Africa in the 21st Century

Key Points

• The War in Darfur  is a major armed conflict in the Darfur region of Sudan that began in 2003 when the Sudan Liberation Movement and the Justice and Equality Movement rebel groups began fighting the government of Sudan, which they accused of oppressing Darfur’s non-Arab population. Other factors at the roots of the event were conflicts between semi-nomadic livestock herders and those who practice sedentary agriculture, water access, and the Second Sudanese Civil War.
• In response, the government mounted a campaign of aerial bombardment supporting ground attacks by an Arab militia, the Janjaweed. The government-supported Janjaweed were accused of committing major human rights violations, including mass killing, looting, and systematic rape of the non-Arab population of Darfur. They have frequently burned down whole villages, driving the surviving inhabitants to flee to refugee camps, mainly in Darfur and Chad.
• The Government of Sudan and the SLM of Minni Minnawi signed a Darfur Peace Agreement in 2006, but since only one rebel group subscribed to the agreement, the conflict continued. The 2011 Darfur Peace Agreement, also known as the Doha Agreement, was signed between the government of Sudan and the Liberation and Justice Movement. Although the conflict is considered resolved, civil conflicts in Sudan continue.
• Immediately after the Janjaweed entered the conflict, rapes of women and young girls were reported at a staggering rate. Multiple casualty estimates have been published since the war began, ranging from roughly 10,000 civilians (Sudan government) to hundreds of thousands. In 2004, United States Secretary of State Colin Powell declared the Darfur conflict to be genocide although experts continue to disagree over whether the war crimes committed during the conflict fall into that category.
• International attention to the Darfur conflict largely began with reports of war crimes by Amnesty International and the International Crisis Group in 2003. However, widespread media coverage did not start until the outgoing United Nations Resident and Humanitarian Coordinator for Sudan, Mukesh Kapila, called Darfur the “world’s greatest humanitarian crisis” in 2004. In 2008, the International Criminal Court filed ten charges of war crimes against Sudan’s President Omar al-Bashir.
• In 2011, a referendum was held to determine whether South Sudan should become an independent country and separate from Sudan. South Sudan, with the majority of the population adhering either to indigenous religions or Christianity, formally became independent from Sudan (predominantly Muslim). The country continues to be ravaged by civil wars, is the least developed country in the world, and faces a massive humanitarian crisis.

Key Terms

• Janjaweed: A militia that operate in western Sudan and eastern Chad. Using the United Nations definition, it comprised Sudanese Arab tribes, the core of whom are from the Abbala (camel herder) background with significant recruitment from the Baggara (cattle herder) people. This UN definition may not necessarily be accurate, as instances of members from other tribes have been noted.
• South Sudanese Civil War: A conflict in South Sudan between forces of the government and opposition forces. In 2013, President Kiir accused his former deputy Riek Machar and ten others of attempting a coup d’état. Machar denied trying to start a coup and fled. Fighting broke out, igniting the civil war. Ugandan troops were deployed to fight alongside South Sudanese government. The United Nations has peacekeepers in the country as part of the United Nations Mission in South Sudan.
• Second Sudanese Civil War: A conflict from 1983 to 2005 between the central Sudanese government and the Sudan People’s Liberation Army. Although it originated in southern Sudan, the civil war spread to the Nuba mountains and Blue Nile. It lasted for 22 years and is one of the longest civil wars on record. The war resulted in the independence of South Sudan six years after it ended.
• War in Darfur: A major armed conflict in the Darfur region of Sudan that began in 2003 when the Sudan Liberation Movement and the Justice and Equality Movement rebel groups began fighting the government of Sudan, which they accused of oppressing Darfur’s non-Arab population. As of 2017, the war is nominally resolved.

War in Darfur

The War in Darfur is a major armed conflict in the Darfur region of Sudan that began in 2003 when the Sudan Liberation Movement (SLM or Sudan Liberation Army – SLA) and the Justice and Equality Movement (JEM) rebel groups began fighting the government of Sudan, which they accused of oppressing Darfur’s non-Arab population. Several other factors have been identified at the roots of the present conflict. One involves the land disputes between semi-nomadic livestock herders and those who practice sedentary agriculture. Water access has also been a major source of the conflict. The Darfur crisis is also related to the Second Sudanese Civil War, raged in southern Sudan for decades between the northern, Arab-dominated government and Christian and animist black southerners.

The region became the scene of a rebellion in 2003 when the JEM and the SLM accused the government of oppressing non-Arabs in favor of Arabs. The government was also accused of neglecting the Darfur region. In response, it mounted a campaign of aerial bombardment supporting ground attacks by an Arab militia, the Janjaweed. The government-supported Janjaweed were accused of committing major human rights violations, including mass killing, looting, and systematic rape of the non-Arab population of Darfur. They have frequently burned down whole villages, driving the surviving inhabitants to flee to refugee camps, mainly in Darfur and Chad. By mid-2004, 50,000 to 80,000 people had been killed and at least a million driven from their homes, causing a major humanitarian crisis in the region.

The Government of Sudan and the SLM of Minni Minnawi signed a Darfur Peace Agreement in 2006. Only one rebel group, the SLM, subscribed to the agreement. The JEM rejected it, resulting in a continuation of the conflict. The agreement included provisions for wealth sharing and power sharing and established a Transitional Darfur Regional Authority to help administer Darfur until a referendum could take place on the future of the region. The leader of the SLM, Minni Minnawi, was appointed Senior Assistant to the President of Sudan and Chairman of the transitional authority in 2007.

In 2010, representatives of the Liberation and Justice Movement (LJM), an umbrella organization of ten rebel groups formed that year, started a fresh round of talks with the Sudanese Government in Doha, Qatar. A new rebel group, the Sudanese Alliance Resistance Forces in Darfur, was formed and the JEM planned further talks. These talks ended without a new peace agreement, but participants agreed on basic principles, including a regional authority and a referendum on autonomy for Darfur. In 2011, the leader of the LJM, Tijani Sese, stated that the movement had accepted the core proposals of the Darfur peace document proposed by the joint-mediators in Doha. The 2011 Darfur Peace Agreement, also known as the Doha Agreement, was signed between the government of Sudan and the LJM. This agreement established a compensation fund for victims of the Darfur conflict, allowed the President of Sudan to appoint a vice president from Darfur, and established a new Darfur Regional Authority to oversee the region until a referendum can determine its permanent status within the Republic of Sudan. The agreement also provided for power sharing at the national level.

Social Impact of War

Immediately after the Janjaweed entered the conflict, the rape of women and young girls, often by multiple militiamen and throughout entire nights, was reported at a staggering rate. Children as young as 2 years old were victims, while mothers were assaulted in front of their children. Young women were attacked so violently that they were unable to walk following the attack. Non-Arab individuals were reportedly raped by Janjaweed militiamen as a result of the Sudanese government’s goal to completely eliminate black Africans and non-Arabs from Darfur.

Multiple casualty estimates have been published since the war began, ranging from roughly 10,000 civilians (Sudan government) to hundreds of thousands. In 2005, the UN’s Emergency Relief Coordinator Jan Egeland estimated that 10,000 were dying each month, excluding deaths due to ethnic violence. An estimated 2.7 million people had been displaced from their homes, mostly seeking refuge in camps in Darfur’s major towns. In 2010, the Center for Research on the Epidemiology of Disasters published an article in a special issue of The Lancet. The article, entitled Patterns of mortality rates in Darfur conflict, estimated with 95% confidence that the excess number of deaths is between 178,258 and 461,520 (with a mean of 298,271), with 80% of these due to disease.

