(Formerly IRIN News) Journalism from the heart of crises

  • Refugees pour into Cameroon fearing Boko Haram

    It’s still early in the morning in Cameroon’s Far North Region, but hundreds of Nigerian refugees are already hurrying along the Gada Mboulo bridge, a few precious belongings balanced on their head or grasped in their arms.

    Fleeing increasingly frequent and deadly Boko Haram attacks, they go through the usual formalities with the Cameroonian military and then walk along a long, dusty dirt road before branching off to find a temporary home.

    Many continue on to the Minawao refugee camp, some 40 kilometres west of the regional capital Maroua. The others find refuge with nearby host communities or set up temporary camp in the bush.

    Ibrahim Okpyeh explains why he made such a rapid departure from his Nigerian hometown of Gombe.

    “That country was hell,” he tells IRIN, pointing back to Nigeria on the other side of the bridge. “Never have I seen so many atrocities. These people [Boko Haram militants] killed everyone in our village. They burned my car, our homes and looted cattle.”

    Okpyeh says he and many others walking alongside him had no choice but to leave.

    Inna Djamilla had to walk for more than two weeks before reaching the Cameroon border.

    “They killed my husband and my eldest son,” she tells IRIN. “What good still remains in this country (Nigeria) that has gone to shit? We have been forced to abandon everything and flee. Several days were spent hiding in the bush. It was horrible.”

    Changing tactics

    In recent weeks, the reach of Boko Haram has extended beyond northeastern Nigerian and the Cameroonian border regions further into Cameroon itself, with a spate of suicide bombings in crowded, public places in Maroua adding to existing fears of raids on frontier villages.

    Dozens have been killed and hundreds more injured as five suicide bombings rocked the Far Northern Region in the space of just a few weeks. The Cameroonian government responded by tightening security, banning burkas and other full-face veils as well as introducing curfews and checkpoint searches of vehicles and baggage.

    See: Cameroon pays high price for joining Boko Haram fight

    “The sect (Boko Haram) has opted for an asymmetrical war,” Mathias Owona Nguini, political scientist and lecturer at the University of Yaoundé II Soa, told IRIN, adding that the failure of Cameroon and Nigeria to cooperate in the past had helped the Islamist extremists to spread.

    Newly-elected Nigerian President Muhammadu Buhari has made a recent effort to forge closer relations with Cameroon as well as neighbouring Chad, which is also suffering increased insecurity and attacks from Boko Haram. Buhari has made state visits to both countries since being sworn into office in late May. Nigeria has also reportedly pledged $30 million towards the regional task force that is taking on the militants.

    “We cannot fight against Boko Haram without [better] coordination among states,” Nguini said, urging Cameroon and Nigeria to overcome territorial disputes around Lake Chad and unite against the militants.

    Leon Koungou, another political scientist who is a security specialist, drew a link between the emergence of so-called Islamic State and Boko Haram’s increasingly macabre tactics, using children as young as 10 years old as human bombs to explode in open markets packed full of civilians.

    “The scenario is quite similar as that seen in Iraq,” he said. “The movement has clearly pledged allegiance to the (so-called) Islamic State, and is part of the same approach: one that is to reach not only the morale of states who are mobilising against their actions but also of the public, and to build a territory with substantial resources.”

    More attacks, more refugees

    The increased insecurity in northeastern Nigeria and the border region has led to a surge of refugees in recent weeks, most of them trying to flee further into Cameroon and away from the Boko Haram threat.

    Between 150 and 300 Nigerian refugees are now being registered each day at the Minawao camp, according to the UN’s refugee agency, UNHCR. The number of Cameroonians fleeing their homes has also increased, although there are no recent, official numbers for internally displaced people.

    Mahamat Baiwon, a UNHCR protection officer in Maroua, explained how the refugee agency and Cameroonian government officials were intercepting the incoming refugees soon after they crossed the border.

    “We want to know where they want to go: either to the Minawao camp or back to another secure area of Nigeria,” he told IRIN.

    Baiwon said most choose the camp, where they hope to benefit from the free food aid distributions and other services, but added that Minawao had now become “saturated with refugees.”

    Created in 2013, and expected to host a maximum of 20,000 refugees, the camp’s population now stands at more than 44,000. In the last six months alone, the number of residents has increased by more than 14,000. Another 30,000 Nigerians are believed to have taken refuge in Cameroon outside the camp, according to local authorities.

    The Cameroonian government, along with UNHCR and the World Food Programme (WFP), say they now need to build a second camp to accommodate the increasing number of refugees, but that just 30 percent of the funding appeal has been met.

    “We’re stilling waiting for donors to respond,” said Laurent Eyenga, who works at Cameroon’s Ministry of Land Management.

    Health concerns

    With fewer than 30 borehole hand-pumps and only 280 latrines in Minawao – many of which are no longer functional – camp officials say the risk of disease is high.

    Cholera is of particular concern, as more than 100 people died during an outbreak in April. Now, the camp is more crowded and dirty than ever.

    “With the changing demographics, the non-observance of hygiene is deplorable,” Zra Mokol, head of a health clinic near the camp, told IRIN. “Given the current situation, if the (cholera) epidemic were to come again, it would be a disaster.”

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    Boko Haram attacks cause refugee influx
  • The Gravedigger and the President: Chadian torture victims face former president

    Clement Abaifouta, 55, has been waiting nearly 25 years to put one question to Hissène Habré, the former president of Chad: “Why did you arrest me?”

    Video: The Gravedigger and the President

    Film by Aida Grovestins and Ricci Shryock 

    Abaifouta was arrested on 12 July, 1985, when he was 23 years old. He had won a scholarship to study in Germany and reckons his travel plans raised suspicions in Habré's government that he was an opposition supporter. 

    Instead of going to university, he first spent two weeks at the headquarters of the political police, known as the Documentation and Security Directorate (DDS), before being moved to a prison, with no access to his family or lawyers.

    He was held there for four years. 

    According to groups such as Human Rights Watch, thousands of people in Chad were wrongfully imprisoned, tortured and even killed during Habré's rule, which lasted from 1982 to 1990.

    Justice at last?

    Now, after years of delayed proceedings, victims finally have their chance at justice.

    Habré went to court on Monday in Dakar, Senegal, where he faces charges of crimes against humanity, torture and war crimes before the Extraordinary African Chambers, a special unit within the Senegalese court system inaugurated by Senegal and the African Union in February 2013 to prosecute the “person or persons” most responsible for international crimes committed in Chad between 1982 and 1990.

    The trial is expected to last three months. It's the first time one state is prosecuting the former leader of another.

    “This shows that victims can mobilise to create the political conditions to bring a dictator or a torturer to justice no matter where he is,” said Reed Brody, a counsel at Human Rights Watch who has worked with victims since 1999. 

