The main factors behind Africa’s health tragedy are the lack of foresight and political will required to ensure sustainable health development, financing and universal primary health care, argues Rotimi Sankore. Through exploring comparative statistics for African and Western health systems and by underlining the effects of institutional under-funding and the brain drain, the author contends that future generations of Africans may yet look back and conclude such policy to be the equivalent of institutional ‘manslaughter’.

Through exploring the importance of sustainable and long-term health financing, Rotimi Sankore argues that effective primary health care will only be achieved when key obstacles in the shape of a lack of clear policies and Africa’s critical health workforce shortage are addressed. He stresses the debate around ‘health systems versus disease specific interventions’ to be a phantom one akin to asking whether food is more important than water to human life, arguing that the real challenge for the future will lie in creating and implementing effective policies that tackle persistent institutional and resource-based issues.

1. AU MEMBER STATES MUST STRENGTHEN CAPACITY OF THE AU COMMISSION AND ASSEMBLY OF HEADS OF STATES TO COPE SIMULTANEOUSLY WITH LONG-TERM DEVELOPMENT GOALS, AND ‘EMERGENCY’ ISSUES SUCH AS ZIMBABWE:

The dominance of Zimbabwe’s governance and human rights challenges at the recently concluded 2008 African Union midyear summit in Egypt highlights that AU member states urgently need to strengthen their capacity to follow through on details of, and implementation of commitments to key African development issues – alongside other equally important issues that are not summit themes.

Specifically the Commission of the African Union needs to be provided with more resources and capacity to ensure AU ability to maintain 100% focus on long-term key development goals while simultaneously coping with emergencies on governance, human security, and peace and security issues. In addition, the Assembly of Heads of State themselves need to build their own capacity to cope with these ‘emergencies’ at summit level, alongside producing clear decisions and outcomes on summit themes. Issues like Zimbabwe, Darfur or the food crisis could hardly be described as a surprise to any of our Heads of State. They also need to provide the crucial resources for in country summit preparation, and implementation of outcomes between summits by a strengthened AU Commission, the AU Executive Council, relevant line Ministers and the Ambassadors on the Permanent Representatives Council.

First, a statement of principles; Every African is obliged to stand up for equality, democracy, human rights and social justice - not just for ourselves as individuals or only in our villages, cities, countries and regions - but for all Africans across Africa regardless of gender, ethnicity, race, political or religious beliefs. These must be the bedrock of genuine Pan-Africanism. All of Africa's anti slavery, anti colonial and liberation struggles regardless of their shortcomings [and yes they had shortcomings] were based on these very principles and the concept of an Africa United for social and economic development is nothing but empty rhetoric if it is not based on them.

Consequently for any body genuinely concerned about the future of Africa there can be no politics of convenience. To be sure, the Zimbabwean crisis is not the only crisis in Africa, and this writer believes that all African's must engage any crisis that endangers the social and economic development of Africa on the basis of the above stated principles - be it in Darfur, DRC - or Zimbabwe.

However, the Zimbabwean crisis is arguably the only ongoing crisis in which one side (the incumbent government) and its supporters have mobilised African support and silenced many by asserting more or less that its critics are sympathisers, supporters or agents of foreign interests and former colonial masters. This has wrongly narrowed the framework of the debate on the Zimbabwean crisis into an oversimplified context of African nationalism and anti colonialism versus imperialism and colonialism. If the name of Africa is being invoked in justification of government policy then Africans must have a position on it. As we sometimes say, you can't call on your people, and not expect your people to call on you.

The above in turn underlines an outstanding feature of the crisis - that the current Zimbabwean government is based on the country's liberation movement - which was supported by the majority of Africans, people of African descent and anti colonialists universally against the undemocratic minority white Rhodesian regime of Ian Smith and its supporters. The Zimbabwean government has re-mobilised this historical support by positioning itself as continuing the liberation struggle to “reclaim our land”.

By framing issues in terms of: Are you for land reform or not? Are you for or against white farmers? Are you for or against colonialism? Are you for Africans or the colonialists? President Mugabe has posed in a more sophisticated way; the rhetorical statement so crudely articulated by George Bush that it eventually backfired - “you are either with us or with the enemy”.

Such “you are with us, or with the enemy” rhetoric regardless of the cause which claims to serve, its sophistication or crudeness is dangerous to human rights, to social justice and ultimately to Africa's development because it suggests that anything can be done in the name of defending 'us' against the alleged 'enemy' or even worse, that anything can be done to alleged 'enemies' in the name of defending 'us'. It also suggests that no wrong can be done in the name of fighting the alleged 'enemy' and ultimately that anything but unquestioning loyalty is betrayal.

The continuously evolving logic of such rhetoric is that the definition of enemy is elastic and 'they' [but not the government] can be held responsible for anything and everything that goes wrong. Any acceptance of such a political philosophy by either African citizens or leaders will stagnate intellectual progress in all fields and place Africa in a state of permanent backwardness.

We must make no mistake about it - all of human progress - in science, technology, the social sciences and politics, philosophy and the arts - is based on challenging and improving the status quo or building on previous 'standards'. Put simply, all of human progress is based on rigorous examination of existing conventional wisdoms and on dissent. Every African and in this case every Zimbabwean must therefore have, and exercise the rights to freedom of opinion, expression, association and assembly without fear of, or actually being beaten senseless, incarcerated or killed. A situation in which people face potential sanctions for not toeing the official line - are assaulted by 'law enforcement' agents merely for singing and dancing [to anti government songs], women are detained for peaceful protests, passports are seized and lawyers are beaten for representing clients is absolutely unacceptable. If it was wrong for minority white regimes to have such policy and practice, it is even more wrong for a black majority government based on a liberation movement to do the same.

Africans cannot accept any policies from people on whose behalf we protested when the same treatment was meted out to them. All Africans must therefore stand firm against any idea that being in 'opposition' means people are not human, or that they are human but don't have human rights. It's a question of principle. All political parties must be aware of the possibility that they will not always be in power - including ZANU-PF. Then they will expect their rights to be defended.

If the state of social and economic development is a key indicator of the state of affairs in a country, a no less important indicator lies in the possibility that all citizens can criticise their government and its policies, offer alternate opinions and ultimately change their government by civil means if that is the wish of the majority. No government - not even the governments of or leaders of liberation movements can arrogate to themselves perpetual wisdom and power.

People can debate indefinitely whether or not the Zimbabwean crisis is as a result of poor government policies, or has been provoked by sanctions and dirty tricks campaigns by 'colonialists' or both. What there is no debate about is that there is a political crisis linked to the apparently indefinite stay in power of President Mugabe. There is absolutely nothing anti Mugabe about anyone wondering if after 20 years as President another Zimbabwean out of its over 12 million citizens - whether from his party or any opposition party - cannot be elected to lead the country.

In Mozambique, Namibia, South Africa, Tanzania, Zambia and other countries leaders of liberation or anti-colonial movement governments have stepped down and are still living - Mandela, Kaunda, Chissano, Nujoma, Mkapa and the list is growing. In Ghana and Zambia where the last African Union and SADC summits respectively held and the Mugabe government made it a point to mobilise its supporters there have been successful changes of the party of government in 2000 and 1991 respectively without the roof caving in on those countries. 20 years is enough for any President to make contributions to the progress of his or her country. Nobody needs foreign governments to tell us that. On the whole African democracy is not perfect but on the balance it is heading in the right direction. Zimbabwe cannot be an exception to this progressive trend.