In 2004, in testimony before the Senate Foreign Relations Committee,  United States Secretary of State Colin Powell declared the Darfur conflict to be genocide. However, in 2005, an International Commission of Inquiry on Darfur, authorized by UN Security Council Resolution 1564 of 2004, issued a report stating that “the Government of the Sudan has not pursued a policy of genocide.” Nevertheless, the Commission cautioned, “The conclusion that no genocidal policy has been pursued and implemented in Darfur by the Government authorities, directly or through the militias under their control, should not be taken in any way as detracting from the gravity of the crimes perpetrated in that region. International offences such as the crimes against humanity and war crimes that have been committed in Darfur may be no less serious and heinous than genocide.” In 2007, the International Criminal Court (ICC) issued arrest warrants against the former Minister of State for the Interior, Ahmad Harun, and a Janjaweed militia leader, Ali Kushayb, for crimes against humanity and war crimes. In 2008, the ICC filed ten charges of war crimes against Sudan’s President Omar al-Bashir, three counts of genocide, five of crimes against humanity, and two of murder. Prosecutors claimed that al-Bashir “masterminded and implemented a plan to destroy in substantial part” three tribal groups in Darfur because of their ethnicity. In 2009, the ICC issued a warrant for al-Bashir’s arrest for crimes against humanity and war crimes, but not genocide. This is the first warrant issued by the ICC against a sitting head of state.

Estimates of the number of human casualties range up to several hundred thousand dead, from either combat or starvation and disease. Mass displacements and coercive migrations forced millions into refugee camps or across the border, creating a humanitarian crisis.

International Response

International attention to the Darfur conflict largely began with reports of war crimes by Amnesty International and the International Crisis Group in 2003. However, widespread media coverage did not start until the outgoing United Nations Resident and Humanitarian Coordinator for Sudan, Mukesh Kapila, called Darfur the “world’s greatest humanitarian crisis” in 2004. Organizations such as STAND: A Student Anti-Genocide Coalition, later under the umbrella of Genocide Intervention Network, and the Save Darfur Coalition emerged and became particularly active in the areas of engaging the United States Congress and President.

It is expected that al-Bashir will not face trial until he is apprehended in a nation which accepts ICC jurisdiction, as Sudan is not a party to the Rome Statute, which it signed but did not ratify. The Sudanese government has announced that the Presidential plane would be accompanied by jet fighters. However, the Arab League announced solidarity with al-Bashir. Since the warrant, he has visited Qatar and Egypt. The African Union also condemned the charges. Some analysts argue that the ICC indictment is counterproductive and harms the peace process. Only days after the ICC indictment, al-Bashir expelled 13 international aid organizations from Darfur and disbanded three domestic aid organizations. In the aftermath of the expulsions, conditions in the displaced camps deteriorated.

South Sudan

The Second Sudanese Civil War was a conflict from 1983 to 2005 between the central Sudanese government and the Sudan People’s Liberation Army. It was largely a continuation of the First Sudanese Civil War of 1955 to 1972. It is one of the longest civil wars on record (22 years). A peace agreement was signed in 2005 and one of its promises was the autonomy of the south within the next six years, followed by a referendum on independence.

In 2011, a referendum was held to determine whether South Sudan should become an independent country and separate from Sudan. 98.83% of the population voted for independence. South Sudan, with the majority of population adhering either to indigenous religions or Christianity, formally became independent from Sudan (predominantly Muslim), although certain disputes still remained, including the division of oil revenues, as 75% of all the former Sudan’s oil reserves are in South Sudan. South Sudan continues to be ravaged by civil wars, with tens of thousands displaced. The fighters accuse the government of plotting to stay in power indefinitely, not fairly representing and supporting all tribal groups while neglecting development in rural areas. Inter-ethnic warfare that in some cases predates the war of independence is widespread.

In 2013, a political power struggle broke out between President Kiir and his former deputy Riek Machar, as the president accused Machar and ten others of attempting a coup d’état. Fighting broke out, igniting the South Sudanese Civil War. Up to 300,000 people are estimated to have been killed in the war, including in massacres. Although both men have supporters from across South Sudan’s ethnic divides, subsequent fighting has been communal, with rebels targeting members of Kiir’s Dinka ethnic group and government soldiers attacking Nuers. About 3 million people have been displaced in a country of 12 million, with about 2 million internally displaced and about 1 million fleeing to neighboring countries, especially Kenya, Sudan, and Uganda.

Ravaged by conflicts, South Sudan has the least developed economy in the world and is acknowledged to have some of the worst health indicators in the world. About half the population does not have access to an improved water source, defined as a protected well, standpipe, or a handpump within 1 km. In 2017, South Sudan and the United Nations declared a famine in parts of the country, with the warning that it could spread rapidly without further action. The UN World Food Program notes that 40% of the population of South Sudan, 4.9 million people, need food urgently.

Key Points

• Boko Haram is an Islamic extremist group based in northeastern Nigeria, also active in Chad, Niger, and northern Cameroon. Mohammed Yusuf founded it in 2002 when he established a religious complex and school that attracted poor Muslim families from across Nigeria and neighboring countries. The center had the political goal of creating an Islamic state and became a recruiting ground for jihadists. By denouncing the police and state corruption, Yusuf attracted followers from unemployed youths.
• The government repeatedly ignored warnings about the increasingly militant character of the organization. Yusuf’s arrest elevated him to hero status. Stephen Davis, a former Anglican clergyman who has negotiated with Boko Haram many times, blames local Nigerian politicians who support local bandits to make life difficult for their political opponents. In particular, Davis has blamed the former governor of Borno State, Ali Modu Sheriff, who initially supported Boko Haram.
• Boko Haram seeks the establishment of an Islamic state in Nigeria. It opposes the Westernization of Nigerian society and the concentration of the wealth of the country among members of a small political elite. The sharia law imposed by local authorities may have promoted links between Boko Haram and political leaders. The group had alleged links to al-Qaeda, but in March 2015, it announced its allegiance to the Islamic State of Iraq and the Levant.
• Boko Haram conducted its operations more or less peacefully during the first seven years of its existence. That changed in 2009 when the Nigerian government launched an investigation into the group’s activities following reports that its members were arming themselves. Since then, Boko Haram has been attempting to overthrow the Nigerian government through various militant, including terrorist, strategies.
• Boko Haram began to target schools in 2010, killing hundreds of students by 2014. A spokesperson for the group said such attacks would continue as long as the Nigerian government continued to interfere with traditional Islamic education. Boko Haram has also been known to kidnap girls, who it believes should not be educated, and use them as cooks or sex slaves. In 2014, Boko Haram kidnapped 276 female students from the Government Secondary School in the town of Chibok in Borno. As of January 2017, 195 of the 276 girls were still in captivity.
• The Nigerian government’s response has revealed the political and military weaknesses of the state apparatus and as of March 2017, Boko Haram continues its terrorist activities. While human rights abuses committed by Boko Haram are widely known, the conflict has also seen numerous human rights abuses conducted by the Nigerian security forces in an effort to control the violence, as well as their encouragement of the formation of numerous vigilante groups.