    “This is the first time in history, in anywhere in the world that victims have been able to go after a tyrant in another country and to bring him to court. This has the capacity to inspire many victims and survivors from other countries.”

    Habré has denied the allegations and called the trial “a farce.” His lawyers say he refuses to participate in court proceedings. 

    “First of all you should recognise that Chad, from 1982 to 1990, was in a conflict – internal conflict and an international conflict with Libya,” Habré's attorney Francois Serres told IRIN. “The control of Mr. Habré over the territory was very limited… It doesn't mean that we do not recognise that there were potential victims in Chad at this moment. We do not recognise the way the accusation has been organised in order to put this trial today to the face of the world.”

    But according to Human Rights Watch, which has uncovered thousands of documents from the former president’s time in office, Habré knew about the torture and political killings of thousands of Chadians. 

    “The documents of Hissène Habré's political police at the time show that he was constantly informed of what was going on,” Brody said. “They show direct relationship between Habré and the political police.”

    A long-awaited moment

    Abaifouta, who still lives in Chad’s capital N'Djamena with his wife, four children, and a dog named CPI (the French acronym for “International Criminal Court”), has traveled to Dakar for the trial. He and more than 100 other alleged victims will each get the chance to testify against Habré in the coming weeks.

    For Abaifouta, it's a chance to face the man he says put him in prison for four years and forced him to bury the bodies of his fellow prisoners each day – sometimes dozens at a time.

    “The day they [the DDS] interrogated me, I demanded to meet Hissène Habré,” Abaifouta said. “They told me it wasn't possible. [Being imprisoned without cause] was already an injustice, and during my entire detention, I [told myself]: ‘The day I leave, I will reclaim my rights. I will reclaim justice.’”

    That will take a little bit longer still: on Tuesday, Habré’s lawyers failed to show up for his trial, prompting the court to appoint new ones and to postpone proceedings until September.

    "We are not discouraged," Abaifouta told IRIN, after he heard the trial was delayed another 45 days. "We have already waited 25 years. It doesn't hurt us."

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    VIDEO: Justice for Habré's victims?
  • Hear it from the people: What's wrong in the Central African Republic?

    The room was packed. Everyone wanted to speak: unsurprising after years of conflict that has claimed thousands of lives and seen the Central African Republic riven by ethnic and religious cleansing.

    After a lifetime of being ignored, the ordinary people of CAR are finally having their say, taking advantage of a unique opportunity to speak truth to power.

    In the town of Baoro, 400 kilometres from the capital Bangui in northeastern Nana Mabéré prefecture, power took the form of Minister of Communications Victor Wake. Loud applause and ululations punctuated each intervention.

    Many spoke of the horrors the town suffered under the control of the rebel Seleka alliance that toppled president Francois Bozizé in March 2013 and remained in power for 10 months.

    “There was violence here and brutal attacks by the ex-Seleka which cost the lives of 163 people, including 30 women and 10 children,” said a man who identified himself as secretary of the town’s self-defence units.

    “They burned houses, including my own. We counted 1,586 burned houses. But nothing has been done for the victims here,” the man added.

    Another speaker recalled: “When the [rebels] came they threatened me and I hid in the bush. I drank dirty water and fell sick and was evacuated to a hospital in Bangui for two months.”

    “The Selekas came and torched my field and stole all my animals. Many houses were burned here but the owners have got no help at all. It’s sad. That’s what we want you to tell the president.”

    Destroyed houses in the village of Boyeli (near Bozoum) burned by the Seleka in January 2014

    Les effets personnels de musulmans empilés dans les rues à Bozoum
    Nicholas Long/IRIN
    Destroyed houses in the village of Boyeli (near Bozoum) burned by the Seleka in January 2014
    http://www.irinnews.org/photo/
    Monday, February 3, 2014
    Obstacles à l’aide et aux évacuations en RCA*
    Destroyed houses in the village of Boyeli (near Bozoum) burned by the Seleka in January 2014

    Since late January, meetings like this, called grassroots popular consultations, have been taking place in all of CAR’s 16 prefectures as well in neighbouring countries such as Cameroon, Chad, and the two Congos - where some 190,000 CAR citizens live as refugees.

    The consultations are a prelude to the Bangui Forum on National Reconciliation, due to be held from 27 April to 4 May, which aims to shore up a new peace deal and determine the eligibility criteria for elections slated for later this year

    “Mr. Minister, unemployment is rampant here in Baoro. Young people are just hanging around town with nothing to do. Bring the NGOs here to give them work,” said a woman who took the floor.

    “Then there is security. The gendarmes and police don’t have the resources to do their job; they don’t even have a motorbike. Think about giving the security forces at least a vehicle,” she added.

    The Bangui Forum will bring together peoples’ representatives chosen during the popular consultations, leaders of armed groups, transitional authorities and political parties, as well as prominent members of civil society.

    CAR’s constant political unrest can be directly linked to a failure of governance, a failure to deliver basic services and security to most of the population, especially the farthest-flung and most marginalized areas that are prone to armed opposition.

    Minister of Communications Victor Wake leads consultations in the town of Baoro in April 2015 as part of reconciliation efforts in the Central African Republic

    Communications Minister Wake presides over the Baoro meeting
    Crispin Dembassa-Kette/IRIN
    Minister of Communications Victor Wake leads consultations in the town of Baoro in April 2015 as part of reconciliation efforts in the Central African Republic
    http://www.irinnews.org/photo/
    Tuesday, April 7, 2015
    Hear it from the people: What's wrong in the Central African Republic?...
    Minister of Communications Victor Wake leads consultations in the town of Baoro in April 2015 as part of reconciliation efforts in the Central African Republic

    Wake explained that the object of the consultations was to “let the people speak, encourage everyone to unburden themselves, to let loose their fears and hopes, to identify the challenges to overcome and hear their ideas about how to emerge from crisis for once and for all.”

    The people of Baoro did not waste their rare opportunity to tell it like it is, and provided a grim snapshot of the ills and dire needs that plague most of the country.

    Another speaker railed at the sense of impunity and called for the town’s jail to be rebuilt.

    “FACA (CAR’s dilapidated army) and the police and gendarmes should be given weapons to provide security. Also, our hospital must be given medical supplies and competent staff,” he said.

    “I call on the government to build an agricultural development centre in our town, to support farmers and livestock-raisers with subsidies and loans. Young people must also be helped by giving them income-generating activities,” said another speaker.

    The town of Baoro air their grievances at an April 2015 consultation meeting that is part of reconciliation efforts in the Central African Republic

    Crispin Dembassa-Kette/IRIN
    The town of Baoro air their grievances at an April 2015 consultation meeting that is part of reconciliation efforts in the Central African Republic
    http://www.irinnews.org/photo/
    Tuesday, April 7, 2015
    Hear it from the people: What's wrong in the Central African Republic?...
    The town of Baoro air their grievances at an April 2015 consultation meeting that is part of reconciliation efforts in the Central African Republic

    The grievances are much the same all over the country, according to summaries of the consultations presented recently at the Bangui headquarters of CAR’s provisional parliament.

