s Minister of Health, Benedict Xaba, he and South African Health Minister Aaron Motsoaledi, and Lesotho’s former Minister of Health, Mphu Ramatlapeng, began pushing for the declaration in 2010. Xaba, the son of a miner, admitted that he has lost members of his family to TB.

    South Africa is supporting the declaration and related initiatives, including a 1,000-day campaign to meet TB and HIV targets in the region, but the country has not yet officially signed the declaration, according to Lynette Mabote, regional HIV, TB and human rights advocacy team leader at the AIDS Rights Alliance of Southern Africa (ARASA), a civil society body that has been heavily involved in the declaration and advocacy around TB in mines.

    How big a problem is TB in the mines?

    The South African Department of Health estimates the country's gold mining industry has the highest number of new TB cases annually in the world - up to 7,000 cases per 100,000 people per year - according to its TB Strategic Plan for South Africa 2007-2011.

    Data collected from autopsies on formers miners have also shown a prevalence of latent and undiagnosed TB as high as 90 percent, according to a 2009 study.

    Why is TB a problem on the mines?

    While many people may carry latent TB infection, active TB infection will usually only occur in a small number of them. However, those with compromised immune systems and HIV co-infection are up to 30 times more likely to develop active TB.

    In South Africa, where HIV prevalence is about 18 percent, many miners are no doubt living with HIV but face additional occupational risks, according to Rodney Ehrlich from the Centre for Occupational and Environmental Health Research at University of Cape Town. He describes these risks as:

    • A high burden of silicosis, a respiratory disease that develops due to inhaling silica dust during the mining process and could be viewed as an immune deficiency illness;

    • Silica dust load in the lungs and previous lung damage;

    • Poor living conditions, including overcrowding;

    • Circular migration between neighbouring countries and South Africa, leading to interrupted TB/HIV treatment and poor access to care.

    The mines have also not escaped the growing epidemic of drug-resistant tuberculosis, which in the absence of wide access to molecular testing has not only been harder to diagnose but also to treat. Research released in 2010 estimated that that almost four percent of the national multidrug-resistant TB (MDR-TB) burden, where TB is found to be resistant to both the commonly used first-line drugs isoniazid and rifampicin, may reside on the country's mines.

    Falling employment figures indicate that the mines now employ considerably fewer miners than in the late 1980s, Ehrlich added. Commodity prices dropped in 2008 and 2009, leading to further lay-offs, which may greatly complicate addressing the needs of affected miners who are no longer employed and will be relying on already stressed health systems in rural areas or home countries for treatment.

    What did countries commit to in the declaration?

    Countries agree to taking tangible actions like establishing independent mining ombudsmen to handle health-related complaints, harmonising treatment protocols related to addressing HIV, TB and silicosis on the mines, and - controversially for some - classifying TB and silicosis acquired in the mines as such.

    At a meeting of SADC health ministers in April 2012, mining companies were reluctant to classify TB and silicosis, a respiratory disease linked to exposure to silica dust produced during gold mining, as occupational diseases. In addition, the responsibility of mining companies to ensure treatment of mine workers with these diseases even after employees have left the company was a sticking point, according to David Mametja, head of South African Department of Health's TB Control and Management Programme.

    The document now calls on employers to take full responsibility for the management of all occupational diseases, including TB associated with silicosis post-employment.

    However, activists have cautioned that national legal frameworks must be changed to ensure TB is treated as an occupational disease. This would have to include provisions for mine workers who have left employment but later developed active TB.

    "The history around the issue of occupational health is littered with companies not taking responsibility," activist Gregg Gonsalves told IRIN at South Africa's 2012 TB conference. "It has to be about regulation - states have to regulate their business practices. Only in jurisdictions where that has happened has that problem been solved. It has to come through statues and regulation."

    The declaration also calls for the development of a minimum package of services to facilitate cross-border care.

    "Our referral systems do not take into consideration the dynamics that are experienced in the region as far as TB in the mines is concerned," said Stephen Sianga, SADC secretariat director for social and human development and special programmes. "There are challenges regarding standard treatment, both between countries and within countries, where you find that the system used in the mines is different to that used in the public health system."

    While TB treatment regimens across the SADC are largely already harmonized, activists have long been calling for the same to be done regarding HIV treatment. This would also facilitate the use of health passports, which would enhance cross-border care, as would the standardization of a minimum package of HIV, TB and silicosis services.

    What happens next?