Key Terms

• sharia: The religious law forming part of the Islamic tradition. It is derived from the religious precepts of Islam, particularly the Quran and the Hadith. In Arabic, the term refers to God’s divine law and is contrasted with fiqh, which refers to its scholarly interpretations. Its application in modern times has been a subject of dispute between Muslim traditionalists and reformists.
• al-Qaeda: A militant Sunni Islamist multi-national organization founded in 1988 by Osama bin Laden, Abdullah Azzam, and several other Arab volunteers who fought against the Soviet invasion of Afghanistan in the 1980s. It has been widely designated as a terrorist group.
• Boko Haram: An Islamic extremist group based in northeastern Nigeria, also active in Chad, Niger and northern Cameroon. The group had alleged links to al-Qaeda, but in March 2015, it announced its allegiance to the Islamic State of Iraq and the Levant (ISIL). It was ranked as the world’s deadliest terror group by the Global Terrorism Index in 2015.
• Islamic State of Iraq and the Levant: A Salafi jihadist extremist militant groups led by and mainly composed of Sunni Arabs from Syria and Iraq. In 2014, the group proclaimed itself a caliphate, with religious, political, and military authority over all Muslims worldwide. As of March 2015, it had control over territory occupied by ten million people in Syria and Iraq and nominal control over small areas of Libya, Nigeria, and Afghanistan. It also operates or has affiliates in other parts of the world, including North Africa and South Asia.

Origins of Boko Haram

Boko Haram is an Islamic extremist group based in northeastern Nigeria, also active in Chad, Niger, and northern Cameroon.
Mohammed Yusuf founded the sect that became known as Boko Haram in 2002 in Maiduguri, the capital of the northeastern state of Borno. He established a religious complex and school that attracted poor Muslim families from across Nigeria and neighboring countries. The center had the political goal of creating an Islamic state and became a recruiting ground for jihadists. By denouncing the police and state corruption, Yusuf attracted followers from unemployed youths. It has been speculated that Yusuf founded Boko Haram because he saw an opportunity to exploit public outrage at government corruption by linking it to Western influence.

The government repeatedly ignored warnings about the increasingly militant character of the organization. The Council of Ulama advised the government and the Nigerian Television Authority not to broadcast Yusuf’s preaching, but their warnings were ignored. Yusuf’s arrest elevated him to hero status. Borno’s Deputy Governor Alhaji Dibal has reportedly claimed that al-Qaeda had ties with Boko Haram, but broke them when they decided that Yusuf was an unreliable person. Stephen Davis, a former Anglican clergyman who has negotiated with Boko Haram many times, blames local Nigerian politicians who support local bandits to make life difficult for their political opponents. In particular, Davis has blamed the former governor of Borno State, Ali Modu Sheriff, who initially supported Boko Haram but no longer needed them after the 2007 elections, when the group became much more powerful.

Boko Haram seeks the establishment of an Islamic state in Nigeria. It opposes the Westernization of Nigerian society and the concentration of the wealth of the country among members of a small political elite, mainly in the Christian south of the country. Nigeria is Africa’s biggest economy, but 60% of its population of 173 million (2013) live in dire poverty. The sharia law imposed by local authorities, beginning with Zamfara in 2000 and covering 12 northern states by late 2002, may have promoted links between Boko Haram and political leaders. The group had alleged links to al-Qaeda, but in March 2015, announced its allegiance to the Islamic State of Iraq and the Levant (ISIL or ISIS) and since then publicly uses the name “ISIL-West Africa Province” or its variants.

Boko Haram Insurgency

Boko Haram conducted its operations more or less peacefully during the first seven years of its existence. That changed in 2009 when the Nigerian government launched an investigation into the group’s activities following reports that its members were arming themselves. Prior to that, the government reportedly repeatedly ignored warnings about the increasingly militant character of the organization, including those from a military officer. When the government came into action, several members of the group were arrested in Bauchi, sparking deadly clashes with Nigerian security forces that led to the deaths of an estimated 700 people. During the conflict with the security forces, Boko Haram fighters reportedly “used fuel-laden motorcycles” and “bows with poison arrows” to attack a police station. The group’s founder and then-leader Mohammed Yusuf was killed during this time while still in police custody. After Yusuf’s killing, Abubakar Shekau became the leader and held this
position until August 2016, when he was succeeded by Abu Musab al-Barnawi,  the first surviving son of Mohammed Yusuf.
The group suffered a split in 2016 and Shekau and his supporters continued to operate independently.

After its founding in 2002, Boko Haram’s increasing radicalization led to a violent uprising in 2009. Its unexpected resurgence following a mass prison break in 2010 was accompanied by increasingly sophisticated attacks, initially against soft targets, and progressed in 2011 to include suicide bombings. The government’s establishment of a state of emergency in 2012, extended in the following year to cover the entire northeast of Nigeria, led to an increase in both security force abuses and militant attacks.

After the killing of Yusuf, the group carried out its first terrorist attack in Borno in 2010, which resulted in the killing of four people. Since then, the violence has only escalated in terms of both frequency and intensity. In 2010, a Bauchi prison break freed more than 700 Boko Haram militants, replenishing their force. In 2011, a few hours after Goodluck Jonathan was sworn in as President of Nigeria, several bombings purportedly by Boko Haram killed 15 and injured 55. The same year, Boko Haram claimed to have conducted the Abuja police headquarters bombing, the first known suicide attack in Nigeria. Two months later the United Nations building in Abuja was bombed, signifying the first time that Boko Haram attacked an international organization. By early 2012, the group was responsible for over 900 deaths. In 2013, Nigerian government forces launched an offensive in the Borno region in an attempt to dislodge Boko Haram fighters after a state of emergency was called. The offensive was initially successful but eventually failed.

Chibok Schoolgirls Kidnapping

Boko Haram began to target schools in 2010, killing hundreds of students by 2014. A spokesperson for the group said such attacks would continue as long as the Nigerian government continued to interfere with traditional Islamic education. Boko Haram has also been known to kidnap girls, who it believes should not be educated, and use them as cooks or sex slaves.

In 2014, Boko Haram kidnapped 276 female students from the Government Secondary School in the town of Chibok in Borno. Fifty-seven of the schoolgirls managed to escape over the next few months and some have described their capture in appearances at international human rights conferences. A child born to one of the girls and believed by medical personnel to be about 20 months old also was released, according to the Nigerian president’s office. Newspaper reports have suggested that Boko Haram was hoping to use the girls as a negotiating pawns in exchange for some of their commanders in jail. In 2016, one of the missing girls, Amina Ali, was found. She claimed that the remaining girls were still there, but that six had died.
As of January 2017, 195 of the 276 girls were still in captivity. Furthermore, thousands of other children have disappeared in the nearby regions. Despite the high-profile campaign #BringBackOurGirls, international efforts to free the kidnapped girls have failed.

Parents and others took to social media to complain about the government’s perceived slow and inadequate response. The news caused international outrage against Boko Haram and the Nigerian government. On April 30 and May 1, 2014 protests demanding greater government action were held in several Nigerian cities. Most parents, however, were afraid to speak publicly for fear their daughters would be targeted for reprisal.