The African Union under the stewardship of Chairperson Konaré (himself a former leader of Mali that also led by example) has come a long way from the OAU and it must underline this point. It is a sign of progress that the AU leadership and many member governments have so far agreed with African rights campaigners that leaders of countries with unresolved rights and governance issues cannot Chair the AU unlike the days when even the worst of despots like Idi Amin could Chair the former OAU with impunity. The AU and SADC must continue in the spirit of the AU constitutive Acts, SADC Declaration and other key principles and discourage the idea that African leaders must stay in power indefinitely so as to avoid defeat by colonialists. The colonialists have essentially been defeated. That is why the country is called Zimbabwe not Rhodesia, and President Mugabe not Ian Smith has been President for 20 years.

Yes some foreign interests will continue to meddle in Africa, whether directly or through proxies - this happens in almost all parts of the world. But the future of Africa is now in the hands of Africans. Our governments can therefore not adopt the same repressive policies of the colonialists in the name of continuing the fight against them. It is important to emphasise that democracy is imperfect universally and also that the pendulum of power often swings from one end to the other between ideologies, parties, and factions within parties. Parties also evolve and change and what they stand for today may not be what they stood for yesterday or will stand for tomorrow. For example, the world watched in disbelief during the 2000 Bush versus Gore election fiasco in the United States which were it to have happened in Africa under the same circumstances would have been described as “typically African”.

In the spirit of parliamentary democracy with no term limits, former Conservative leader Margaret Thatcher whom presided over the last days of the Rhodesian regime and whom regarded the ANC in South Africa as a 'terrorists' was tempted to go on indefinitely after 11 years as UK Prime Minister until hounded out in tears by anti poll tax mass protests and her own party. Most recently former Labour leader Tony Blair under pressure from his own party and the public barely managed to negotiate a dignified exit after 10 years in office.

In Latin America where some governments would consider themselves as liberation type governments, Daniel Ortega and the Sandinistas for instance lost elections in 1990 to openly foreign backed Contra's after coming to power in 1979 on the back of a popular rebellion that overthrew the Somoza dynasty. By the 2006 the Sandinistas had been voted back into power. How may people looking at US politics today would realise that founders of the Republican party in 1854 included anti-slavery activists and that the Democrats now heavily supported by African Americans once benefited handsomely from slave owners. The point here is that majority of African countries have been independent for only between 13 and 50 years and Africans must take a longer-term view of political history.

If despite obviously democratic imperfections many African and non African countries have managed to change leaders and parties of governments without the world coming to an end, there is no reason why it is impossible for Zimbabwe to have a future without President Mugabe in power, or for President Mugabe to live without being in power. Even Ian Smith leader of the Rhodesian government that committed countless atrocities against Africans and swore that Black majority rule would never happen has lived in post colonial Zimbabwe - and is now a grand old man of 88.

There is nothing personal about upholding democracy; the interests of the citizens of a country must always come before that of the leadership of any government. The above underlines the fact that people can also debate without end about whether the Zimbabwean economy is collapsing, has already collapsed, or will never collapse. The fact is that an estimated three million [undoubtedly very Black] Zimbabweans have fled the country with many living as refugees in neighbouring countries. They must be running from something. We now face the debacle of armed racist farmers on the South African Zimbabwe border fulfilling their racist fantasy by being presented with opportunities to hunt down and round up Zimbabweans fleeing across the border in the name of defending South Africa from invading “illegal foreign criminals”. Even if the present Zimbabwean government claims it bears absolutely no responsibility and that drought, withdrawal of credit lines, sanctions or even the cycle of boom and bust that has caused recessions even in advanced industrial economies is responsible for the economic misery, the fact is that it is almost impossible to offer alternatives without being “bashed”.

No one but the government can be blamed for the rash of legislation that has no other role than to contain, intimidate or suppress criticism and peaceful opposition. The laws and policies speak for themselves “Public Order and Security Act”, “Interception of Communications Act” and so forth. How many people demanding uncritical loyalty for the Zimbabwean government would happily live under laws which its just a question of a matter of time before anyone becomes an arbitrarily victim. It makes no difference if the foot in the boot kicking you and your rights into a dungeon is Black or White. A kick is a kick.

'Sanctions' cannot be blamed for everything. By way of comparison Cuba a country of similar population and even greater anti-imperialist zeal has faced well-documented and comprehensive blockades, sanctions and invasions [not to mention numerous assassination attempts against its leadership] by “foreign interests” over a greater 40-year period and on a scale far surpassing anything Zimbabwe will ever experience. Despite obvious democratic deficits, the Cuban government has won grudging admiration of even its critics because healthy life expectancy in Cuba - at 67 and 70 years respectively for men and women respectively - has risen and been sustained at a level equivalent to and in some cases higher than in the most advanced industrial countries. In Zimbabwe current healthy life expectancy has sunk to 34 years and 33 years respectively for men and women, also making Zimbabwe one of the countries in the world where men are expected to live longer than women.

This is not an endorsement of any section of, or all of the opposition, or even of hypocritical foreign policy from some countries - but rather of the right of all citizens including the political opposition to exist without fear of repression. Just as we know that being a liberation fighter does not guarantee that anyone will be the best possible leader in government, we all know that being an 'opposition' movement or leader is not a guarantee that anybody will do better than those they seek to replace. Regardless, one of the indisputable conditions for the development of Africa is that the principles and culture of democracy must be institutionalised. No one should insult the memory of countless Africans murdered by colonial settlers to facilitate stealing of their land by suggesting repressive laws are necessary to implement or defend land reform. Without doubt land reform is a necessary part of social justice for Africans, but it must be judicious, equitable and transparent land reform based on respect for human rights and the rule of law - not land reform used as a political cudgel to 'bash' all critical voices.

I have heard some people argue that the 'enemies' of Africa now crying about human rights did not burden their conscience with such luxuries when benefiting from 400 years of industrial scale slavery, colonialism and brutal exploitation of Africa and its peoples. In other words, that 'white farmers' deserve some of their own medicine. Not only does such thinking reduce African's to the moral bankruptcy of colonialists, it also fails to understand that it risks granting unlimited and indefinite power to Africa's actual and imaginary liberators such that we may all end up be shackled by them. Africa's liberation movements drew their moral strength from the fact that on the balance, they fought for social justice, human rights, equality and democracy - for all - not for card-carrying members of ruling parties.

The philosophical algebra of this equation is that there should be no expectations that these principles can be discarded as inconvenient while still counting on the unwavering support of all Africans. Africans must therefore unite for social justice and human rights across Africa - including in Zimbabwe. Some people also think that because of either real or imagined 'western' hypocrisy we must always give unconditional loyalty to the Mugabe or any government that claims to be defending Africa against 'imperialism'.

The hypocrisy may be real but our primary concern must be the welfare of Africans, not whether President Bush as part of his politics of convenience - supports the Musharraf military regime in Pakistan which was suspended from the Commonwealth in 1999 for overthrowing an elected government (while simultaneously passing the Zimbabwe Democracy and Economic Act), or even whether some of the western media engage in 'colonial mentality' reporting which fulfils negative stereotypes of Africa. Our health care system, education, food and overall social justice and development must come first. It is impossible to build on development achievements if everyone must agree with official policy. Regardless of party affiliation nobody's stomach is neutral on the question of hunger. No disease asks for your party card.

While all Africans with any dignity must remain firmly anti-colonial and anti-racist, we must also view with scepticism any blanket anti-western and anti-white rhetoric. Not withstanding that some foreign governments described the ANC and other liberation movements as “communists” and “terrorists” or both, while simultaneously supporting bandit governments such as the Mobutu regime, Africa's anti colonial and liberation movements were supported by millions across the world including from the West. Even some governments such as the Swedish were proud supporters of liberation movements and post independence governments long before it became fashionable to do so.