    In the run-up to the August 2012 signing of the declaration, civil society groups like ARASA called for a five- or 10-year action plan, with concrete steps to be taken to implement the declaration. Now, SADC will be looking to operationalize the declaration at national level through a code of conduct.

    According to Mabote, the draft code was dismissed by ministers of health at a SADC meeting in Angola in July 2012. An SADC technical working group reworked the document in November, but a final version of the document has yet to be released.

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    TB crisis on Southern Africa's mines
  • African migrants pay high prices to send money home

    New data from the World Bank has revealed that African migrants pay more to send money home to their families than any other migrant group in the world. 

    While South Asians pay an average of US$6 for every $100 they send home, Africans often pay more than twice that - and in South Africa, which has the highest remittance costs on the continent, nearly 21 percent of money set aside for family members back home is spent on getting it there.

    With an estimated 120 million Africans depending on remittances from family members abroad for their survival, health and education, the World Bank argues that high transaction costs are cutting into the impact remittances can have on poverty levels. 

    To address this, the Bank is partnering with the African Union Commission and member states to establish the African Institute for Remittances, which will work towards lowering the transaction costs of remittances to and within Africa. It will also leverage the potential of remittances to influence economic and social development. 

    “The World Bank’s approach supports regulatory and policy reforms that promote transparency and market competition and the creation of an enabling environment that promotes innovative payment and remittance products,” said Marco Nicoli, a finance analyst at the Bank who specializes in remittances.

    Costly and difficult

    Owen Maromo, a 33-year-old farmworker who lives in De Doorns, a grape-growing region in South Africa’s Western Cape Province, told IRIN that his family in Zimbabwe relies on the money he sends home every month. 

    “I’ve got a house there and I need to pay rent. I’m also taking care of my youngest brother - since my mum died four years ago - and my wife’s family.

    “Almost every Zimbabwean here is budgeting to send money back home,” he added. “If they could, they would send money home on a weekly basis.”

    In a 2012 report by the Cape Town-based NGO People Against Suffering Oppression and Poverty (PASSOP), interviews with 350 Zimbabwean migrants revealed some of the reasons sending money home from South Africa is both costly and difficult.

    "There are a lot of people whose money just disappears. Almost on a daily basis, you hear those stories" 

    A key impediment is the stringent regulatory framework that governs cross-border transfers from South Africa. Exchange control legislation, for example, requires money transfer operators (MTOs) to partner with a bank. According to PASSOP, this has had the effect of stifling competition that would likely reduce transaction costs.  

    Legislation intending to counter money laundering and terrorist financing requires that customers provide proof of residence and proof of the source of their funds before they can access financial services. This effectively excludes the many migrants living in informal settlements and those who are paid in cash. 

    PASSOP found that even among migrants who do have access to banks and MTOs like Western Union and MoneyGram, many lack the financial literacy to make use of them. 

    “Some have just come from rural areas in Zimbabwe, so it takes time for them to know about such things,” said Maromo, adding that lack of documentation was another major obstacle. “If you’re undocumented, you can’t go through the banks.”

    Three-quarters of the Zimbabwean migrants interviewed by PASSOP relied instead on “informal” remittance channels, such as giving money or goods to bus drivers, friends or agents to send home. This is often not much cheaper than using banks or MTOs, and it is significantly riskier. Of the respondents who used such methods, 84 percent reported negative experiences, including theft of their money, loss or destruction of their goods and long delays in remittances reaching intended recipients. 

    Maromo relayed his own experience sending money home through an agent who charged a 15 percent commission to channel the money through his South African bank account before handing it over to Maromo’s relatives in Zimbabwe. “Some time ago, I nearly lost 2,000 rand ($225) because I deposited it in [the agent’s] account and he was saying he didn’t have it and giving excuses. In the end, we got the money, but it cost us nearly 1,000 rand ($113) in airtime calling Zimbabwe,” he said.

    “Some are using bus drivers or those people who are going home, and you have to trust them because you’re desperate, but there can be a lot of problems,” he added. “There are a lot of people whose money just disappears. Almost on a daily basis, you hear those stories.”

    Lowering transaction fees

    Now, Maromo uses a UK-based online transfer service called Mukuru.com, which is popular with many Zimbabweans living overseas. The proof of residence and source of funds requirements are the same as for traditional MTOs, but the site charges 10 percent on transfers from South Africa to Zimbabwe - less than most banks. 

    The South African Reserve Bank and the treasury have committed to bringing the cost of remittances down to 5 percent by relaxing regulations for smaller money transfers, negotiating with regulators in the Southern African Development Community on exchange control regulations, and removing the requirement that MTOs partner with banks.