Government’s Response

The Nigerian military is, in the words of a former British military attaché speaking in 2014, “a shadow of what it’s reputed to have once been.” They are short of basic equipment, morale is said to be low, and senior officers are alleged to be skimming military procurement budget funds intended to pay for the standard issue equipment of soldiers. In 2013, the Nigerian military shut down mobile phone coverage in the three northeastern states to disrupt the Boko Haram’s communication and ability to detonate improvised explosive devices (IEDs). The shutdown was successful from a military-tactical point of view but it angered citizens in the region and engendered negative opinions toward the state and new emergency policies. While citizens and organizations developed various coping and circumventing strategies, Boko Haram evolved from an open network model of insurgency to a closed centralized system, shifting the center of its operations to the Sambisa Forest. This fundamentally changed the dynamics of the conflict.

In mid-2014, Nigeria was estimated to have had the highest number of terrorist killings in the world over the past year, 3477 killed in 146 attacks. The governor of Borno, Kashim Shettima noted in 2014: “Boko Haram are better armed and are better motivated than our own troops. Given the present state of affairs, it is absolutely impossible for us to defeat Boko Haram.”

In 2015, it was reported that Nigeria had employed hundreds of mercenaries from South Africa and the former Soviet Union to assist in making gains against Boko Haram. U.S. efforts to train and share intelligence with regional military forces is credited with helping to push back against Boko Haram, but officials warn that the group remains a grave threat. As of March 2017, Boko Haram continues suicide bombings and other terrorist strategies.

The conflict has also seen numerous human rights abuses conducted by the Nigerian security forces in an effort to control the violence as well as their encouragement of the formation of numerous vigilante groups. Amnesty International accused the Nigerian government of human rights abuses after 950 suspected Boko Haram militants died in detention facilities run by Nigeria’s military Joint Task Force in 2013. Furthermore, the Nigerian government has been accused of incompetence and supplying misinformation about events in more remote areas.

Human Rights Watch has also reported that Boko Haram uses child soldiers, including 12-year-olds. According to an anonymous source working on peace talks with the group, up to 40 percent of the fighters in the group are underage. The group has forcibly converted non-Muslims to Islam.

Key Points

• Somalia is a country located in the Horn of Africa, with an estimated population of 12.3 million. The Supreme Revolutionary Council seized power in 1969 and established the Somali Democratic Republic. Led by Mohamed Siad Barre, the government collapsed in 1991 as the Somali Civil War broke out. During this period, due to the absence of a central government, Somalia was a failed state. This term refers to a political body that has disintegrated to a point where basic conditions and responsibilities of a sovereign government no longer function properly.
• The early 2000s saw the creation of fledgling interim federal administrations. The Transitional National Government (TNG) was established in 2000, followed by the formation of the Transitional Federal Government (TFG) in 2004, which reestablished national institutions such as the military. In 2006, the TFG, assisted by Ethiopian troops, assumed control of most of the nation’s southern conflict zones from the newly formed Islamic Courts Union (ICU). This Islamist organization assumed control of much of the southern part of the country and promptly imposed sharia law.
• Following this defeat, the ICU splintered into several different factions. Some of the more radical elements, including Al-Shabaab, regrouped to continue their insurgency against the TFG and oppose the Ethiopian military’s presence in Somalia.  By mid-2012, the insurgents lost most of the territory that they had seized.
• In 2011–2012, a political process providing benchmarks for the establishment of permanent democratic institutions was launched. Within this administrative framework a new provisional constitution was passed in 2012, reforming Somalia as a federation. Following the end of the TFG’s interim mandate, the Federal Government of Somalia, the first permanent central government in the country since the start of the civil war, was formed and a period of reconstruction began.
• By 2014, international stakeholders and analysts have begun to describe Somalia as a fragile state making some progress towards stability. A fragile state is a low-income country characterized by weak state capacity and/or weak state legitimacy, leaving citizens vulnerable to a range of shocks. As the war continues, the country is facing a plethora of challenges caused not only by the decades of fighting but also by hostile environmental conditions.
• According to the Central Bank of Somalia, about 80% of the population is nomadic or semi-nomadic pastoralists. The UN notes that extreme “inequalities across different social groups” are widening and continue to be “a major driver of conflict.” Droughts and resulting famines continue to ravage the country. Somalia is also consistently ranked as one of the worst places in the world to live for a woman.

Key Terms

• fragile state: A low-income country characterized by weak state capacity and/or weak state legitimacy, leaving citizens vulnerable to a range of shocks.
• Islamic Courts Union: A group of sharia courts that united themselves to form a rival administration to the Transitional Federal Government (TFG) of Somalia, with Sharif Sheikh Ahmed as their head. Western media often refer to the group as Somali Islamists.
• failed state: A political body that has disintegrated to a point where basic conditions and responsibilities of a sovereign government no longer function properly. The Fund for Peace notes the following characteristics: loss of control of its territory or of the monopoly on the legitimate use of physical force therein; erosion of legitimate authority to make collective decisions; inability to provide public services; and inability to interact with other states as a full member of the international community.
• Somali Civil War: An ongoing civil war taking place in Somalia that grew out of resistance to the Siad Barre regime during the 1980s. By 1988–90, the Somali Armed Forces began engaging various armed rebel groups, including the Somali Salvation Democratic Front in the northeast, the Somali National Movement in the northwest, and the United Somali Congress in the south. The clan-based armed opposition groups eventually managed to overthrow the Barre government in 1991, but the war continues.
• Al-Shabaab: A Salafist jihadist fundamentalist group based in East Africa. In 2012, it pledged allegiance to the militant Islamist organization Al-Qaeda. In February of the year, some of the group’s leaders quarreled with Al-Qaeda over the union and quickly lost ground.
  The group describes itself as waging jihad against “enemies of Islam,” and is engaged in combat against the Federal Government of Somalia and the African Union Mission to Somalia (AMISOM).
• Transitional Federal Government: The internationally recognized government of the Republic of Somalia until August 2012, when its tenure officially ended and the Federal Government of Somalia was inaugurated. It was established as one of the Transitional Federal Institutions (TFIs) of government as defined in the Transitional Federal Charter (TFC) adopted in 2004 by the Transitional Federal Parliament (TFP).

Somalia: Background

Somalia is a country located in the Horn of Africa, with an estimated population of 12.3 million. Around 85% of its residents are ethnic Somalis and the majority are Muslim. In antiquity, Somalia was an important commercial center and during the Middle Ages, several powerful Somali empires dominated the regional trade. In the late 19th century, the British and Italian empires gained control of parts of the coast and established the colonies of British Somaliland and Italian Somaliland. Italy acquired full control of the northeastern, central, and southern parts of the area. Italian occupation lasted until 1941, yielding to British military administration. British Somaliland would remain a protectorate, while Italian Somaliland became a United Nations Trusteeship under Italian administration in 1949. In 1960, the two regions united to form the independent Somali Republic under a civilian government.

The Supreme Revolutionary Council seized power in 1969 and established the Somali Democratic Republic. Led by Mohamed Siad Barre, the government collapsed in 1991 as the Somali Civil War broke out. Various armed factions began competing for influence in the power vacuum. During this period, due to the absence of a central government, Somalia was a failed state. The term
refers to a political body that has disintegrated to a point where basic conditions and responsibilities of a sovereign government no longer function properly.
Common characteristics of a failed state include a central government so weak or ineffective that it is unable to raise taxes or other support and has little practical control over much of its territory (hence there is a non-provision of public services). As a result, widespread corruption and criminality, the intervention of non-state actors, the involuntary movement of populations, and sharp economic decline can occur. In the 1990s, Somalis returned to customary and religious law in most regions. Some autonomous regions, including the Somaliland and Puntland, emerged.