President Mugabe is a former teacher and one of Africa's most educated and experienced leaders. After over 2 decades in power, he does not really need anyone to tell him that it is not only possible to be in office without being in power; it is also possible to be in power without moral authority. Once any leader anywhere gets to that point it is irrelevant what you claim to stand for. What will become relevant is that you did not stand down when you should have done so - of your own free will - and in the best interests of your people.

*Sankore is a Pan-Africanist and Human Rights Campaigner.

*Comments and responses to , or comment online at

From the 1-3 July 2007, African leaders will meet in Accra, Ghana at the 9th Ordinary Session of the Assembly of the African Union. The major agenda item is the proposal and plans for the United States of Africa. Africa’s underdevelopment as manifested in its public health catastrophe is not on the AU summit agenda. This raises the crucial question of the kind of unity African leaders wish to achieve. Significantly the debate about the proposed union has revolved mainly around political issues without commensurate attention to the development issues which were no less important to the founders of the Pan African movement.

It is now six years since Heads of State of African Union member states pledged in Abuja in 2001 to commit at least 15 per cent of national budgets to health. To say it is tragic that in 2007 only two out of fifty three AU member countries (Botswana and Seychelles) have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy.

In these past few weeks, all roads led to the G8 Summit in Germany. In what has become an annual ritual since the turn of the century, international campaigners Bono, Bob Geldof and an impressive assortment of Development and AIDS related organisations led the calls for more aid to Africa, and for Africa not to be forgotten in the clamour over climate change. As usual, selected African leaders turned up with begging bowls and for photo calls. Leading international campaigners have since described the aid pledged by the G8 this month as 'a farce' and 'grossly inadequate'.

We know that many of the more developed countries have played historical roles in under developing Africa. 400 years of industrial scale slavery, in addition to colonialism, ruthless exploitation of Africa’s resources, cynical ‘interventions’ and the debt burden have cost Africa dearly. The ‘foreign’ aid to Africa is a percentage of what has been taken out in human and natural resources, and is but a small step towards repairing the damage done to Africa.

But we also know that African leaders cannot seriously expect other countries to commit to, or meet pledges to ‘save’ Africa when they themselves appear indifferent to Africa’s future. To be going forward with plans for African unity without simultaneously meeting the most fundamental commitment to African development – that of health - is misguided to say the least.

It is comical for us to be calling on the G8 countries to meet the recent Gleneagles pledges when the vast majority of AU member states have not met their own Abuja 2001 pledge. This is not a pledge we can afford to pass unfulfilled. The Africa Public Health Rights Alliance (APHRA) and its '15% Now!' Campaign revealed on Human Rights Day (December 10) 2006 that by crossing continental, sub regional, country, health, disease specific and development information from a wide range of agencies and institutions we computed that an estimated 8,000,000 Africans are dying annually from preventable, treatable and manageable diseases and health conditions – mainly Malaria, TB, HIV, child and maternal mortality. This figure does not include organ related disease (heart, liver, kidney and lung diseases), an assortment of cancers, vaccine preventable diseases and so forth which could very easily add another million – or more. The consistency of these figures over the past six years alone means that Africa has suffered an estimated 48,000,000 preventable deaths since 2001.

By coincidence, the dream of the United States of Africa is planned to be actualised by 2015, the same year the Millennium Development Goals are to be met. If Africa’s health catastrophe continues unabated we could loose another 72,000,000 lives by then. This is the equivalent of whole nations dying out within a year or a decade. Many African countries (such as Botswana, Burundi, Eritrea, Gambia, Lesotho, Liberia, Libya, Namibia and Swaziland) have populations of between 1-8,00,000. Most of the island countries have populations of less than a million. Even Africa’s most populous countries (DRC, Ethiopia, Kenya, South Africa, Sudan - with the exception of Nigeria at 130,000,000) all have populations of between 30-80,000,000.

It would therefore not be an exaggeration to describe over 120 million preventable deaths between 2001 and 2015 as genocide – by inaction. In this case and for every life lost, government indifference to Public Health is the equivalent of an Interehamwe machete or Nazi gas chamber. If we were set up memorials to the preventable deaths from one year alone, we would need 100 stadiums in Africa with the capacity to each host 80,000 skulls – each a stadium of shameful silence, and a monument to government without responsibility.

Africa Must Unite! But for it to be a meaningful unity it must not be a unity of the dead. It must not be unity as a continental graveyard.

Meeting the 15 per cent pledge will be a significant indication that African leaders care for their countries and are prepared to live up to their primary responsibility of keeping their citizens alive and healthy. No meaningful and sustainable development of Africa can happen without sustainable financing for health care. Indeed the status of public health is the most significant indicator of social and economic development. This is why the Right to Health is the most crucial Right of all – we all have to be alive and well to exercise any other Rights. The dead have no Rights – except perhaps the ‘Right to a decent burial’.

To postpone the meeting of the 15 per cent pledge to the future is to accelerate the death of Africa. We call on the African Union to place the 2001 15 per cent pledge on the July 2007 summit agenda and at the very least to introduce it as urgent business [under item vii, AOB]. We further call on them to make it a major agenda item of the next summit or to call a special summit dedicated to meeting the 15% pledge. This should be preceded by a special summit of Finance and Economic Development Ministers

To further illustrate the full scale of Africa’s health disaster, it is not enough to demonstrate only the unprecedented scale of preventable death. It is also crucial to demonstrate the scale of Africa’s impotence and one example will suffice.

Without health workers, no amount of free medicines can be delivered to citizens, and all ‘foreign’ AID is meaningless. Yet many African governments have no clue how close to death their countries are due to shortage of health workers of all categories.

The DRC with a population of 57 million, roughly equivalent to the populations of UK, France and Italy has only 5,827 doctors compared to the France’s 203,000, Italy’s 241,000 and the UK’s 160,000. But it is not just a case of the most developed countries being able to train more health workers, or to poach from Africa to make up their shortfalls. Cuba with a population of about 11 million has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi’s 266, Zambia’s 1,264 and Zimbabwe’s 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as the G8 Countries, the Scandinavian and other developed countries while the average life expectancy for African countries compared to it here is 37 to 40 years. The success of Cuba in the areas of health care and education demonstrates it can be done. Despite issues with the Castro government, western countries have visited Cuba to study how they have achieved their health success. To come anywhere near meeting the World Health Organisation recommended health worker’s to patient ratio or meeting the health based MDG’s these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years. The DRC will need to train and retain at least 150,000. The numbers for nurses, pharmacists and most categories of health workers are comparable across board. This should be Africa’s priority.

In other words, there is no alternative to long term in country sustainable financing to rebuild Africa’s Public Health systems including health workers and improved working conditions and remuneration for them, adequately equipped clinics and hospitals, improved sanitation and environmental health, clean drinking water and so forth. Without these Africa may achieve its dream of continental unity, but it will be a fools paradise.

We are for a United Africa. But it must be a unity of the living, and of a healthy African people – able to enjoy full civil, social, economic and political Rights - not a unity of the diseased, dead and dying. Successfully unity can only be based on successful development of which health is the corner stone.

The Africa Public Health Rights Alliance and its 15 per cent Now campaign calls on you to join the undersigned below in signing the petition calling on AU member countries to fulfil their 15 per cent Abuja pledge as the first genuine step towards a healthy United States of Africa.

* Rotimi Sankore is Coordinator, Africa Public Health Rights Alliance and its “15% Now!” Campaign.