    The nation’s preoccupations, “hinge on impunity, security, meeting basic needs, peaceful coexistence between communities, national reconciliation and social cohesion,” General Babacar Gueye, UN envoy to CAR, said in remarks to open the Bangui presentation.

    In eastern Haut-Mbomou prefecture, “people feel abandoned to the mercy of armed groups such as Joseph Kony’s Lord’s Resistance Army [a rebel group of Ugandan origin] and groups of armed peuhls [an ethnic minority],” said consultation facilitator Bernadette Gambo.

    “People also told us of the kidnapping of around 2,000 children by rebels in South Sudan. Their parents are demanding their return and want better security in their area,” she said.

    Minister of Reconciliation Jeanette Détoua conducted the consultations in the Democratic Republic of Congo, where some 75,000 CAR citizens live as refugees.

    “Our compatriots in DRC said that former presidents Francois Bozizé and (Seleka leader) Michel Djotodia should come back to the country to seek forgiveness because they are to blame for this division between the people of Central Africa. They also said that those who are not Central African and who came to divide the country should be sent home,” she said.

    "If we listen to them, we can find the solutions"

    CAR has tried before to seek reconciliation by involving government officials, party leaders, civil society and rebel commanders in peace talks or dialogue, but there is hope that this effort is different.

    “Previous processes have always favoured politico-military actors to the detriment of these crises’ innocent victims,” said interim President Catherine Samba Panza. 

    Applauding this new approach, the UN Development Programme’s Africa Director Abdoulaye Mar Dieye said on a recent visit to CAR: “Solutions to peace and development lie with the people. If we listen to them, we can find the solutions.”

    Former Seleka rebels at first openly opposed the public consultations, but may now be coming round to the idea.

    “In five of the 16 prefectures, there was resistance from armed groups and the facilitators came back to Bangui,” said Detoua, the reconciliation minister.

    In the central town of Kaga-Bandoro, the rebels briefly abducted the regional prefect and the town’s mayor who had been set to lead the consultation there. And, in Bambari, they chased a whole team of facilitators out of town.

    However, after negotiations with the rebels, consultations were later held successfully in both locations.

    Everyone is finally getting a chance to have their say. For those unable to attend the consultations, the government has even set up a special hotline.

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    Speaking truth to power... at last
  • Killing us softly

    A recent public outcry in China, sparked by a damning documentary about air pollution, was based on well-founded fear:

    Of the 100 million people who viewed the film on the first day of its online release, 172,000 are likely to die each year from air pollution-related diseases, according to regional trends.* 

    Worldwide, pollution kills twice as many people each year as HIV/AIDS, malaria and tuberculosis combined,** but aid policy has consistently neglected it as a health risk, donors and experts say. 

    Air pollution alone killed seven million people in 2012, according to World Health Organization (WHO) figures released last year, most of them in low and middle-income countries (LMICs) in the Asia Pacific region.*** 

    In a self-critical report released late last month the World Bank acknowledged that it had treated air pollution as an afterthought, resulting in a dearth of analysis of the problem and spending on solutions. 

    “We now need to step up our game and adopt a more comprehensive approach to fixing air quality,” the authors wrote in Clean Air and Healthy Lungs. “If left unaddressed, these problems are expected to grow worse over time, as the world continues to urbanise at an unprecedented and challenging speed.”

    A second report released last month by several organisations – including the Global Alliance on Health and Pollution, an international consortium of UN organisations, governments, development banks, NGOs and academics – also called for more funding towards reducing pollution. 

    “Rich countries, multilateral agencies and organisations have forgotten the crippling impacts of pollution and fail to make it a priority in their foreign assistance,” the authors wrote. 

    Housebound in China 

    A dense haze obstructs visibility more often than not across China’s northern Hua Bei plain and two of its major river deltas. Less than one percent of the 500 largest cities in China meet WHO’s air quality guidelines. Anger over air pollution is a hot topic among China’s increasingly outspoken citizenry.  

    “Half of the days in 2014, I had to confine my daughter to my home like a prisoner because the air quality in Beijing was so poor,” China’s well-known journalist Chai Jing said in Under the Dome, the independent documentary she released last month, which investigated the causes of China’s air pollution.

    The film was shared on the Chinese social media portal Weibo more than 580,000 times before officials ordered websites to delete it

    Beyond the silo

    Traditionally left to environmental experts to tackle, the fight against pollution is increasingly recognised as requiring attention from health and development specialists too. 

    “Air pollution is the top environmental health risk and among the top modifiable health risks in the world,” said Professor Michael Brauer, a public health expert at the University of British Columbia in Canada and a member of the scientific advisory panel for the Climate and Clean Air Coalition, a consortium of governments and the UN Environment Programme. “Air pollution has been under-funded and its health impacts under-appreciated.”

    Pollution – especially outdoor or “ambient” air pollution – is also a major drag on economic performance and limits the opportunities of the poor, according to Ilmi Granoff, an environmental policy expert at the Overseas Development Institute, a London-based think tank. It causes premature death, illness, lost earnings and medical costs – all of which take their toll on both individual and national productivity.

    “Donors need to get out of the siloed thinking of pollution as an environmental problem distinct from economic development and poverty reduction,” Granoff said. 

    Pollution cleanup is indeed underfunded, he added, but pollution prevention is even more poorly prioritised: “It’s underfunded in much of the developed world, in aid, and in developing country priorities, so this isn’t just an aid problem.”

    Mounting evidence 

    Pollution kills in a variety of ways, according to relatively recent studies; air pollution is by far the most lethal form compared to soil and water pollution. 
     

    Microscopic particulate matter (PM) suspended in polluted air is the chief culprit in these deaths: the smaller the particles’ size, the deeper they are able to penetrate into the lungs.  Particles of less than 2.5 micrometres in diameter (PM2.5) are small enough to reach the alveoli, the deepest part of the lungs, and to enter the blood stream.  

    From there, PM2.5 causes inflammation and changes in heart rate, blood pressure, and blood clotting processes - the precursors to fatal stroke and heart disease.  PM2.5 irritates and corrodes the alveoli, which impairs lung function - a major precursor to chronic obstructive pulmonary disease. It also acts as a carcinogen.

    Most research looks at long-term exposure to PM2.5 but even studies looking at the hours immediately following bursts of especially high ambient PM2.5 (in developed countries) show a corresponding spike in life-threatening heart attacks, heart arrhythmias and stroke.

    Asia worst affected

    The overwhelming majority - 70 percent - of global air pollution deaths occur in the Western Pacific and Southeast Asia regions.  South Asia has eight of the top 10 and 33 of the top 50 cities with the worst PM concentrations in the world.  