Path to Central Government

The early 2000s saw the creation of fledgling interim federal administrations. The Transitional National Government (TNG) was established in 2000, followed by the formation of the Transitional Federal Government (TFG) in 2004, which reestablished national institutions such as the military. In 2006, the TFG, assisted by Ethiopian troops, assumed control of most of the nation’s southern conflict zones from the newly formed Islamic Courts Union (ICU), which subsequently splintered into more radical groups.
The ICU is an Islamist organization, which assumed control of much of the southern part of the country and promptly imposed sharia law.

Following this defeat, the ICU splintered into several different factions. Some of the more radical elements, including Al-Shabaab, regrouped to continue their insurgency against the TFG and oppose the Ethiopian military’s presence in Somalia. Throughout 2007 and 2008, Al-Shabaab scored military victories, seizing control of key towns and ports in both central and southern Somalia. By 2009, Al-Shabaab and other militias managed to force the Ethiopian troops to retreat, leaving behind an under-equipped African Union peacekeeping force to assist the TFG’s troops.

Due to a lack of funding and human resources, an arms embargo that made it difficult to reestablish a national security force, and general indifference on the part of the international community, Somali President
Abdullahi Yusuf Ahmed found himself obliged to deploy thousands of troops from Puntland to Mogadishu to sustain the battle against insurgent elements in the southern part of the country. In 2008, Ahmed announced his resignation, expressing regret at failing to end the country’s 17-year conflict as his government had been mandated to do. He also blamed the international community for its failure to support the government.

By mid-2012, the insurgents lost most of the territory that they had seized. In 2011–2012, a political process providing benchmarks for the establishment of permanent democratic institutions was launched. Within this administrative framework a new provisional constitution was passed in 2012, which reformed Somalia as a federation. Following the end of the TFG’s interim mandate, the Federal Government of Somalia, the first permanent central government in the country since the start of the civil war, was formed and a period of reconstruction began.

In combination with the ongoing civil war, the 2011-2012 drought and famine resulted in a refugee crisis. By September 2011, more than 920,000 refugees from Somalia had reportedly fled to neighboring countries, particularly Kenya and Ethiopia. At the height of the crisis, the UNHCR base in Dadaab, Kenya hosted at least 440,000 people in three refugee camps, although the maximum capacity was 90,000. More than 1,500 refugees continued to arrive every day from southern Somalia, 80 percent of whom were women and children. UN High Commissioner for Refugees spokeswoman Melissa Fleming said that many people had died en route.

Fragile State

By 2014, Somalia was no longer at the top of the fragile states index, dropping to second place behind South Sudan. International stakeholders and analysts have begun to describe Somalia as a fragile state making some progress towards stability. A fragile state is a low-income country characterized by weak state capacity and/or weak state legitimacy leaving citizens vulnerable to a range of shocks. As the war continues as of March 2017, the country is facing a plethora of challenges caused not only by the decades of fighting, mismanagement, and political chaos, but also by hostile environmental conditions.

Despite the civil war, Somalia has maintained an informal economy based mainly on livestock, remittance/money transfers from abroad, and telecommunications. Due to a dearth of formal government statistics, it is difficult to determine the actual condition of the Somali economy. Unlike the pre-civil war period when most services and the industrial sector were government-run, there has been substantial, albeit unmeasured, private investment in commercial activities. This has been largely financed by the Somali diaspora and includes trade and marketing, money transfer services, transportation, communications, fishery equipment, airlines, telecommunications, education, health, construction, and hotels. Somalia has some of the lowest development indicators in the world. According to the Central Bank of Somalia, about 80% of the population are nomadic or semi-nomadic pastoralists who keep goats, sheep, camels, and cattle. The nomads also gather resins and gums to supplement their income. The UN notes that extreme “inequalities across different social groups” are widening and continue to be “a major driver of conflict.”

Droughts and resulting famines continue to ravage the country. Between mid-2011 and mid-2012, a severe drought affected the entire East Africa region, causing a severe food crisis across Somalia, Djibouti, Ethiopia, and Kenya that threatened the livelihood of 9.5 million people. Many refugees from southern Somalia fled to neighboring Kenya and Ethiopia, where crowded, unsanitary conditions together with severe malnutrition led to a large number of deaths. The food crisis in Somalia primarily affected farmers in the south rather than the northern pastoralists. Human Rights Watch (HRW) consequently noted that most of the displaced persons belonged to the agro-pastoral Rahanweyn clan and the agricultural Bantu ethnic minority group. The United Nations officially declared famine in two regions in the southern part of the country, the first time a famine had been declared in the region by the UN in nearly thirty years. Tens of thousands of people are believed to have died in southern Somalia before famine was declared. This was mainly a result of Western governments preventing aid from reaching affected areas to weaken the Al-Shabaab militant group against whom they were engaged. The food crisis in southern Somalia was no longer at emergency levels by the beginning of 2012.

In 2011, Maryan Qasim, a medical doctor, former minister for women’s development and family affairs, and an adviser in the TFG, wrote a column for The Guardian titled “The women of Somalia are living in hell.” In it, she professed to be “shocked” that Somalia was ranked 5th worst place in the world to be a woman, arguing that the country is “the worst [place] in the world” for women. She notes that it is not the war but being pregnant that constitutes the greatest risk for women’s life. The lack of medical care and infrastructure puts pregnant women at risk of death, the rate of which is higher only in Afghanistan. She concludes, “Add to this the constant risk of getting shot or raped, as well as the ubiquitous practice of female genital mutilation (FGM) – something 95% of girls aged 4 to 11 face – make women’s lives in Somalia almost unlivable.”

According to a 2005 World Health Organization estimate, about 97.9% of Somalia’s women and girls underwent female genital mutilation, a premarital custom mainly endemic to Northeast Africa and parts of the Near East. Encouraged by women in the community, it is primarily intended to protect chastity, deter promiscuity, and offer protection from assault.

As of March 2017, a new wave of drought ravages Somalia. It has left more than 6 million people, or half the country’s population, facing food shortages with several water supplies becoming undrinkable due to the possibility of infection. In February 2017, a senior United Nations humanitarian official in Somalia warned of a famine in some of the worst drought-affected areas without massive and urgent humanitarian assistance. He also stated that the omission of such an immediate response “will cost lives, further destroy livelihoods, and could undermine the pursuit of key state-building and peacebuilding initiatives.” In March 2017, UN Secretary-General António Guterres urged a massive scale-up in international support to avert a famine.