In its 2006 annual report, the WHO reports that out of 57 countries, 36 countries in sub-Saharan Africa suffer from a severe shortage of health workers, such as doctors, nurses, pharmacists, lab technologists, radiographers and other frontline or support staff. Rotimi Sankore argues that the ‘brain drain’ is slowly and indirectly killing the continent.

In times of crisis and epidemics, diplomacy is a luxury the dying cannot afford, especially when millions of Africans know that an over emphasis on niceties will almost surely lead to millions more deaths.

Conventional wisdom has it that Africa is suffering from an AIDS crisis. In reality, Africa is suffering from a public health crisis, and the AIDS pandemic is the most significant symptom of that crisis, which has been worsened by the drain on Africa’s healthcare workforce to the ‘West’. The amazingly wrong political diagnosis of the challenging healthcare problems facing Africa and indeed the planet, has blunted the obvious fact that tuberculosis, malaria, a host of other preventable diseases and malnutrition still claim more African lives than the 2 million deaths attributed to HIV/AIDS annually. Combined with HIV and AIDS, these diseases are rapidly turning Africa into a continental graveyard. Yet the emphasis remains mainly on AIDS, which has been crowned the most sexy villain.

The countries with little or no health worker shortages and better health infrastructure have managed to cope better with HIV/AIDS because they are better able with preventable diseases like TB, sexually transmitted infections, sexual and reproductive rights education and malnutrition. AIDS is a problem on its own, but it is also being fed by other unresolved health problems and the lack of political will and courage. Resolving Africa’s public healthcare crisis will resolve most of the other issues and be a step towards isolating AIDS which can then be tackled more easily. The first step must be resolving the health worker shortages, which includes dealing with the “brain drain”.

2006 has been a landmark year for HIV/AIDS in terms of the number of huge international meetings and conferences organised. These include the Abuja African Union Special Summit on HIV/AIDS, Tuberculosis and Malaria in June; the UN General Assembly Special Session on HIV/AIDS (UNGASS); and the 16th International AIDS Conference in Toronto in August.

These events reflect the huge progress that has been made in tackling HIV/AIDS. With the exception of the most backward governments and institutions, it is clearly understood by the majority that inequality in gender relations is one of the most significant factors behind heterosexual transmission.

On the other hand, these events underscore the huge failures and missed opportunities in the struggle against HIV/AIDS, the biggest yet being the comprehensive failure to resolve the human resource and health infrastructure crisis in Africa.

The problem seems to be that acknowledging, prioritising and acting on the “brain drain” problem means that governments of countries that have benefited from the “brain drain” have to take responsibility, and cease their recruitment of healthcare workers from Africa. Likewise, many African governments will also have to address their governance problems and the working conditions for healthcare workers as means to counter the “brain drain”.

United Nations population researchers conclude that unless the spread of HIV is halted or reversed, Africa will top the global AIDS death league with about 100 million deaths by 2025. This is more than double the projections for India and China of 31 million and 18 million respectively, both of which have larger populations than Africa. People aged between 16 and 45 years of age will be most affected.

It is remarkable that institutions and social movements alike focus not on the continent’s health care crises, but on anti-retroviral drugs only. Anti-retroviral drugs are useful but when there are no healthcare workers to administer them to patients, they become useless

To drive the point home, let me put it like this, no war can be fought successfully without soldiers.

In April 2006, the World Health Organisation (WHO) officially acknowledged what African intellectuals have been saying for the last three decades, that the “brain drain” from all sectors of African society, but especially from the health sector, is slowly and indirectly killing the continent.

In its 2006 annual report, the WHO reports that out of 57 countries, 36 countries in sub-Saharan Africa suffer from a severe shortage of health workers, such as doctors, nurses, pharmacists, lab technologists, radiographers and other frontline or support staff. The report noted that the richest countries are filling their shortages by draining away doctors, nurses and others from less developed countries. As a result, one in four doctors and one in twenty nurses trained in Africa, is now working in the 30 most industrialised countries. Consequently, Africa is the only continent where the absolute number of shortage of health workers (817,992) far outstrips the current stock of 590,198.

Other studies have shown that “the majority of the countries in sub-Saharan Africa also do not meet the WHO’s recommended ratio of 1 to 1,000 [doctors]. Indeed, there are fewer than 10 doctors for every 100,000 people in 24 of the 44 Sub-Saharan African countries for which the statistics are available.” (Orji, Utsimi & Uwaje in paper presented to the International eHealth Association in 2005).

In contrast, Cuba has a doctor-population ratio of 1 to 165, South Korea 1 to 337, the UK 1 to 610, the USA 1 to 358, and Italy 1 to 165 (UNDP/Human Development Report, 2004). Figures from the International Development Research Centre (IDRC) state that on average, “The doctor-patient ratio is currently one per 500 in wealthy countries, and only one per 25 000 in the 25 poorest countries.”

The main factor that contributes to the low doctor-patient ratio in Africa is the “brain drain”. Quoting WHO and OECD figures amongst others, the IDRC illustrates the problem in Nigeria and South Africa. “One-third to a half of all graduating doctors in South Africa migrate to the US, UK and Canada, at a huge annual cost to South Africa (lost investment in education/training). Including all health personnel, the losses for South Africa reach US$37 million annually. This exceeds the combined (multilateral and bilateral) estimated education assistance for all purposes, not just health professional training, received by South Africa in 2000.” Alongside this, “over 21 000 Nigerian doctors are practising in the US, while there is an acute shortage of physicians in Nigeria.”

Not surprisingly, the IDRC concludes that “another reason for the deterioration of health-care systems in developing countries is the ‘brain drain’ of health professionals… which primarily benefits wealthier nations, such as the UK, the US and Canada, [and] calls into question G8 commitments to support developing countries in reaching health targets of the International and Millennium Development Goals”.

IDRC findings also reveal that “developing countries invest about US$500 million each year in training health-care professionals, who are then recruited by or otherwise move to developed countries… Meanwhile the United States, with its 130, 000 foreign physicians, saved an estimated US$26 billion in training costs for nationals… while estimates suggest that Africa spends approximately US$4 billion annually on salaries of 100 000 foreign experts (all sectors, not only health) to ‘build capacity’ and/or provide technical assistance, and incurs a loss of US$184 000 per migrating African professional”.

Dr Peter Ngatia of AMREF puts it more sharply: “Africa literally subsidises the West. It is a reverse subsidy from the poor to the rich… History is replete with instances of outflows of human resources from Africa to the rest of the world. The disgraceful and shameful slave trade epitomises this outflow, which robbed parts of the African continent of its young and strong-bodied men and women. This was followed by the colonial exploitation of the same in-fighting imperial wars that had nothing to do with Africa. The recent migration of workers, in the opinion of many, is nothing new. It is a perpetuation and perfection of what started centuries ago and has continued unabated.”

He expands by saying “According to the International Organisation for Migration (IOM), Africa has already lost one third of its human capital and is continuing to lose its skilled personnel at an increasing rate, with an estimated 20,000 doctors, university lecturers, engineers and other professionals leaving the continent annually since 1990. This same source estimates that there are currently 300,000 highly qualified Africans in the diaspora, 30,000 of whom have PhDs.”

Taking these factors into account, a coalition led by the US based Physicians for Human Rights, HIV Medicine Association and Association of Nurses in AIDS Care issued a 15 point plan at the July 2006 G8 summit aimed at ending Africa’s healthcare worker shortage. The statement emphasised that “G8 countries, particularly the US and UK, should reduce their reliance on health workers from abroad and seek to become self-sufficient in meeting their own health worker needs. For example, they should increase the domestic training of nurses, doctors, and other health workers. The United States should also develop a code of practice on international recruitment of health professionals, which includes not actively recruiting health workers from developing countries except in the context of an agreement with those countries that respects the right to health in those countries and is mutually beneficial.”