     

    WHO says a city’s average annual PM levels should be 20 micrograms per cubic meter.  But cities such as Karachi, Gaborone, and Delhi have yearly PM averages above 200 micrograms per cubic meter. 

    The main source of PM2.5 in indoor air, or household air, is burning solid fuels for cooking and heating, using wood, coal, dung or crop leftovers - a common practice in rural areas of low and middle-income countries that lack electricity.  

    Almost three billion people live this way, the majority in the densely populated Asia Pacific region: India and China each hold about one quarter of all people who rely on solid fuels. For these people, the daily average dose of PM2.5 is often in the hundreds of micrograms per cubic meter. 

    Filling the gaps

    Unlike many other health risks air pollution is very cost-effective to address, Brauer said. Analysis of air quality interventions in the US suggests a return on investment of up to $30 for every dollar spent. 

    “We already know how to reduce these risks, as we have done exactly that in high income countries, so this is not a matter of searching for a cure - we know what works,” he said.

    But the World Bank report said that unless it starts gathering better data on local air quality in LMICs, the amounts and sources of air pollution and the full gamut of its health impacts, “it is not possible to appropriately target interventions in a cost-effective manner.”

    Granoff said there are also gaps in government capacity to monitor, regulate and enforce pollution policy. 

    Beijing hopes to bring PM2.5 concentrations down to safe levels by 2030, and has said it will fine big polluters. 

    The World Bank report said China is also charging all enterprises fees for the pollutants they discharge; establishing a nationwide PM2.5 monitoring network; instituting pollution control measures on motor vehicles; and controlling urban dust pollution.

    But enforcing environmental protections has been a longstanding problem in China.

    “Pollution policy will only succeed if citizens are aware of the harm, able to organise their concern [through advocacy campaigns], and have a responsive government that prioritises public welfare over the narrower interests of polluting sectors,” Granoff said. 

    While more people die from household air pollution than from ambient air pollution, the latter – through vehicles, smokestacks and open burning – still accounted for 3.7 million deaths in 2012, according to the WHO. 

    A change in the air

    Kaye Patdu, an air quality expert at Clean Air Asia, a Manila-based think tank - and the secretariat for the UN-backed Clean Air Asia Partnership, comprising more than 250 government, civil, academic, business and development organisations - said the aid community is finally starting to recognise the importance of tackling air pollution.  

    Last year’s inaugural UN Environment Assembly adopted a resolution calling for strengthened action on air pollution.  
    WHO Member States are planning to adopt a resolution on health and air quality at the upcoming World Health Assembly in May. 
    The proposed Sustainable Development Goals, which will set the post-2015 international development agenda, address city air quality and air, soil and water pollution. 

    None of the experts IRIN contacted could provide a breakdown of total aid spending on all forms of toxic pollution (air, water and soil pollution that is harmful to human health).  So IRIN asked each of the major global donors for their figures.  

    Three responded.  

    A back-of-envelope calculation of all reported spending on toxic pollution by USAID, the European Commission and the World Bank suggests that between them they committed about US$10 billion over 10 years. This does not include aid spending on the diseases that pollution causes. The World Bank’s spending figures eclipsed those of other the other donors. 

    By very rough comparison, HIV/AIDS, malaria and tuberculosis, with half the death toll of air pollution, received $28 billion via public sector commitments to the Global Fund – the world’s largest financier of programs that tackle these diseases – over the same period, a fraction of total spending on these diseases. 

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    *Based on WHO statistics for per capita mortality rates in the Western Pacific region in 2012. 

    **The mortality figures for air pollution come from 2012 statistics and were released by WHO in 2014, while the figures for the infectious diseases come from 2013 statistics and were released by the Institute for Health Metrics and Evaluation in 2014 (the Global Burden of Disease study).

    ***Includes deaths from both household air pollution (4.3 million) and ambient air pollution (3.7 million): the combined death toll is less than the sum of the parts because many people are exposed to both. 

    For more: 

    The relationship between household air pollution and disease

    Ambient air pollution and the risk of acute ischemic stroke 

    Cardiovascular effects of exposure to ambient air pollution 

    Particulate air pollution and lung function  

    Long-term exposure to ambient air pollution and incidence of cerebrovascular events: Results from 11 European cohorts within the ESCAPE Project  

    OECD's The Cost of Air Pollution report
     

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    Killing us softly
  • Working to keep the peace: The impact of job schemes on ex-rebels

    Job-creation schemes are the traditional way to tackle the post-conflict problem of unemployed ex-fighters and to reduce the threat they can pose to peace and stability in fragile states.

    The theory - encapsulated in most demobilisation, disarmament and reintegration (DDR) programmes - is that jobs can be generated through training and capital inputs; that employment decreases the risks of re-recruitment; and once armed with a pay cheque, ex-combatants settle down and reintegrate more easily into society.

    Those assumptions were tested in a recent study exploring whether employment could reduce lawlessness and rebellion among high-risk men in Liberia. Of those who took part in the training scheme that was studied, 74 percent had fought in Liberia’s traumatic 14-year civil war.  The study concluded that training and cash incentives did encourage lawful employment, and as a result the men resisted being signed up by mercenary recruiters during a neigbouring conflict.  But there was no evidence employment improved their societal reintegration – they remained violent and anti-social.

    The NGO Action on Armed Violence (AoAV) works with ex-fighters and other troubled young men, typically involved in illegal mining and logging in remote “hotspots”, providing agricultural training and farm inputs. The income-generating scheme gave the researchers - Christopher Blattman of Columbia University and Jeannie Annan, of the International Rescue Committee - what they described as a unique opportunity to study employment-led rehabilitation.

    Their study found that even the highest risk men where “overwhelmingly interested in farming” as a result of the AoAV training. But although they spent 20 percent more time on farming, they didn’t abandon their illicit activities. Instead, they adjusted “their portfolio of occupations”, and saw a modest rise of $12 a month in earnings. Crucially the men reported “24 percent less engagement” with mercenary recruiters when Cote d’Ivoire’s short war erupted in 2011 – and none went to fight.

    The study’s findings were published in the Social Science Research Network.

    DDR employment programmes generally have a low success rate: Often the primary goal is to get a peace agreement signed, not sustained economic reintegration – a failing witnessed from the Central African Republic to the Democratic Republic of Congo.

    The study suggests that the single-trade focus of most DDR programmes fails to appreciate how, in the real world, the poor use multiple streams of income to mitigate risk. Liquid capital is key. The AoAV scheme demonstrated, almost accidentally, the power of cash incentives. As a result of a supply problem, roughly a third of the men expecting a second farm input installment were told to expect instead a cash payment – conditional on them not taking up mining or mercenary work. This financial inducement worked. 