Key Points

• BRICS is the acronym for an association of five major emerging national economies: Brazil, Russia, India, China, and South Africa. Originally the first four were grouped as BRIC. The BRICS members are developing or newly industrialized countries, distinguished by their large, sometimes fast-growing economies and significant influence on regional affairs. In 2010, South Africa joined the BRIC grouping, after being formally invited by the BRIC countries. The group was renamed BRICS – with the “S” standing for South Africa – to reflect the expanded membership.
• The economy of South Africa is the largest in Africa. South Africa accounts for 24 percent of Africa’s gross domestic product and is ranked as an upper-middle-income economy by the World Bank – one of only four such countries in Africa. Since 1996, at the end of over 12 years of international sanctions, South Africa’s GDP has almost tripled to $400 billion and foreign exchange reserves have increased from $3 billion to nearly $50 billion, creating a diversified economy with a growing and sizable middle class within two decades of establishing democracy and ending apartheid.
• After 1994, government policy brought down inflation, stabilized public finances, and attracted foreign capital. However, economic growth was still subpar until 2004, when it picked up significantly. Both employment and capital formation increased. During the presidency of Jacob Zuma, the government has begun to increase the role of state-owned enterprises.
• Unlike most of the world’s formerly poor and now developing countries, South Africa does not have a thriving informal economy. Only 15% of South African jobs are in the informal sector. Mining has been the main driving force behind the history and development of Africa’s most advanced economy. South Africa is one of the world’s leading mining and mineral-processing countries. The agricultural industry contributes around 10% of formal employment, relatively low compared to other parts of Africa, contributing around 2.6% of GDP.
• The manufacturing industry’s contribution to the economy is relatively small, providing just 13.3% of jobs and 15% of GDP. Labor costs are low, but not nearly as low as in most other emerging markets, and the cost of the transport, communications, and general living is much higher. Over the last few decades, South Africa and particularly the Cape Town region has established itself as a successful call center and business process outsourcing destination. Tourism also creates a substantial percentage of jobs in the country.
• High levels of unemployment, income inequality, growing public debt, political mismanagement, low levels of education, no reliable access to electricity, and crime are serious problems that have negatively impacted the South African economy. In 2016, the top five challenges to doing business in the country were inefficient government bureaucracy, restrictive labor regulations, a shortage of educated workers, political instability, and corruption. South Africa continues to have a relatively high rate of poverty and is ranked in the top 10 countries in the world for income inequality.

Key Terms

• BRICS: The acronym for an association of five major emerging national economies. Its members are leading developing or newly industrialized countries, distinguished by their large, sometimes fast-growing economies and significant influence on regional affairs. All five are G-20 members.
• G-20: An international forum for the governments and central bank governors from 20 major economies. It was founded in 1999 with the aim of studying, reviewing, and promoting high-level discussion of policy issues pertaining to the promotion of international financial stability. It seeks to address issues that go beyond the responsibilities of any one organization.
• apartheid: A system of institutionalized racial segregation and discrimination in South Africa between 1948 and 1991, when it was abolished. The country’s first multiracial elections under a universal franchise were held three years later in 1994. Broadly speaking, the system was delineated into petty, which entailed the segregation of public facilities and social events, and grand, which dictated housing and employment opportunities by race.

BRICS

BRICS is the acronym for an association of five major emerging national economies: Brazil, Russia, India, China, and South Africa. Originally the first four were grouped as BRIC, before the induction of South Africa in 2010. The BRICS members are leading developing or newly industrialized countries, distinguished by their large, sometimes fast-growing economies and significant influence on regional affairs. All five are G-20 members. Since 2009, the BRICS nations have met annually at formal summits. In 2015, the five BRICS countries represented over 3.6 billion people, or half of the world population. All five members are in the top 25 of the world by population and four are in the top 10. The World bank expects BRICS growth to pick up to 5.3% in 2017. Bilateral relations among BRICS nations have mainly been conducted on the basis of non-interference, equality, and mutual benefit.

In 2010, South Africa began the formal process of admission to join the BRIC grouping, becoming a member at the end of that year and joining officially in 2011 after being formally invited by the BRIC countries. The group was renamed BRICS – with the “S” standing for South Africa – to reflect the expanded membership.

In April 2011, South Africa formally joined the Brazil-Russia-India-China (BRICS) grouping of countries, identified by President Zuma (first right) as the country’s largest trading partners and also the largest trading partners with Africa as a whole. Zuma asserted that BRICS member countries would also work with each other through the UN, the Group of Twenty (G20) and the India, Brazil, South Africa (IBSA) forum.

South African Economy in the 21st Century

The economy of South Africa is the largest in Africa. South Africa accounts for 24 percent of Africa’s gross domestic product and is ranked as an upper-middle-income economy by the World Bank – one of only four such countries in Africa. Since 1996, at the end of over 12 years of international sanctions, South Africa’s GDP has almost tripled to $400 billion and foreign exchange reserves have increased from $3 billion to nearly $50 billion, creating a diversified economy with a growing and sizable middle class within two decades of establishing democracy and ending apartheid. The nation is the only African member of the G-20.

After 1994, three years after apartheid was abolished and the year of first interracial elections, government policy brought down inflation, stabilized public finances, and some foreign capital was attracted. However, growth was still subpar, but increased significantly in 2004 when both employment and capital formation increased. During the presidency of Jacob Zuma (elected in 2009 and reelected in 2014), the government has begun to increase the role of state-owned enterprises. Some of the biggest state-owned companies are Eskom, the electric power monopoly, South African Airways (SAA), and Transnet, the railroad and ports monopoly. Some of these state-owned companies have not been profitable, which has required bailouts totaling 30 billion rand ($2.3 billion) over 20 years.

South Africa has a mixed economy (consisting of a mixture of markets and economic interventionism). Unlike most of the world’s formerly poor and now developing countries, South Africa does not have a thriving informal economy. Only 15% of South African jobs are in the informal sector, compared with around half in Brazil and India and nearly three-quarters in Indonesia. The OECD attributes this difference to South Africa’s widespread welfare system.

Mining has been the main driving force behind the history and development of Africa’s most advanced economy. Large-scale and profitable mining started with the discovery of a diamond in 1867 and in the 21st century, South Africa is one of the world’s leading mining and mineral-processing countries. Although mining’s contribution to the national GDP has fallen from 21% in 1970 to 6% in 2011, it still represents almost 60% of exports. The mining sector has a mix of privately owned and state-controlled mines.

The agricultural industry contributes around 10% of formal employment, relatively low compared to other parts of Africa, contributing around 2.6% of GDP. Due to the aridity of the land, only 13.5% can be used for crop production and only 3% is considered high potential land. The sector continues to face problems, with increased foreign competition and crime being two of the major challenges. The government has been accused of either putting in too much effort or not enough effort to tackle the problem of farm attacks as opposed to other forms of violent crime.

The manufacturing industry’s contribution to the economy is relatively small, providing just 13.3% of jobs and 15% of GDP. Labor costs are low, but not nearly as low as in most other emerging markets, and the cost of the transport, communications, and general living is much higher. The South African automotive industry accounts for about 10% of South Africa’s manufacturing exports, contributing 7.5% to the country’s GDP. BMW, Ford, Volkswagen, Daimler-Chrysler, General Motors, Nissan, and Toyota all have production plants in South Africa. There are also about 200 automotive component manufacturers in South Africa and more than 150 others that supply the industry on a non-exclusive basis.

The domestic telecommunications infrastructure provides modern and efficient service to urban areas, including cellular and internet services. Over the last few decades, South Africa and particularly the Cape Town region has established itself as a successful call center and business process outsourcing destination. With a highly talented pool of productive labor and with Cape Town sharing cultural affinity with Britain, large overseas firms such as Lufthansa, Amazon.com, ASDA, the Carphone Warehouse, Delta Airlines, and many more have established inbound call centers within Cape Town.

South Africa is also a popular tourist destination. According to the World Travel & Tourism Council, travel and tourism support around 10% of jobs in the country.

While this modern shopping mall serves as evidence that South Africa is becoming economically prosperous, the high levels of unemployment and inequality are considered by the government and most South Africans to be the most salient economic problems facing the country. These issues, and others linked to them such as crime, have in turn hurt investment and growth, consequently having a negative feedback effect on employment.