The British Medical Association has also cautioned that severe shortage of healthcare workers in sub-Saharan Africa because of migration to developed countries is a significant component of Africa’s AIDS crisis, and that countries like the UK must end their reliance on overseas doctors and nurses.

It is crucial to continue to stress the role of the “brain drain” in undermining African development in order to fight the myth that millions of Africans are dying of AIDS because Africa is a useless continent incapable of saving itself from anything. But stressing this is not enough. Africans must also lead from the front, or complain all the way to their graves, where only the silence of the tombstones will speak for them.

There is no doubt that Africa can rebuild its healthcare workforce both by further training and attracting some of those in the diaspora back home. The fact that a small country like Cuba, despite political and economic constraints, has a better doctor to patient ratio than most of the world’s developed countries also shows that it can be done by any country with the right healthcare priorities.

There is no human right more significant than the right to quality public health care. The infected and the deceased need first to live in order that all other rights to be significant.

This is why, as a contribution towards upholding the right to a healthy life in Africa and resolving Africa’s health care crisis, the AIDS and Public Health Program of CREDO-Africa, together with partners in Africa and around the world, are launching a campaign towards:

- That African governments make resolving the health worker shortage their number one public health care priority.
- That governments of countries that have benefited most from the “brain drain” cease such policies and examine ways to compensate Africa’s health care system for the damage their recruitment policies have done. - That the theme of the next International Aids Conference is focussed on scaling up human resources and health care infrastructure, especially in Africa.
- That all intergovernmental organisations such as UNAIDS and its key agencies focus on and act rapidly towards resolving the human resource and infrastructure shortages in Africa and the infrastructure in the next eight to 10 years.

*Sankore is Coordinator of Centre for Research Education & Development of Rights in Africa [CREDO-Africa]. He can be contacted at: [email][email protected]

*Please send comments to [email protected] or comment online at www.pambazuka.org

Part 1 [Nov 1995]

The charade is over
The masquerades
are on parade

Ribbons on heavy chests
One for every life
they have taken

The charade
- Is over
The Ogoni 9
were hung today

Injustice has triumphed
[But only for a day]

On the night of long knives
And wicked jibes
-starched uniforms and corporate suits gloated
as the bodies lay bloated

WHERE?
- they bellowed -
was the international community
when you were swallowed
by the gallows?

Could you not see
their fingers
dripping with oil
could not hold the knife
to cut you loose
from the hangman’s noose

[The charade is over]

The masquerades were on parade
in Auckland
- [and dancing
from Port Harcourt to Abuja
London to Washington
To ringing melodies
of cash registers] -
Hiding behind grotesque masks
of diplomatic disbelief
while their hearts
heaved sighs of relief
that rivers of oil
held up by the damned 9
would now flow

Part 2 [Nov 2005]

The charade is over

The masquerades
-have unmasked themselves
in the Gulf of Guinea

Today - we are united
in our songs - of defiance

We shall chant down
every BULLET and every BARRELL
Every SHELL and every TANK

Repression
has never triumphed
over free expression

Maybe in a skirmish or two
a battle or two
But in a war of words? Never!

You think
the revolution is dead
because you hung nine men?

Emerge from your corporate bunkers
from where you run your licensed bunkering
And you will see
in the eyes of their orphans
the mothers and fathers
of tomorrows revolution

-Pining for Justice
for towns and villages
reduced - to a Shell
of themselves

Amidst the intoxicated
clinking of barrels - of crude champagne
and wobbling stomachs - of your sated tankers
You cannot see
that even if you cant see the revolution
[In the burning light of flared gas]
the revolution sees you….

Rotimi Sankore copyright 95/05

In a world where graphic pictures of starving children are used by development agencies to raise funds from the public in the rich world, ROTIMI SANKORE critiques the phenomenon of ‘development pornograpy’ and argues that it has contributed towards deeper prejudice. New ways must be found to reach the public and more clearly explain the real reasons behind poverty in Africa, he states.

For decades, development and aid charities in the western world have believed the best way to raise funds from the public for their work is to shock people with astonishing pictures of poverty from the 'developing' world. An iconic poster example of these pictures is one of a skeletal looking 2 or 3 year old brown-skinned girl in a dirty torn dress, too weak to chase off dozens of flies settling on her wasted and diseased body and her big round eyes pleading for help. 'A pound means a lot to her'; 'a dollar can mean the difference between life and death'; 'Give something today' are generic riders.

This approach is partly based on the philosophy that 'a picture is worth a thousand words'. Since the development of photography and the mass media, this has been the mantra of any remotely competent photo editor and in modern times campaign and advertising executives.

The Make Poverty History Campaign, Millennium Development Goals and the Commission for Africa have again focused attention on existing poverty in Africa, Asia and Latin America. New targets have been set just as in the 70's and 80's when the target to end world poverty was the year 2000. New targets mean new campaigns and the type of images used to draw attention to the famine in Ethiopia in 1984 and 1985 will need to be updated. Unlike previously however, there are now even more development charities competing for a limited 'market' of givers. The implications are clear. Each image depicting poverty needs to be more graphic than the next to elicit more responses.

As some psychologists have argued, increasing levels of violence on television normalises violence. Subsequent images of violence then need to be more graphic to make an impact. Likewise an addiction to pornography demands increasingly graphic images to provoke even minimum arousal - in this case, a sense of outrage necessary to sustain similar levels of giving. But despite the number of lives saved or enhanced by aid, the most horrendous pictures do not and are incapable of telling the whole story; neither will development charities conclusively solve the problem of poverty that exists worldwide.

Increasingly graphic depictions of poverty projected on a mass scale by an increasing number of organisations over a long period cannot but have an impact on the consciousness of the target audience. That is the desired objective. But there can also be unintended consequences. In this case, the subliminal message unintended or not, is that people in the developing world require indefinite and increasing amounts of help and that without aid charities and donor support, these poor incapable people in Africa or Asia will soon be extinct through disease and starvation. Such simplistic messages foster racist stereotypes, strip entire peoples of their dignity and encourage prejudice.

Some may genuinely think that this is mere exaggeration. But when a leader of the Conservative opposition announces bombastically that under his government, all immigrants, refugees and asylum seekers would be subjected to tests for tuberculosis and HIV/AIDS in order to save the National Health Service millions of pounds, you can tell he thinks he is on to a vote winner. He either sincerely believes most people from those places carry dangerous diseases, or his strategists believe this will tap into the fears and prejudices of millions of voters. Either option is offensive and no amount of denials will avoid the fact that such prejudice is based on negative stereotypes. And where have most of the negative stereotypes come from? Your guess is as good as mine. Periodic appeals for donations using graphic and stereotypical images of poverty reach millions every year. The intentions may be good, but some of the consequences are not. Additionally many Africans and Asians resent negative stereotypes of their continents as anybody would, and find them offensive no matter what cause they are employed for.

Over time, there has been gradual but increasing awareness that pictures can lie even when they are a 'true' likeness of an instant in time. In the former Eastern bloc, images of poverty stricken homeless people in the 'West' were the only picture many had of capitalism. In today's world of digital media and convergence there is a clear understanding by media experts that often-repeated images can and do create a false consciousness of what is real.