    “The potential policy implication is that one-time transfers will not fully deter future criminal or mercenary opportunities. Ongoing incentives, such as cash-for-work programmes or other conditional transfers, could be important compliments,” the study noted.

    Despite the men’s relative economic success, the programme had “little effect on aggression, participation in community life and politics, or attitudes to violence and democracy” – in other words, little progress in terms of social integration. Furthermore, although AoAV’s intervention had a positive impact, an additional $12 a month earned was “not a high return” on the investment. 

    “Cost-effectiveness thus hinges on the hard-to-quantify social returns to lower crime and violence,” the study noted. In a fragile country recovering from conflict, that may well be a price worth paying.

    For further reading on DDR see:

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    How to help ex-rebels adjust to peace
  • Three words of advice for WHO Africa's new chief

    The World Health Organization says the number of new Ebola cases per week rose twice this month for the first time since December.

    This rise in incidence of new cases - if proven to be a trend - will be just one of the challenges facing WHO’s new regional director for Africa, Matshidiso Rebecca Moeti, as she attempts to overcome the multitude of criticism launched against WHO in recent months for its failure to act earlier and more competently during West Africa’s ongoing Ebola outbreak.

    “This is a critical moment for the WHO,” said Michael Merson, director of Duke University’s Global Health Institute. “It’s a real crossroads as to whether or not they’ll be able to reform and become an effective and efficient organization, particularly at the regional level.”

    Moeti, who officially took office 1 February, has vowed to make fighting Ebola WHO’s “highest priority,” while supporting countries to develop strategies to build up their health care systems, and reduce maternal and child mortality, tuberculosis, HIV/AIDS and non-communicable diseases.

    Many international observers say they have high hopes for Moeti, a medical doctor who has more than 35 years of experience working in the national and global public health sector. But she has a tough road ahead – particularly as the number of Ebola cases continues to rise, nearly a year after the outbreak was first declared.

    Here’s some advice from a few experts as Moeti begins her five-year term:

    1. Think Local

    Having competent and qualified staff on the ground, whose skills and expertise are matched to the needs of the country, is key to effectively implementing WHO policies and recommendations.

    “Everyone tends to discuss WHO at the global level and the regional level, but I don’t think this is where the problem lies,” said Fatou Francesca Mbow, an independent health consultant in West Africa. “It really lies in what the WHO is meant to be doing at country level. It is of no use to have very technical people sitting in Washington [D.C.] or Geneva, and then, where things are actually happening, [they become] politicians.”

    Mbow said that despite a wealth of technical documents being produced at headquarters, very often the staff from the field offices are appointed based on political motives. Country and field-level office meetings are often dominated by talk that, while politically correct, says “nothing of real meaning”.

    Staff reform at the local level will require both investing in employee development, including recruiting new and existing talent to the field offices, as well as making posts in “hardship” countries more attractive to the most qualified experts.

    “What often happens is that when people in-country are seen as being quite effective, they tend to get headhunted by the headquarters of the institutions that represent them,” said Sophie Harman, a senior lecturer in international politics at Queen Mary University of London. “So we see a type of brain-drain among people working in these sectors.”

    She said that improving salaries and offering more benefits, as well as taking into account what these people have to offer, could go a long way in incentivising them to stay at their field-level posts.

    “Good documents are interesting,” Mbow said. “But unless you have people at country level who understand them, who participate in writing them, who are able to implement them, who are passionate and committed to doing so, they’re just going to be reports.”

    2. Strengthen health systems

    There were many factors that contributed to the unprecedented spread of the Ebola outbreak, but inherently weak local health systems in the three most-affected countries meant that local clinics did not have the capacity, resources or expertise to handle even the smallest of caseloads.

    WHO must now work with local governments, partners and other on-the-ground agencies in all African countries to train and employ more doctors and nurses, implement universal health care coverage, and invest in better vigilance and surveillance measures.

    “I think the real test will be… how the WHO turns this outbreak into an opportunity to use our energy and thoughts and actions to build health systems that will not only help people [day-to-day], but will be able to respond to health crises like this in the future,” said Chikwe Ihekweazu, a managing partner of the health consulting firm EpiAfric.

    Increasing the number of health workers will be particularly important post-outbreak in Guinea, Liberia and Sierra Leone, where more than 400 health workers have died from Ebola, including some of the countries’ top doctors and nurses.

    “The WHO also needs to help minimise the knock-on effect that the Ebola outbreak is having on other health priorities in the region, such as HIV/AIDS and maternal health,” Harman said. “What we are seeing is that because of Ebola, people are afraid and so they are not accessing health facilities, which might actually reverse some of the many gains we’ve seen in the MDGs [Millennium Development Goals].”

    3. Rebuild credibility

    Despite WHO having, admittedly, acted much too late, both in terms of identifying the Ebola outbreak and then mobilizing resources to contain it – and losing much of its credibility in the process – experts agree that WHO remains a much-needed and relevant global health body, particularly when it comes to technical expertise.

    “We all recognize that the WHO has had a fairly good history in the past,” Ihekweazu said. “And while it was certainly criticized for its slow response at the beginning of the outbreak…the WHO is seen as the leading organisation that provides guidance for countries and I think…we are at a stage where [Africa] needs the WHO as a mutual partner who provides leadership for the continent going forward.”

    Mbow agreed: “What I would say is that when you are criticised, take the blame fairly, but don’t lose sight. And don’t lose confidence in the resources you do have to offer.”

    Restoring donor confidence in WHO will be particularly important, as the regional office for Africa has the largest budgetary needs, the most countries, and, in many ways, the most challenging health problems to deal with.

    “No one wants harm done to the WHO,” Merson said. “We will be a much better, healthier planet, if the WHO is strong and effective… But it is never going to have a huge budget and so I think its strengths should be in standard-setting, norm-setting and providing the best technical sound advice in health that countries need.”

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    3 tips for WHO's new director for Africa
  • Who celebrity advocates are really targeting. And it’s not you.

    This week was a fanfare for celebrity humanitarians: Forest Whitaker appealed for peace in South Sudan alongside UN Under-Secretary-General for Humanitarian Affairs Valerie Amos; Angelina Jolie opened an academic centre on sexual violence in conflict with British Member of Parliament William Hague; and UNICEF Goodwill Ambassador David Beckham launched an initiative for children. 

    In recent years, aid agencies have increasingly used celebrity advocates to raise awareness and money for their causes. There’s just one snag: 

    It doesn’t actually work. At least not as much or in the ways we think. 

    According to research by Dan Brockington, a professor at the University of Manchester, public responses to celebrity activism are surprisingly muted. His work is the first quantitative research on the subject. 

    “Using celebrities for broader outreach, for reaching mass publics and attracting media attention is absolutely not the silver bullet it appears to be,” he told IRIN on the sidelines of a 6-8 February conference at the University of Sussex, where he presented research recently published in the book Celebrity Advocacy and International Development.