Challenges

South Africa has an extreme and persistent high unemployment rate of over 25%, which interacts with other economic and social problems such as inadequate education, poor health outcomes, and crime. The poor have limited access to economic opportunities and basic services. The official unemployment rate, although very high by international standards, still understates the magnitude of the problem because it includes only adults who are actively looking for work, excluding those who have given up looking for jobs. Only 41% of the population of working age has any kind of job (formal or informal). This rate is 30% lower than that of China and about 25% lower than that of Brazil or Indonesia.

There has been substantial human capital flight from South Africa in recent years. South Africa’s Bureau of Statistics estimates that between 1 million and 1.6 million people in skilled, professional, and managerial occupations have emigrated since 1994 and that for every emigrant, 10 unskilled people lose their jobs. Among the reasons cited for wishing to leave the country were declining quality of life and high levels of crime. Furthermore, the government’s affirmative action policy was identified as a factor influencing the emigration of skilled white South Africans. The results of a 1998 survey indicate that skilled white South Africans are strongly opposed to this policy and the arguments advanced in support of it.

Refugees and immigrants from poorer neighboring countries, including the Democratic Republic of the Congo, Mozambique, Zimbabwe, Malawi, and others, represent a large portion of the informal sector. With high unemployment levels among poorer South Africans, xenophobia is prevalent and many South Africans feel resentful of immigrants who are seen as depriving the native population of jobs. Although many South African employers have employed migrants from other countries for lower pay than South African citizens, especially in the construction, tourism, agriculture, and domestic service industries, many immigrants continue to live in poor conditions.

According to a 2015 UNAIDS Report, South Africa has an estimated 7 million people living with HIV, more than any other country in the world. A 2008 study revealed that HIV/AIDS infection in South Africa is distinctly divided along racial lines: 13.6% of black South Africans are HIV-positive, whereas only 0.3% of white South Africans have the disease. Most casualties have been economically active individuals, resulting in AIDS orphans who in many cases depend on the state for care and financial support. It is estimated that there are 1,200,000 orphans in South Africa.

High levels of unemployment, income inequality, growing public debt, political mismanagement, low levels of education, no reliable access to electricity, and crime are serious problems that have negatively impacted the South African economy. In 2016, the top five challenges to doing business in the country were inefficient government bureaucracy, restrictive labor regulations, a shortage of educated workers, political instability, and corruption, while the country’s strong banking sector was rated as a strongly positive feature of the economy. South Africa continues to have a relatively high rate of poverty and is ranked in the top 10 countries in the world for income inequality.

Key Points

• A public health crisis is a difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality tompass the entire planet. Health crises generally have significant impacts on community health, loss of life, and the economy. They may result from disease, industrial processes, environmental disasters, or poor policy. Africa continues to be ravaged by multiple health crises.
• HIV/AIDS is a major public health concern in many parts of Africa. Although the continent is home to about 15% of the world’s population, over 67% of the infected in 2015, more than 25.5 million individuals, were Africans. Out of this number, nearly 19 million lived in eastern and southern Africa, while 6.5 million lived in western and central Africa. High-risk behavior patterns have been cited as being largely responsible for the significantly greater spread of HIV/AIDS in sub-Saharan Africa than in other parts of the world. In 2015, UN reported that the leading cause of death among HIV-positive persons is tuberculosis.
• In 2015, there were 296 million cases of malaria worldwide resulting in an estimated 731,000 deaths. Approximately 90% of both cases and deaths occurred in Africa. In Africa, malaria is estimated to result in losses of US$12 billion a year due to increased healthcare costs, lost ability to work, and negative effects on tourism. Although malaria is presently endemic not only in sub-Saharan Africa but also in a broad band around the equator, which includes many parts of the Americas and Asia, 85–90% of malaria fatalities occur in sub-Saharan Africa.
• The West African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia, and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the fatality rate reported at slightly above 70% although the rate among hospitalized patients was 57–59%.
• A number of regions in Africa have experienced environmental disasters that led to food crises and famines. A major culprit continent is drought, which in combination with ongoing civil wars may produce disastrous results. An acute shortage of food or famine affected Niger (2006), the countries in the Horn of Africa (Somalia, Djibouti, and Ethiopia), asnortheastern Kenya (2006), Africa’s Sahel region and many parts of the neighboring Senegal River Area (2010), and entire East Africa (2011-2012). As of March 2017, Somalia and South Sudan are experiencing severe droughts and experts estimate famines will affect millions of people in both regions.
• In addition to recurrent food crises, malnutrition and poverty are endemic problems that affect the health of massive numbers of Africans across the continent, with particularly tragic impact on children and women. Children’s health and maternal health indicators are particularly alarming in sub-Saharan Africa.

Key Terms

• health crisis: A difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality to the entire planet. It generally has significant impacts on community health, loss of life, and the economy. It  may result from disease, industrial processes, environmental disasters, or poor policy.

Health Crises in Africa

A public health crisis is a difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality to the entire planet. Health crises generally have significant impacts on community health, loss of life, and the economy. They may result from disease, industrial processes, environmental disasters, or poor policy. Africa continues to be ravaged by multiple health crises, some of which are systemic (e.g., consistently high rates of maternal and infant deaths caused by lack of proper health care or poor nutrition), recurrent (e.g., famines caused by droughts), or caused by an outbreak of a particular diseases (e.g., malaria, Ebola, HIV/AIDS).

HIV/AIDS

HIV/AIDS is a major public health concern and cause of death in many parts of Africa. Although the continent is home to about 15%  of the world’s population, over 67% of the infected, more than 25.5 million individuals, were Africans according to data collected by the World Health Organization (WHO) and UNAIDS in 2015. Out of this number, nearly 19 million lived in eastern and southern Africa, while 6.5 million lived in western and central Africa (North Africa, grouped with the Middle East, recorded 230 thousand infected).  In the most affected countries of sub-Saharan Africa, AIDS has raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about 20 years. In fact, the life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life expectancy in some countries as low as 34 years.

High-risk behavioral patterns have been cited as largely responsible for the significantly greater spread of HIV/AIDS in sub-Saharan Africa than in other parts of the world. Chief among these are traditionally liberal attitudes espoused by many communities toward multiple sexual partners and sexual activity before or outside marriage. HIV transmission is most likely in the first few weeks after infection and the risk is increased when people have more than one sexual partner in the same time period. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to have concurrent sexual relations with more than one person. In addition, lack of AIDS-awareness education provided to youth and no access to proper health care contribute to the high rates of infections and deaths. Even if medical facilities are available, patents on many drugs have hindered the ability to make low-cost alternatives.

In 2015, UN reported that the leading cause of death among HIV-positive persons is tuberculosis; synergy between HIV and tuberculosis, termed a co-epidemic, is deadly. One in three HIV-infected individuals die of tuberculosis. “Tuberculosis and HIV co-infections are associated with special diagnostic and therapeutic challenges and constitute an immense burden on healthcare systems of heavily infected countries.” In many countries without adequate resources, the tuberculosis case rate has increased five to ten-fold since the identification of HIV. Without proper treatment, an estimated 90% of persons living with HIV die within months after contracting tuberculosis.