    However, at the time of writing, the Reserve Bank has not yet responded to questions from IRIN about how these changes will be implemented and within what timeframe.

    Rob Burrell, director of Mukuru.com, said achieving the 5 percent target would be tough considering the numerous costs that MTOs have to cover, including fees paid to the companies that collect and pay out the money, the cost of supporting transactions through a call centre, and licensing and reporting requirements. “We would need everyone pulling together,” he said.

    Burrell noted that less stringent laws governing MTOs in the UK mean more competition but much weaker anti-money laundering controls. To operate in South Africa, Mukuru.com has to comply with the regulation that they partner with a local banking license holder.

    “In the UK, it’s easier to obtain your license,"he told IRIN. "There are 4,000 [MTOs operating in the UK] compared to 12 in South Africa, but the downside is that it’s very difficult to police them all.” 

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    Africa's high remittance costs
  • Solving statelessness in Southern Africa

    Frederik Ngubane was born in South Africa to South African parents 22 years ago but, lacking any proof of his origins or nationality, he lives a shadowy, marginal existence. He cannot travel, study or secure formal employment and has lost count of how many times he has been arrested for being undocumented.

    Not considered a national by South Africa or by Kenya or Uganda - the two countries where he grew up - Ngubane is stateless, a predicament he shares with an estimated 12 million people worldwide, according to the UN Refugee Agency (UNHCR), which is mandated with trying to reduce that figure. 

    Nationality confers a host of rights that stateless individuals cannot access, from education and healthcare to the ability to register a marriage or a birth. As a result, statelessness is often passed from one generation to the next. 

    As early as 1954, the international community, under the auspices of the UN, adopted the Convention Relating to the Status of Stateless Persons, which defined who is a stateless person and established a framework for their international protection. A second international convention adopted in 1961 focused on reducing cases of statelessness], primarily by requiring participating states to grant citizenship to children born on their territory who would otherwise be stateless. However, the majority of countries in Africa have not ratified either convention (see map), leaving them under no obligation to pass national legislation that would address the issue. 

    Regional issue

    An individual can end up stateless for a variety of reasons. Orphans whose births were not registered before their parents died and unaccompanied child migrants who arrive in a foreign country without documents are particularly vulnerable. Laws still in place in several African countries, including Malawi and Madagascar, that prevent married women from passing nationality to their children also contribute to the problem.

    According to Sergio Calle-Norena, deputy regional representative for UNHCR, laws allowing for only one nationality and the denial of citizenship to certain groups are the main causes of statelessness in the Southern Africa region.

    "Currently there are no guidelines in the law on how to identify a stateless person and what rights they're entitled to"

    In Zimbabwe, for example, following an amendment to the citizenship act passed in 2001, individuals with dual nationality were given six months to renounce their foreign citizenship or lose their Zimbabwean nationality. The new law affected countless Zimbabweans whose parents had migrated to the country from Zambia, Mozambique or Malawi at a time when white-owned farms and mines offered plentiful employment. Most did not, in fact, hold citizenship in their parents’ countries, making it impossible for them to renounce it, while many were simply unaware of the new law, which was widely viewed as a means for the ruling ZANU-PF party to disenfranchise opposition supporters.

    “I think they didn’t want people like me to vote,” said Promise*, who was born and raised in Harare, the capital, to a Malawian father and a mother with Mozambican parentage. “Most people in high-density areas of Harare are in the same situation, and most are anti-Zanu-PF.”

    The new law stripped both Promise and her mother of their citizenship. They now live in South Africa, where the asylum-seeker system offers them a temporary and precarious form of documentation. 

    “I just kept renewing my asylum-seeker permit every six months, but I decided to take action last year,” said Promise, who is in her early twenties. “I was tired of having no nationality. It was limiting my opportunities. Most universities need a study permit, and I want to study law.”

    Waiting

    Promise approached Lawyers for Human Rights (LHR), a South African NGO that, with funding from UNHCR, has been running a project to provide legal services to stateless individuals since 2011. UNHCR is also funding the international faith-based NGO Caritas to run a similar project in Mozambique, another country with a large burden of statelessness following years of civil war that displaced hundreds of thousands of its citizens.

    South Africa has pledged to sign and ratify the two UN conventions on statelessness by the end of 2013, and both LHR and UNHCR are advocating for this pledge to be honoured and for relevant legislation to be established. In the meantime, LHR is assisting stateless clients on a case-by-case basis. 