     

     
    In a survey he conducted with 2,000 British people, 95 percent of respondents recognized five or more of 12 charities listed to them, including the British Red Cross, Save the Children UK and Oxfam UK. But two-thirds of the respondents did not know a single “high-profile” advocate of any of the NGOs (In this case, music executive Simon Cowell and singers Victoria Beckham and Elton John respectively, among many others). 

    The realpolitik might not be that pleasant. But you'll achieve your goals. 

    Focus groups and interviews with more than 100 “celebrity liaison officers” and other media staff at NGOs further reinforced his findings. 

    What’s more, Brockington says, those who pay attention to celebrities do not necessarily know which causes they support. 

    “People who follow celebrities often do so because they are not political,” he said during the interview. “They are fun, light. You want to live their lives…[People] don’t engage with [celebrities] for the more worthy things.”  

    Celebrity stardom flat-lining 

    Despite the rise in the use of celebrity advocates (which, by the way, dates back to at least Victorian times), the mention of charities in broadsheet and tabloid articles about celebrities only increased ever so slightly between 1985 and 2010, according to a separate study by Brockington. “There has also been a decline in the proportion of newspaper articles mentioning development and humanitarian NGOs at all,” the study found. 

    The perception that celebrities engage the public in the first place may itself be overstated. 

    After a steady rise in coverage of celebrities in the British press over two decades, the percentage of articles mentioning the word celebrity (only a fraction of total articles about celebrities) stopped increasing around 2006 and is now hovering at about four percent of all articles studied, the research found, validating the findings of earlier studies on the same subject (The study looked at The Guardian, The Times, The Independent, Daily Mail, The Mirror and The Sun). 

    The magazine industry’s own statistics show a tapering off of readership in recent years after steady growth.

    Celebrities can be successful in engaging the public – Miley Cyrus made waves last year when she sent a homeless man to pick up her MTV Video Music Awards; Bob Geldof’s charity single on Ebola quickly rose to the top of the charts; and celebrity-driven telethons like the UK’s Comic Relief are generally quite successful. Leonardo DiCaprio’s speech at the opening of the Climate Summit 2014 garnered nearly 2 million views on YouTube – far more than many of the heads of state who also spoke at the summit.

    And the effectiveness of celebrity advocacy in non-Western contexts, which is much less studied, could well be higher. UNICEF, for example, uses more national than global celebrity ambassadors because they often resonate better with local audiences. Social media campaigns can also be extremely successful in some instances, though “not a game-changer”, according to Brockington (For a cold shower on this topic, see Paul Currion’s column on why KONY 2012 may have engaged the public, but ultimately failed).

    Influence without accountability 

    But on the whole, at least in the UK, public interest in celebrity appears to be lower than most people think, Brockington says. But the belief in star power - inaccurate as it may be - lingers: In his survey, 74 percent of respondents said they thought other people paid more attention to celebrities than they did. Statistically, this cannot actually be true, but it proves an important point: If people think that other people care about celebrities, it can become a self-fulfilling prophecy.

    Brockington found that while celebrities may not be as successful as we think in engaging the public, they are still successful at engaging politicians and decision-makers. 

    Why? 

    Because politicians - like most people - like being around celebrities. But also because politicians – also like most people - believe that celebrities express populist sentiment, even though, in fact, they often don’t. So they grant them access and influence. 

    Ben Affleck, for example, has briefed US Congress about the Democratic Republic of Congo and George Clooney has addressed the UN Security Council about Darfur.   

     

    For the small but growing number of academics studying the subject, the gap between celebrity advocacy and public engagement raises a major ethical question: If celebrities wield all this power and influence, yet do not represent popular sentiment, who are they accountable to?  

    “The celebrity is not beholden to his or her public in the same manner as the elected official,” writes Alexandra Cosima Budabin, of the University of Dayton, in an upcoming book: Celebrity Humanitarianism and North-South Relations. “Misguided proposals and ineffective interventions will not endanger a celebrity, whose position is assured by both financial and political elites.”  

    Celebrities’ increasingly powerful voices on issues of humanitarian aid, poverty reduction and famine has allowed them to “often decide for the suffering receivers” and eliminate public scrutiny and debate, according to Ilan Kapoor, a professor at York University in Canada and author of Celebrity Humanitarianism: The Ideology of Global Charity. 

    “…Mostly unelected, private individuals and organizations have, for all intents and purposes, taken over what should primarily be state/public functions,” he writes

    A Machiavellian approach?

    Perhaps even more interestingly, Brockington found in his interviews with staff of NGOs with celebrity advocates that liaison officers know the impact on the public is limited, but use celebrities anyway because they can access and influence not the general public but decision-makers. 

    “The realpolitik might not be that pleasant,” he told the University of Sussex conference, “but you’ll achieve your goals.”

    UNICEF’s announcement of a new initiative for children by its Goodwill Ambassador David Beckham may reflect a clear understanding of this precise point. It reads: “David will use his powerful global voice, influence and connections to raise vital funds and encourage world leaders to create lasting positive change for children,” the statement said. 

    Malene Kamp Jensen, of UNICEF’s Goodwill Ambassador Program – one of the first and largest of its kind, acknowledges that sending a message to policy-makers is a “very, very important role” of celebrity ambassadors: “They do have certain access and platforms.” 

    But she says it is important to engage all segments of society: “You communicate to as many people as possible… I don’t think you can just say: ‘Forget the public; let’s lean on the policy makers. It’s very much a collective effort.” 

    For Jeffrey Brez, of the UN’s Messenger of Peace Programme, the target audience depends on the specific goal in that instance. 

    “Is there a treaty about to be ratified and you need a few extra votes? Is it a humanitarian crisis and you need a bump of visibility to help Congress push through appropriations for humanitarian aid? There are so many moments when they can come in and give you a little boost. It depends … what you’re trying to achieve.”

     

    Celebrity advocacy "industry" 

    Brez and Jensen both challenge the suggestion that celebrities are seen to be a silver bullet to public engagement, insisting they are just one tool in the toolbox. 

    “We’re always looking just to incrementally move the needle,” Brez says. But he complains that he and his colleagues lack real research to assess just how much impact their outreach has. 

    When Project Runway All Stars shot its Season Finale at UN Headquarters, 2 million fashion fans – not the UN’s traditional audience – were exposed to its work in a positive light. But how much did they retain? Did their perceptions of the UN change? 

    Brockington cautions not to read too much into his findings: celebrity advocacy can work, he says, but must be used strategically, for example to influence elites or fundraise among existing supporters. 

    But he says celebrity liaison officers are themselves frustrated by their NGO colleagues’ expectations that if they just throw a celebrity at something, the organisation will be instantly successful at captivating the public imagination. 