While the poverty is real, the subliminal message development 'pornography' conveys is unreal. There has been some development alongside the poverty and the causes of poverty are far more complicated than single pictures can ever convey. In Africa for instance, previous undemocratic rule facilitated or conveniently accepted by many western governments - to fight off the threat of 'communism' - has ensured institutional imbalances in the development of the political and democratic process. As a result former dictators and their cronies have exclusively accumulated fabulous wealth necessary to meet absurd financial conditions set by biased electoral bodies in many countries. Actual electoral expenses that are unregulated run into hundreds of thousands of dollars and in huge countries such as Nigeria (population 130 million) even millions. And then there is the pre and actual ballot rigging using the mass media and state apparatus. Add to this layers of repressive laws - originally introduced by colonial governments to suppress restless natives - that have led to the death, imprisonment, intimidation and exile of tens of thousands of intellectuals, activists, lawyers, journalists, trade unionists, students and scientists and it is clear that most of those managing these economies and societies are not the best qualified to do so.

One dares not even go back to the consequences of 400 years of slavery that directly or indirectly killed and took away over a hundred million Africans and in the process disrupted all social and political development for four centuries, or subsequent colonial repression that in some places lasted over a 100 years. Most of Africa has been independent for only between 10 and 46 years and for most of that period many countries were ruled by left and right wing or simply mad dictators supported by cold war enemies jostling for strategic influence.

With all the slavery, colonialism, mass murder, repression, looting, corruption, trade imbalances, an doutrageous interests on dubious loans that have gone on for 500 years it is no wonder the continent is bruised and battered. No continent subjected to the same conditions would have fared better.

No pictures can explain this. What development 'pornography' shows is the result, not the cause of five centuries of aggressive exploitation of a continent. The relatively smoother development in parts of Asia exists because no industrial scale slavery and destruction of society was imposed there for four centuries. Unlike in Africa, the foundation of most Asian civilisation and culture remained largely intact. Colonialism suspended the natural trajectory of development in Asia that then continued once its yoke was lifted. Were it not for the immortality of the pyramids and scattered records of past African civilisations, the entire continent might have well been declared a historical wasteland.

Without clear explanations of why poverty persists in the developing world, the western public will tire of giving and sooner or later there will be a backlash; some argue that such fatigue has already begun to set in. For now negative stereotypes may already have been so ingrained that the level of ignorant prejudice that facilitated the transatlantic slave trade, the holocaust against European Jews, Apartheid and genocides from the Balkans and Cambodia to Rwanda may have already taken root.

This is no exaggeration. The first step towards institutionalised prejudice, exploitation and violence has always been a false mass belief that other peoples or sections of society are unequal, sub-human, vermin, dangerous, treacherous or whatever is propagated until it becomes an 'accepted truth'. The most universal example of consequences of such false beliefs is the exploitation of and violence perpetuated against women in all societies. Development 'pornography' has unwittingly contributed towards prejudice and must find new ways to reach the public before its good intentions irreversibly facilitate bad ones. Most importantly, what the developing world needs is a reversal of the institutional imbalances that have facilitated repression, exploitation, incompetence and corruption and a pledge from western interests to allow their people to freely define their future.

© Rotimi Sankore. Sankore is a journalist and rights campaigner, who has written widely on history, politics, culture and rights issues in Africa. This article was originally published  in the April newsletter and the website of Bond (British Overseas NGOs for Development) which has 280 member organisations and is the United Kingdom's broadest network of Charities/NGO’s and voluntary organisations working in international development.

* Please send comments to

A tsunami of the sort that hit Asia will hit Africa sooner or later. It's just a question of how much sooner or later: one year, 10 years, a 100 or a 1000 years, and if it will be bigger or smaller. The impact it will largely depend on how prepared the continent, individual countries and governments will be for its consequences.

Tectonic plates on which all continents rest are continuously shifting - triggering underwater quakes and volcanoes. Global warming and melting of polar caps will also raise sea levels, increasing the chances of submersion of coastal areas. Over 30,000 earthquakes are recorded annually. On average one or two are seriously destructive to different degrees. There are 500 active volcanoes and about 50 of them erupt in any given year. More importantly quake zones change as tectonic plates beneath the continents shift. Wishful thinking will not prevent a tsunami, but anticipation, preventive measures, containment and effective emergency measures will nullify or ameliorate its consequences. The time to prepare is now.

Now that the big headlines from Asia are gone its time for sober assessment by the next potential victims and they don't come bigger than Africa. The reason is simple. Africa has the least developed infrastructure to cope with destruction on a mass scale.

Every scale of practical assessment - early warning and evacuation capacity, communications and transport network, flood defences, building safety and standards, population density of coastal cities, medical facilities, emergency relief procedures, emergency stocks of water, food, blankets etc - indicate that were a tsunami of similar scale to that of 26 December to hit Africa today, the death scale would not be around 300,000 as in Asia but between 500,000 and a million depending on what coast of Africa is hit. The number of countries and coastal cities involved will be key factors influencing the casualty rate and for sure the displaced and homeless rate will top the roughly 2 million from the Asian tsunami.

For instance, a major line of seismic activity runs along Africa's western and southwestern coast in the South Atlantic Ocean. A major quake there could trigger a tsunami that will hit the western and south western coast of Africa, including most or all coastal cities and towns in Senegal, Gambia, Guinea Bissau, Sierra Leone, Liberia, Cote D' Ivore, Ghana, Togo, Nigeria, Benin, Sao Tome and Principe, Equatorial Guinea, Cameroon, Gabon, Congo, Angola, Namibia and parts of South Africa. This could include significant coastal cities such as Accra, Cape Town, Lome, Dakar, Banjul, Monrovia, Freetown, Abidjan, Luanda and Lagos that range in population from less than a 100,000, to Lagos which alone has an official population of 14 million. In these cities millions live within two kilometres (tsunami range) of the ocean, especially in Lagos where the estimate is at about three million. The statistics project a monumental disaster.

But a tsunami will not be the first 'natural' disaster to hit Africa. Over the past decade, between four million and six million Africans have died annually from 'tsunami' scales of leading killer diseases, malaria, HIV, TB, measles and typhoid. Malaria alone kills about 3,000 children a day in Africa. Almost double the number of Asian Tsunami victims die every month of preventable or treatable diseases in Africa. Some may feel that if the bodies were laid side by side every month for the cameras, maybe governments would wake up to their responsibilities. With all due respect to the Asian victims and their families, it is no less sad that mosquitoes strike individually and each family suffers in isolated grief.

The relevance of this here is that African governments are already failing their people in respect of preventive measures for the leading causes of death. Even in a war, such a casualty rate would be untenable.

In addition to human life that is not measurable in monetary terms, such losses to disease are bound to have an economic impact. Malaria alone is estimated by world economists to cost Africa in social and economic terms the equivalent of about $12bn a year yet it would cost only a fraction of this to contain it. This is roughly the same figure at the lower end of estimates for reconstruction in the Asian tsunami zones and twice the amount being offered in debt relief by Paris Club and G8 countries to affected Asian countries.

Should Africa then spend time and resources preparing for a tsunami that has as much chances of happening today as in 10 years time while for sure an equivalent number of projected tsunami victims are already dying every month of preventable diseases and will continue to do so for the foreseeable future? The answer is a resounding - Yes! For one thing, a tsunami would knock already stumbling economies and healthcare systems into a coma.

Preventable diseases, terrible as they are, take human life and rob Africa of her most precious resource - its people. Earthquakes and tsunamis will not only take lives, they will simultaneously concentrate and magnify the depth of misery by wrecking cities and creating refugee situations across massive urban areas. For instance, nearly three million people have been displaced by the Asian tsunami and some experts estimate that about four million would have lost jobs. That's four million more families with no income. The projected social implications for basic rights such as education, nutrition and healthcare are mind boggling not to mention social dislocation, anarchy and crime.