    Of the 736 stateless clients that LHR helped in 2012, over a third were born in Zimbabwe; many of them lost their nationality like Promise.

    Another 150 were born in South Africa but are struggling to access nationality in any country. Jessica George, a legal counsellor with LHR, explained that this group of stateless individuals does not qualify for asylum, and they have no way to access legal immigration status other than through an exemption for permanent residence, a process that allows the Home Affairs Minister to grant permanent residency to foreigners with special circumstances. 

    However, exemption applicants can wait up to three years for a decision. “In the meantime, they’re given no temporary permit, so they’re subject to detention, which tends to be prolonged because they can’t be deported,” said George. 

    Ngubane spent three months at Lindela Repatriation Centre, South Africa’s largest holding facility for undocumented migrants awaiting deportation, after being arrested at a Home Affairs Department office while trying to replace a lost birth certificate. The document was his only proof of South African nationality; he had lost both his parents and all contact with his South African relatives during his time in Kenya and Uganda.

    With help from LHR, Ngubane has applied for a permanent residency exemption, but so far he has received no response. In fact, according to George, only one of LHR’s stateless clients has received a decision on permanent residency exemption in the past two years, and it was negative.

    Reforms, training needed

    “I think some training is required in addition to law reform, because it’s clear there’s a misunderstanding about who is a stateless person,” said George. “Currently there are no guidelines in the law on how to identify a stateless person and what rights they’re entitled to.” 

    In cases where a client has a claim to foreign nationality, LHR approaches the country’s embassy for assistance securing citizenship. However, few embassies or consulates provide such services, and for most stateless people, travelling to the country where they have a nationality claim is unaffordable and unfeasible given their lack of travel documents.

    “One of the easiest ways to prevent statelessness would be if consulates provided certain services, so people wouldn’t have to leave South Africa in order to access their citizenship,” said George.

    Calle-Norena of UNHCR says that, besides ratifying the two conventions on statelessness, addressing the problem requires political will. He noted, for example, that South Africa’s Citizenship Act grants nationality to any child born in the country who would otherwise be stateless, but that non-nationals without documents struggled to register their children’s births. “There should be a mechanism that allows [the law] to be applied, but in practice this is not yet operational,” he told IRIN.

    Through a combination of luck and persistence, Promise has succeeded in convincing the Malawian authorities to grant her citizenship. She has never been to Malawi but plans to move there as soon as she receives her passport. 

    Ngubane says he has tried applying for Kenyan citizenship, “but the embassy said there’s no way they can help me.” 

    Numerous visits to home affairs offices in several provinces have not yielded any results, other than several attempts by corrupt officials to solicit bribes in return for a birth certificate or refugee status.

    “If you don’t have money, you suffer,” he said. 

    *not her real name

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    Solving statelessness in Southern Africa
  • Widespread flooding hits Southern Africa

    Several Southern African countries are dealing with the effects of flooding following heavy rains over much of the region in the past week.

    In South Africa’s northern Limpopo Province, floodwaters claimed 10 lives and left hundreds stranded after the Limpopo River burst its banks. By 22 January, the rain had subsided, but rescue operations were still underway in Musina, near South Africa’s border with Zimbabwe, said Tseng Diale, spokesperson for the province’s Disaster Management Centre.

    Across the border, in Zimbabwe’s Beitbridge District, the rains damaged roads and left some areas impassable, according to state-owned newspaper The Herald, which reported that since the onset of the rainy season, floods and lightning strikes had claimed 124 lives.

    In Mozambique, a UN situation report estimated that by 20 January, nearly 20,000 people throughout the country had been affected by the heavy rains. Nearly 6,000 had been displaced, the majority of them in the capital, Maputo, where the drainage system was overwhelmed by 157mm of rain falling in less than 24 hours. Nine temporary shelters have been set up in the city, and authorities have declared an “orange alert”, with the aim of scaling-up monitoring measures and strengthening preparedness in case the situation worsens. 

    Northern Botswana also experienced heavy downpours that resulted in severe flooding of the Dukwi Refugee Camp, about 130km outside the city of Francistown. According to the UN Refugee Agency (UNHCR),  about 120 refugee homes were inundated by floodwaters, and pumps have stopped working, leading to a shortage of clean water in the camp. Skillshare International, an NGO that provides vocational training programmes in the camp, is sheltering 400 of the displaced in its classrooms, and UNHCR is providing food and trying to establish temporary ablution facilities.

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    Floods hit Southern Africa

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