Malaria

Malaria is a mosquito-borne infectious disease affecting humans and other animals. The disease is widespread in the tropical and subtropical regions that exist in a broad band around the equator, including much of sub-Saharan Africa, Asia, and Latin America. In 2015, there were 296 million cases of malaria worldwide resulting in an estimated 731,000 deaths. Approximately 90% of deaths occurred in Africa, where malaria is estimated to result in losses of US$12 billion a year due to increased healthcare costs, lost ability to work, and negative effects on tourism.

The WHO estimates that in 2015 there were 214 million new cases of malaria resulting in 438,000 deaths. Others have estimated the number of cases at between 350 and 550 million. The majority (65%) occur in children younger than age 15. In sub-Saharan Africa, maternal malaria is associated with up to 200,000 estimated infant deaths yearly. Efforts at decreasing the disease in Africa since the turn of millennium have been partially effective, with rates dropping by an estimated 40% on the continent. Although malaria is presently endemic not only in sub-Saharan Africa but also in a broad band around the equator, which includes many parts of the Americas and Asia, 85–90% of malaria fatalities occur in Sub-Saharan Africa.

Ebola

The West African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia, and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with a fatality rate reported at slightly above 70% although the rate among hospitalized patients was 57–59%. Small outbreaks occurred in Nigeria and Mali and isolated cases were recorded in Senegal. The number of cases peaked in October 2014 and then began to decline gradually following the commitment of substantial international resources. In March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred.

The outbreak left about 17,000 survivors of the disease, many of whom report symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to “hide” in a recovered survivor’s body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the strain of Ebola responsible for the West Africa outbreak. The vaccine has not yet had regulatory approval, but it is considered so effective that 300,000 doses have already been stockpiled.

In June 2014, it was reported that local authorities did not have the resources to contain the disease, with health centers closing and hospitals becoming overwhelmed. There were also reports that adequate personal protection equipment was not provided for medical personnel. The Director-General of MSF said: “Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.”

Food Shortages

Since 2000, a number of regions in Africa have experienced environmental disasters that led to food crises and famines. For example, a severe localized food security crisis occurred in some regions of Niger from 2005 to 2006. It was caused by an early end to the 2004 rains, desert locust damage to some pasture lands, high food prices, and chronic poverty. In the affected area, 2.4 million of 3.6 million people were considered highly vulnerable to food insecurity. An international assessment stated that of these, over 800,000 faced extreme food insecurity and another 800,000 in moderately insecure food situations were in need of aid.

The crisis had long been predicted after swarms of locusts consumed nearly all crops in parts of Niger during the 2004 agricultural season. In other areas, insufficient rainfall resulted in exceptionally poor harvests and dry pastures, affecting both farmers and livestock breeders. The fertility rate in Niger is the highest in the world at 7.6 children per woman. The consequence is that population of Niger is projected to increase tenfold in the 21st century to more than 200 million people in 2100. Experts predict population growth-induced famines in the 21st century, because the agricultural production cannot keep up with the population growth.

A major culprit of food shortages on the continent is drought, which in combination with ongoing civil wars may produce disastrous results.
In 2006, an acute shortage of food affected the countries in the Horn of Africa (Somalia, Djibouti, and Ethiopia) as well as northeastern Kenya. The United Nations’s Food and Agriculture Organization (FAO) estimated that more than 11 million people in these countries were affected by widespread famine, largely attributed to a severe drought and exacerbated by military conflicts in the region. A large-scale, drought-induced famine occurred in Africa’s Sahel region and many parts of the neighboring Senegal River Area from February to August 2010. It is one of many famines to hit the region in recent times. The Sahel is the ecoclimatic and biogeographic zone of transition between the Sahara desert in the north of Africa and the Sudanian savannas in the south. Similarly, between July 2011 and mid-2012, a severe drought affected the entire East Africa region. Said to be “the worst in 60 years,” the drought caused a severe food crisis across Somalia, Djibouti, Ethiopia, and Kenya that threatened the livelihood of 9.5 million people. Many refugees from southern Somalia fled to neighboring Kenya and Ethiopia, where crowded, unsanitary conditions and severe malnutrition led to a large number of deaths. Other countries in East Africa, including Sudan, South Sudan, and parts of Uganda, were also affected by a food crisis. As of March 2017, Somalia and South Sudan are experiencing severe droughts and experts estimate famines will affect millions of people in both regions.

In addition to recurrent food crises, malnutrition is an endemic problem that affects massive numbers of Africans across the continent, which has had a particularly tragic impact on children.
Globally, more than one third of under-5 deaths are attributable to malnourishment. In Africa, some progress has been registered over the decades but the situation in some regions remains dire. Sub-Saharan Africa accounted for 3,370,000 deaths of children under 5 in 2011 (WHO, 2012), which corresponds to 9,000 children dying every day and six children dying every minute. Out of 3 million neonatal deaths worldwide, approximately 1.1 million are found in sub-Saharan Africa (WHO, 2012).

Given that vitamin A is critical for proper functioning of the visual system and for maintaining immune defenses, its deficiency remains a public health issue. In Africa, vitamin A deficiency contributes to 23% of child deaths. In 2009, the prevalence of low serum retinol, associated with vitamin A deficiency, was 37.7% in Ethiopia, 49% in the Congo, and 42% in Madagascar. The immediate causes of this deficiency are the low rates of consumption of animal products, the poor bioavailability of vitamin A in cereal-based diets, the consumption of green leaves with low lipid content, and an increased bodily demand for vitamin A owing to the infections that frequently affect African children.

There are equally disturbing levels of zinc deficiencies, which has seriously adverse effects on growth, the risk and severity of infections, and level of immune function. Although the actual prevalence is unclear, zinc deficiency is recognized as one of the main risk factors for morbidity and mortality. It contributes to over 450,000 deaths per year among children under 5 years, particularly in sub-Saharan Africa. It affected 57% of children under 5 in Senegal, 72% in Burkina Faso, and 41.5% in Nigeria in 2004. The main causes of this deficiency in children are a lack of zinc-rich easily absorbed foods (such as meat, poultry, and seafood) and the over-consumption of foods that inhibit zinc absorption, such as cereals, roots, and tubers, which are among Africa’s staples.

Anemia is quite prevalent in Africa, especially among young children, due mainly to a diet that is low in animal-based foods. In 2006, about 67.6% of children under 5 and overall 83.5 million children were anemic. Through its effects on metabolic processes, iron deficiency retards growth and development. It impairs the immune response and increases susceptibility to infection, delays motor development, and diminishes concentration (impairing cognitive and behavioral capacities). It therefore prevents 40-60% of African children from attaining their full mental capacities. Moreover, of the 26 health risks reported by the WHO Global Burden of Disease project, iron deficiency is ranked ninth in terms of years of life lost.

Maternal Health

According to a UN report,

A woman’s chance of dying or becoming disabled during pregnancy and childbirth is closely connected to her social and economic status, the norms and values of her culture, and the geographic remoteness of her home. Generally speaking, the poorer and more marginalized a woman is, the greater her risk of death. In fact, maternal mortality rates reflect disparities between wealthy and poor countries more than any other measure of health. A woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialized countries.

The risk for maternal death (during pregnancy or childbirth) in sub-Saharan Africa is 175 times higher than in developed countries and risk for pregnancy-related illnesses and negative consequences after birth is even higher. Poverty, maternal health, and outcomes for the child are all interconnected. Poverty is detrimental to the health of both mother and child.