In Africa, the domino effect from a refugee crisis in major cities would also sink already non-existent public housing sectors. Health wise, Africa already looses the highest percentage of its trained health care personnel every year to emigration and a public health crisis is looming in major cities. A tsunami hit would massively complicate the malaria, TB, HIV and measles situation, not to mention diseases transmitted by contaminated water and malnutrition.

Economically speaking, the fact that historically, coastal cities in Africa have evolved into main centres of commerce (flowing from when slaves were transported through them and later raw materials for the same trans Atlantic routes) means that any significant mass destruction of these cities will have a multiplier effect on national economies not dissimilar to shockwaves from a nuclear bomb. Already stumbling economies will be laid comatose.

Any observant visitor to major coastal cities in North America, Japan or Australia for instance would not have failed to notice that there are tsunami warning systems and evacuation routes planned in advance and clearly marked. Australia for instance issued a tsunami warning within half an hour of the December quake. These indicate clearly that even reasonably developed economies cannot afford the potential loss of life that could be wreaked by such natural disasters. Some will argue that the pacific and Indian oceans are more prone to tsunamis. While this is true, surely it is a warning shot that the Asian tsunami travelled seven hours to east Africa thousands of miles away and killed 137 in Kenya, Seychelles, Somalia, Tanzania and Madagascar.

Having realised that a warning system (giving 15 minutes to 2 hours notice) could have saved at least 200,000 lives, all countries in the Asia region met in Thailand within a month of the Asian tsunami to agree on logistics for establishing an Indian Ocean tsunami warning system. The cheapest system possible will be ready by 2006 and will cost about $8m. India alone is planning to invest $29m in warning systems. Enthusiasm at the conference was so high that countries clashed over where the coordinating centre should be located with some offering more money than it would cost to establish it to secure the centre. When the Asia-wide warning system is ready, Africa will be virtually the only continent without a tsunami warning system. If other continents think it necessary to protect themselves, why not Africa? Governments and people need to be ready and on current form this will not happen.

For instance, how many governments (never mind people) know that on the 29th of January 2005 a moderate 5.5 quake occurred just North of Ascension Island a mere 1035 km (650 miles) SSW of Monrovia, Liberia. Earthquakes are devastating in part because of the element of surprise and relative unpredictability. Just two or three notches up the scale and for sure West Africa (and probably south West Africa) would now be in a state of mourning. The Asian tsunami was an 8.7 to nine on the Richter scale and travelled at roughly 500mph. Africa had seven hours yet managed to loose 137 lives despite this being sufficient time to be half way round the world. It goes without saying that it needs no further debate to make the case for a warning system.

But a warning system alone will not do. People will also need to know what danger signs to look out for, what to do, where to go and how to get there. If all houses cannot be quake proof as they increasingly are in most parts of California and Japan, there must be available public places such as schools and hospitals designed and built to withstand waves, floods and quakes. As Tim Radford, a science editor with the UK Guardian, pointed out in a recent article, "survival depends not just on open lines, wakeful authorities and an educated public, but educated planners, builders and building inspectors as well". The social and communications network needed to pass warnings on to citizens must be established and road and transport networks improved. Greek scientists have established that simply widening road junctions and roundabouts leading to higher ground would save hundreds of lives in the event of a tsunami.

Warning systems need not cost the GDP of entire countries. A Swedish company (MedDay) announced at the end of January a cheaper system based on mobile phones which Asian countries are eager to test run. According to the company it will take about six weeks to install. But this can only be an interim measure. Development of electricity, medical and other modern infrastructure are the long-term solution. African countries must get in on such preparation and preventive measures.

Until this is done, hundreds of thousands of Africans will go about their daily lives waiting to die in a 'natural' disaster. Should this eventually happen, it will be nothing short of criminal negligence and no amount of debt relief, international rescue and relief teams and foreign aid workers from international charities will be able to hide the fact that Africa leaders would have once again failed their people in upholding that most basic right of all - the right to life.

*Sankore is coordinator of CREDO for Freedom of Expression and Associated Rights an NGO focussing on rights issues in Africa. Pleas send feedback to [email][email protected] and [email protected]

The 120th anniversary of Africa's partition passed largely unmarked in November 2004. While some no doubt would wonder what the significance of this is today those that are aware of the partition and its implications will be able to see its negative implication for Africa's development and parallels with cold war era balkanisation of the world into east versus west spheres of influence. Some would even argue that Hitler's brazen land grab or policy of "Lebensraum " in which the Nazis claimed expansionism and conquest was vital for the continued political and economic development of Germany sprang from the objectives of the Berlin conference. Without doubt however the goal of the Berlin conference was to consolidate expansionism for resources and markets through negotiation rather than war.

Globalisation came to Africa via the transatlantic slave trade about 500 years before the term became 'sexy' or was even coined. This massive plundering and abuse of Africa's most valuable resource - its citizens - provided millions of slave workers and stupendous profits for the forerunners of many of today's multi million dollar business empires and their countries of origin. The equivalent present day would be to have today's multinationals backed by states to forcibly recruit millions to work in factories and industries as slave labour for 400 years with absolutely no pay beyond food and water supported by floggings, amputations and hangings to keep the workers in line. The idea is not far fetched. The creation of an artificial class of non-persons by way of demonising Jews created the slave labour for the companies behind the Nazi war production machine. If six million perished in Germany and some parts of Europe within six years in a state policy partially hidden from society but subsequently exposed, think what could have happened over a period of 400 years of unrestricted savagery by numerous states and a clearer picture emerges of the most savage, violent, and comprehensive mass violation of rights in human history.

Some 'experts' squabble of whether Africa lost 25, 50 million or a 100 million to this bestial policy sanctioned by states, and use various criteria to compute varying figures - abductees that actually arrived alive at slave plantations, those that ended up at the bottom of the ocean, those that died resisting, those that died as a result of displacement and its consequences such as disease and hunger, children that died after loosing their families etc. This is beside the point. Not only were millions in their youth and productive prime lost, millions more were psychologically destroyed and displaced and most importantly the development of society was more or less suspended for 400 years. We only need to look at the impact of the holocaust on Jews, or the current Darfur crisis to see what state sanctioned policies of destruction of a people can do to the stability, development and psychology of peoples and their societies.

But this is not the main focus of this write up. The significance of the above is that it was against this background that the Partition of Africa - a continuation of the policy of plundering by other means - from human to natural resources - was enforced. The Berlin Conference of 1884 formalised the scramble for and partition of Africa by colonial powers. The conference was hosted by the German government of Otto Von Bismarck and led to Africa being carved up for the exploitation of its resources along the lines of modern day gangsters dividing cities into market spheres of influence to avoid arbitrary gang warfare that is bad for 'business'.

By the end of the conference of 13 European powers and the United States, the template had been laid down for the creation or superimposition of roughly 50 countries the majority of which cut arbitrarily across the logic of nationality, geography, language or other uniting factors. The then major players were Britain, Germany, France, and Portugal, which between them already controlled most of the coastal territories where forts were established for protection of trading companies. Belgium, Italy and Spain played supporting roles with the others haggling in vain for crumbs. The broad division that resulted was:

- Hosts Germany grabbed Namibia (German Southwest Africa) and Tanzania (German East Africa), Togo land, some of Cameroon and Benin.
- Great Britain pressed its naval and military advantage and secured Egypt, parts of Sudan, Uganda and Kenya (or British East Africa), most of southern Africa including South Africa, Zambia, Zimbabwe (or Rhodesia), Botswana and significant areas of West Africa especially Nigeria and Ghana (Gold Coast).
- Belgium and King Leopold II held tight to the Democratic Republic of Congo (then known as Belgian Congo).
- France secured most of western and central Africa, then known as French West Africa and French Equatorial Africa and later some of North Africa.
- Portugal took Mozambique and Angola
- Italy got Somalia (Italian Somaliland) and a portion of Ethiopia.
- While Spain made do with the smallest territory - Equatorial Guinea (Rio Muni).