    Could the bubble eventually burst if more people become aware of the limits of celebrity advocacy? Unlikely, Brockington says, given what has now become a celebrity advocacy “industry”, in to which NGOs invest a lot of time and resources.  

    “There is a fair bit of smoke and mirrors in this… [but] a lot of people are vested in this. They want it to work. There’s all sorts of strong collective interests in sustaining it.”

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    Does celebrity advocacy actually work?
  • IRIN’s Top Picks: Aid corruption, Boko Haram and Caliphatalism

    Welcome to IRIN's reading list. Every week our global network of specialist correspondents share some of their top picks of recent must-read research, interviews, reports, blogs and in-depth articles to help you keep on top of global crises. We also highlight key upcoming conferences, book releases and policy debates.

    Four to read:

    With shift to local aid, corruption a rising challenge 

    One of the big talking points during the World Humanitarian Summit consultations has been the need to give more money directly to local organisations, but the US Agency for International Development (USAID) is finding this is not as straightforward as it sounds. “We recognize working on the local push, but aid is going to poorly governed places, and this is going to bring difficult trade-offs and complicated issues,” noted Neil Levine, director of USAID’s Center of Excellence for Democracy, Human Rights and Governance. Read this Devex blog for more on balancing ground-up funding with politics and accountability.

    Caliphatalism?

    This is a long, narrative piece by a former resident of the Iraqi city of Mosul, now living in Dubai, giving a personal account of how the group calling itself Islamic State (IS) took hold. The story starts in 2007 and is an important reminder that IS did not just appear in Mosul in June last year. A rare look into the once-multi-cultural but always troubled city that has dominated so many headlines in the past eight months.

    The death of international development 

    Published a few months ago but still worth a read, Jason Hickel, a research fellow at the London School of Economics, argues in this blog that people no longer believe in development and foreign aid because decades of pouring money into poor countries has not delivered results. Calling out the Narrative Project - a behind-the-scenes initiative launched by the Bill and Melinda Gates Foundation, Oxfam, Save the Children and others aimed at countering the fatigue and apathy towards foreign aid projects – he says changing the language will not help. Hickel says the “paternalistic story of charity and aid, white saviours and poor brown victims” is no longer relevant and it’s time to “tell the real story about how the rich get richer off the backs of the poor”. Poor countries, he argues, will only escape poverty when rampant tax evasion ends in the developed world and when a real dose of fairness is injected into the global trading system.

    Co-Chairs' Summary: Regional Consultation Europe and Others Group - Budapest

    Next year the great and the good, the big and the small, the old-timers and tyros of the burgeoning, $20 billion emergency aid business are going to gather in Turkey to #ReShapeAid at the World Humanitarian Summit. What’s it all about? What needs to be fixed? How do we do it? Answers to these questions and many, many more can be found in this impressively exhaustive summary of preliminary consultations held in Europe earlier this month. A must-read for collectors of trending abstract nouns (such as “access,” “proximity” “protection,” “resilience” and “innovation”).

    One to watch:

    Embedding with Aid Agencies: Editorial Integrity and Security Risks 

    Shrinking editorial budgets have resulted in journalists turning to aid agencies to cover news from the frontlines of crises. Is this a threat to editorial integrity or are aid agencies filling a growing gap in foreign reporting? Watch IRIN CEO Ben Parker discussing this topic with senior communications experts and journalists at the Frontline Club in London. 

    From IRIN:

    Fleeing Boko Haram - survivors' stories  

    Our Editor-at-Large Obi Anyadike has been in northern Nigeria this week reporting on the election delay and the humanitarian impact of Boko Haram. Read his reports from Maiduguri and our story on how thousands of Nigerians who fled to Chad are now stranded and in dire need of food and medical support.

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    IRIN’s Top Picks: 12 February 2015
  • Thousands of Boko Haram refugees "stranded" in Chad

    Many fled the killings by canoe and had no time to take anything with them as they paddled for their lives across Lake Chad. Now thousands of Nigerians who escaped attacks by Boko Haram are stuck on some of the countless little islands that dot the lake and are in dire need of food, water, shelter and medical care.

    Unless these refugees can be located and moved to an established refugee camp at Baga Sola, 70km from the Nigerian border, “they are going to remain extremely vulnerable where they are,” said Alice Armanni Sequi, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Chad.

    Many of the islands are little more than swampy marshes or sandbars. While some are inhabited, their residents have little to offer the refugees except their homes: Chad’s Lake Region is one of the poorest parts of one of the poorest and least developed countries in the world. In some communities, the recent influx has more than doubled the population.

    “The current situation is quite complex,” said Mamadou Dian Balde, the deputy representative for the UN Refugee Agency (UNHCR) in Chad. “Many of the refugees have settled in places where we cannot provide them with any support, even though we desperately want to,” he said, explaining that some of the islands are at least a day’s motorboat ride from the shore.


    A growing crisis

    More than 17,000 Nigerians have taken refuge in Chad since May 2013, according to UNHCR. An additional 100,000 have fled to Niger and 37,000 to Cameroon.

    The biggest influx into Chad - more than 14,000, at a rate of up to 1,000 a day - followed Boko Haram’s 3 January attack on the northeastern Nigerian town of Baga. Hundreds of people were killed and entire villages burned.  More than one in five of the new arrivals lack any form of shelter, according to the International Federation of Red Cross and Red Crescent Societies.

     

    “Most refugees in the past year or two went to Niger, which is closer and easier to access [overland], or even Cameroon,” Balde said. “The fact that they started to come in large numbers [across the lake] into Chad was an act of desperation.”


    Relocation

    The camp at Baga-Sola, known as Dar-es-Salam (“place of peace”) can house 15,000 refugees and is currently hosting just over 3,000. UNHCR is working with the Chadian government to transport an additional 2,000 refugees on the islands to the camp.

    The Ministry of Public Health has posted doctors and nurses in Dar-es-Salam and added extra health workers to communities hosting large numbers of refugees. Disease and outbreaks, such as malaria and cholera, remain of concern, however. And in this part of Chad, maternal healthcare is next to non-existent.


    Identifying returnees

    Local authorities say they know of at least 1,100 Chadians who had been living and working in Nigeria and who fled back home when the violence erupted. Aid agencies say the actual number is probably much higher.

    The return of these breadwinners has cut off a financial lifeline for many families.

     “Although they have returned to their families of origin, they carry many of the same vulnerabilities as the Nigerian refugees,” Sequi said. “And as they live in their households of origin, among host communities, they are harder to identify. This puts them at a greater risk of remaining in the shadow of aid, which has until now been largely concentrated in refugee camps.”


    Struggling host communities

    In the Lake Region, almost a third of the population does not have regular access to enough food to live a healthy life, according to the UN’s World Food Programme. Malnutrition rates among children under five exceed the emergency threshold of 15 percent.