The negative impact of the partition on Africa could not have been lost on the colonial powers especially Bismarck of Germany whose entire 40-year political career was devoted to the unification of Germanic states including fighting three wars including the Franco-Prussian war of 1870-71 and executing an endless series of diplomatic manoeuvres that played his neighbours against each other. (The subsequent defeat of Germany in the first and second world wars led to the loss of its colonies)

For the "natives' already disoriented by the slave trade and its consequences, expansionism, protectorates and artificial states not only meant the denial of the right to self determination, it meant suppression and containment by state machineries designed for colonial rule. Colonial economies were not designed to develop the colonies but rather to create wealth for the colonial powers. An entire legislative framework and state apparatus was specifically designed to ensure that "the law" crushed any signs of dissidence. Sedition, criminal defamation, insult laws, states of emergency, detention without trial, pass laws etc became key instruments of control by colonial authorities or white minority governments in southern Africa. These frameworks and culture of intolerance for opposing views were largely inherited by many African states and laid the foundation of institutional abuse of rights in many modern African countries today.

It is utterly impossible to sustain human rights within the context of unviable states, failed states, or states perpetually in a state of conflict either because they are an artificial construct with ruling elites based very narrowly ethnic, language, racial or other artificial divisions. Also, the artificial borders created by the partition of Africa broke apart ethnic nationalities and in many cases fused them artificially with others nationalities within new states. Ruling elites were cultivated either from minorities or majorities or artificially created and sustained using the army and or police. These divide and conquer policies were unsustainable indefinitely and it was just a matter of time before conflicts broke out over political or economic domination. In some countries, the process of independence leading to the withdrawal of colonial powers or served as the trigger for long suppressed divisions to boil over. Either way, the entire construct of these states was aimed at exploiting and violating the rights of citizens.

By the time of independence, many African countries were stuck with these artificial constructs and a change of guard offered no solution. Not insignificantly, the independence era coincided with the cold war era and any leaders actually asserting independence were promptly labelled communists and dispatched via coups, murder or both. Some countries such as the DRC are yet to recover from the consequences of such interference and disruption that led to the murder of its elected Prime Minister Patrice Lumumba and the imposition of Mobutu. If as in the case of Ghana's Nkrumah new leaders actually advocated African Unity and a reversal of the colonial borders and fiefdoms of new political leaders then other insecure African governments anxious to maintain the status quo also opposed them. Where soldiers were not directly prompted to seize power, the fragile nature of many states and their non productive nature meant that in the struggle for political power, the most organised and best armed body of men would inevitably become aware of their potential power and sweep squabbling politicians aside. The assumption of power by armies largely trained to serve colonial interests by holding down populations could only lead to more institutional violation of rights. Despite their occasional anti-imperialist posturing and theatrics designed to confuse issues and consolidate their hold on power, this was the true nature of the Mobutu's and Idi Amin's.

The cold war also resulted in prolonging the life of white minority rule in southern Africa as the liberation movements were seen as pro communist or socialist and the white minority governments pro west and pro capitalist. Cold war rivals sustained all sorts of undemocratic governments of the left, right or centrist kind, as Africa once again became an arena of conflict.

In other words, the interruption of social, economic and political development by four centuries of slavery, the repressive legislative frameworks, state apparatus, institutions and culture created by colonial authorities, the non productive nature of many economies, the unviability of others, artificially constructed states, long periods of military or civilian dictatorships that plundered the countries, the cold war fall out and so forth have all combined to create the present political culture and political economy which prevails in much of Africa and makes it difficult if not impossible to uphold human rights in a sustainable form.

Any move away from this past which had as its central feature the institutional violation of rights must therefore have as its new central feature, the institutional promotion of rights. Its not a coincidence, that the new African Union has emerged in a decade that has seen more elections in Africa than in the last 40 to 50 years of independence of most Africa countries. In the case of some southern African countries, independence was only won in the last 10 to 20 years. Compared to the relative 600 to 700 years of stability and development in Europe only accelerated or held back by revolution or war for certain periods its easy to see why Africa remains the least developed continent despite its potential. The context becomes clearer in comparison with the Asian colonies which had their civilisations, cultures and developmental trajectories affected by decades of colonialism - but crucially not suspended or destroyed by 400 years of slavery followed by carving up and imposition of mostly artificial states. The result is that Asia has an unbroken sense of history and culture and recovered quickly but not yet completely from colonialism. In the case of China and Japan, the results of relative lack of disruption are clear to see. Were it not for the immortality of the pyramids, mummification techniques that indicate advancements in medical science and undeniable archaeological evidence of several African civilisations thousands of years older than many European and Asian civilisations, Africa and civilisation would never be mentioned in the same breath. As it stands, Hollywood is still in denial as evidenced by its continuous portrayal of ancient Egypt by white actors. This travesty and violation of historical and cultural rights can only be equalled by a spectacle of African actors portraying ancient Greece, Rome or China without any sense of irony.

The largely unbroken development of Europe over the last few centuries also explains why modern day European military dictatorships such as Franco in Spain, Salazar in Portugal or more recently in Greece and the Balkans did not fundamentally upset the development of those societies even though some of them and Franco in particular lasted over 30 years - longer than most African dictatorships. Even where as in the case of Hitler and Mussolini dictatorship and war led to destruction, the Marshall plan with its more or less free billions of dollars reconstructed and even gave impetus to further development of those societies.

Most importantly and not surprisingly, major European governments subsequently came to the conclusion that the creation of a European Union would help break the cycle of wars and conflict in Europe and create the developmental basis for future socio economic and political stability. At the heart of this today is the promotion of European level core rights instruments, which provide more protection to citizens than the rights regimes in many individual countries hence the tendency to resort to the European Courts for the protection of rights, denied in-country. "I will go to Europe" has become a fashionable slang by many that feel cheated and unprotected.

The adoption of several rights based treaties and protocols by the new African Union is a step in the right direction and the recent declaration of a treaty signing week within the last month shows that the Commission of the African Union in particular clearly understands the role that promotion of rights can play in the development of modern society. The mission, vision and strategic plan promoted by the Commissions current Chair Prof. Alpha Konare are evidence of this. It is far from clear however that many African governments understand this as evidenced by the lethargy towards signing, ratifying and institutionalising instruments that will enhance the protection of rights such as the African Court of Human Rights /Court of Justice and the Protocol for the Protection of Rights of Women. This trend must be reversed. The broad sketches of African and world history and development above demonstrate that no where on the planet is the institutionalisation of rights more crucial to development than in Africa.

The political integration of Africa is aimless and doomed unless done on a rights basis that reverses hundreds of years of a largely imposed political culture rights abuses which can in turn unleash its creative and developmental potential. The protection of rights can also not be sustained on the basis of underdevelopment. Governments largely based on exploitation, preservation of ruling elites, or that preside over underdeveloped societies tend to deny free expression and core rights of association, assembly, political participation and ignore key economic and social rights such as health care, housing, food security and so forth. The summary and core of the rights imperative is that all societies need these rights to develop and cannot develop further without the protection of these rights.

Sankore is Coordinator of CREDO for Freedom of Expression & Associated Rights an NGO focussing on rights issues in Africa.