    The economic situation has been made worse by the closure of Chad’s land border with Nigeria in August, which halted the movement of local traders, herders and merchants, and has led to food shortages and rising food prices.

    The host communities “must not be forgotten by the aid community,” Sequi said. “They shared all they had [with the refugees], depleting their own food stocks and economic assets...So increasing our assistance to host and local communities remains critical.”

    According to OCHA, some $31 million is needed to meet humanitarian needs in the Lake Region, including those of the refugees. How much of this will come through is uncertain: last year’s Chad appeal was just 36 percent funded.

     “Chad is historically an underfunded crisis,” Sequi said. “The humanitarian community in Chad is constantly faced with the challenge of finding the financial inputs to do our work, and it’s no less for this operation.”

    WFP, which has supplied more than 6,000 refugees with emergency food rations, and has begun distributing one-month rations to people in the camp, says that it will need nearly $11 million to meet the needs of everyone.

    “The refugees that we received last year, we were able to react to quite quickly, and provide them with food aid distributions,” said Peter Musoko, the deputy country director for WFP in Chad. “Today, our biggest challenge is that the situation itself is almost completely unfunded.”

    OCHA says it is now reaching out to the Central Emergency Response Fund (CERF) to support aid operations in response to the Nigeria crisis.

    For the moment, many agencies have been fronting their internal cash to ensure the immediate response, Sequi said, but added that this is not sustainable, nor will it allow for any scale-up.

    The UN says it is planning for the arrival of many as 30,000 Nigerian refugees over the coming months, depending on the security situation.

    "It’s one of those situations where the challenge is greater than the resources available,” Sequi said. “Humanitarian actors are doing all they can but…getting more funding for our response in the region will be critical to our ultimate success.”

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    Boko Haram refugees "stranded" in Chad
  • After Ebola: What next for West Africa’s health systems

    As rates of Ebola infection fall in Guinea, Liberia and Sierra Leone, planning has begun on how to rebuild public health systems and learn lessons from the outbreak.

    Nobody is declaring victory yet. But in Sierra Leone, the worst-affected country, there were 117 new confirmed cases reported in the week to 18 January, the latest statistics available, compared with 184 the previous week and 248 the week before that. Guinea halved its cases in the week to 18 January – down to 20 – and Liberia held steady at eight. 

    The epidemic is not over until there are zero cases over two incubation periods – the equivalent of 42 days. “It’s like being only a little bit pregnant – there’s no such thing as a little Ebola. We have to get to zero, there can be no reservoirs of Ebola,”  Margaret Harris, spokesperson of the World Health Organization (WHO), told IRIN. 

    But after 21,724 cases and 8,641 deaths in nine countries since the epidemic began in Guinea last year, there is some light. And health workers are already starting to look at what’s next. “Right now important meetings are going on in each country to work out what needs to be done to rebuild - in some significant respects to build health systems almost anew - and to build back better,” said Harris. 

    A European Union donor conference is due at the beginning of March in Brussels. “What we want to see as a country is a resilient health system that can withstand shocks,” Liberia’s Assistant Health Minister Tolbert Nyenswah told IRIN. “Our plan [to be presented in Brussels] will be finalized by the end of February. It will be well costed with tangible goals.”

    Ebola tested the public health systems in the three West African countries to near destruction – most places in the world would have also struggled. But where the three failed was at the basic “nitty-gritty” level of “standard surveillance, testing and monitoring, the containment of cases, the bread and butter of public health”, said Adia Benton, a social anthropologist at Brown University in Rhode Island.

    Citizen and state

    A successful malaria campaign in Sierra Leone last week, which reached 2.5 million people, and a planned polio and measles vaccination programme in Liberia, are positive signs for the health services. But the list of necessary reforms is long: stronger surveillance; healthcare that will work after the international partners leave; access to affordable services. The list must also embrace longer-term structural changes, including the relationship between citizen and state.

    According to Antonio Vigilante, Deputy Special Representative for the Consolidation of Democractic Governance in the UN Mission in Liberia, and Resident Coordinator, “there is a golden opportunity to have a different start, to have a more balanced development that leaves outcomes in the hands of the people. It’s a very delicate stage, full of opportunities, which should not be missed.”

    Liberia is one of the world’s poorest countries and Ebola has been a tragic addition to the burden. It has destroyed livelihoods; already dizzying rates of unemployment have worsened; and food prices have soared. Both rural and urban communities are suffering.

    Vigilante is worried the economic impact of Ebola, and the interruption of immunization and reproductive health services during the crisis, could put more people at risk than the virus itself did. “A number of [social protection] measures in the recovery phase would need to be universal,” he said. One example would be if Liberia scaled up its pilot Social Transfer Programme, launched in 2009, to provide just US$40 per year to two million children. There would be sizeable “knock on effects on local markets and entrepreneurship” at minimal cost, according to the Washington-based Centre for Global Development

    Lesson learned: “Community, community, community. Engagement, engagement, engagement”

    Schools are due to re-open on 2 February in Liberia, and a strong case could be made for a universal school feeding programme to attract and retain children in class. “Even before Ebola many children were out of school,” UNICEF spokesman in Liberia, Rukshan Ratnam, noted.

    Money matters

    But will the donors come to the party? Donors pledged $1.5 billion to a UN coordinated appeal for Ebola last year, but $500 million is still unpaid. “If we cannot close that funding gap we will snatch defeat from the jaws of victory. It’s as simple as that,” Bruce Aylward, WHO assistant director-general in charge of the Ebola response, told reporters on 23 January. 

    Wasted dollars can be expected in a crisis when the priority is effectiveness - stopping the outbreak - rather than efficiency in how the money is spent. That equation will change if Ebola does not come roaring back with the rains in April, and donors begin to look at competing needs.

    There is potential to re-purpose Ebola infrastructure - some of it now idle with a glut in treatment facilities - if donors are willing to be flexible, said Vigilante. Laboratories used for testing could be incorporated into national laboratory services; some of the more permanent treatment units could be re-launched as community-based health facilities; contact tracers could be used as community mobilizers. 

    “We certainly lost staff as a result of Ebola. But the converse of that is there was a very rapid upskilling as people were trained to work in the treatment units or as contact tracers. It’s a group we should build on,” said Harris. “It’s really important we don’t lose them in the transition to a normal service.”

    Local heroes

    Among the lessons learned across the region has been the importance of consulting, engaging and empowering local communities: their lack of trust in central government was a major handicap in tackling the epidemic. “Community, community, community. Engagement, engagement, engagement,” said Harris. “We need to listen more. We need to do a lot of work with sociologists and anthropologists.”

    Liberia in particular has a highly centralized system of government, but local communities have emerged as critical players in the response with a new can-do attitude. “People given a chance can do a fantastic job,” said Vigilante. 

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    After Ebola

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