Monday, 31 December 2012

POVERTY: WEST AFRICA: Cholera - lessons learned

DAKAR, 31 December 2012 (IRIN) - The cholera epidemic that struck Guinea and Sierra Leone in 2012 is winding down. What to do now? Start preparing - for cholera.

That’s part of the message from donors, aid workers and health officials after the most serious cholera outbreak in years that infected some 30,000 people and killed 400 others in the two countries - mostly in Sierra Leone. They say there should be better preparations for cholera, based on lessons learned and on a strategy in Guinea that was put to the test in 2012.

Since 2009 the UN Children’s Fund (UNICEF), Action Against Hunger (ACF), the Guinean government, the European Union aid body ECHO, and the US Agency for International development (USAID) have taken steps to prepare for an outbreak - including setting up community detection sites, public information campaigns and drills.

“Cholera thrives on disorganization,” said Christophe Valingot, water, sanitation, and hygiene (WASH) specialist with ECHO. “Cholera spreads very rapidly - it can go from 30 cases to several hundred cases per week in a very short period. When there is little to no preparation, we’ve lost the chance to avoid all those infections.”

But preparation is hardly a motivator for governments and donors. “We had a very difficult time justifying funds for this preparation work in Guinea,” Valingot said.

Strategies needed

Data from the past decade in West Africa show that a country can go several years with few to no cases of cholera then be hit with thousands of cases. “Donors, NGOs, and governments go all-out during a serious epidemic then it’s as if that all disappears completely with a couple of calmer periods,” Valingot said. “What this means in the end is meagre progress against cholera.”

Health workers said UNICEF’s strategy proved effective in Guinea this year and ECHO and UNICEF are looking to replicate it across the region.

So why did Guinea still see some 7,300 cases? For one, the strain found in the region is far more virulent than past strains, said François Bellet, WASH specialist with UNICEF’s West and Central Africa regional office.

“Of course we can’t possibly know what the situation would have been in Guinea in the absence of this strategy,” he told IRIN. “But given the virulence of this strain we might well have avoided a Zimbabwe 2008-09.” In that period cholera infected some 100,000 people in Zimbabwe and killed more than 4,000.

As of mid-December Sierra Leone had 22,345 cases and 286 deaths in a population of 5.6 million; Guinea, whose population is nearly double that, registered 7,321 cases and 121 deaths.


WASH and health experts say the use of GPS in Guinea’s capital Conakry was critical. Plotting clusters of cholera cases on a map helps health workers better target WASH activities. GPS also facilitates follow-up visits to identify high-risk practices that accelerate the disease’s spread. Mapping and GPS were not systematically used in Sierra Leone, say UNICEF and ACF.

Bellet said the sentinel sites in Guinea were vital because they facilitated rapid health, water, and sanitation responses. The first cases of cholera in Guinea, in February, were detected and signalled at these community sites by people trained as part of the preparedness strategy. One of these community members contacted health officials, saying: “That thing has come back.”

“They knew it was cholera before any biological tests,” Bellet said.

They also knew it was more aggressive than usual. One traditional leader in the Guinean seaside village of Kaback told UNICEF he had witnessed six major epidemics but had never seen such a virulent illness. For Bellet this underscores the importance of community engagement and local wisdom.

At an 11 December meeting of ECHO, UNICEF, and ACF to recap this year’s outbreak and response, one recommendation was to create sentinel sites in Sierra Leone. Participants also noted the importance of maintaining the sites in Guinea, where state funding is lacking and trained workers often move on.

Safe water, proper sanitation

While preparation and hygiene education must be a year-round affair, above all what needs to be constant is the availability of safe water and proper sanitation. Only in Africa - and primarily West Africa - are cholera cases on the rise each year. This correlates to the poor progress on water and sanitation infrastructure, ECHO’s Valingot said.

“Cholera is a disease signalling loud and clear that something’s wrong,” he said. “If there is a high rate of cholera, this likely means there are a lot of children dying of other diarrhoeal diseases. Vibrio cholerae is not constantly present - often it is brought in. And if there are no barriers - proper sanitation, safe water - it explodes.”

Epidemiologist Stanislas Rebaudet, who analysed the cholera strain found in Guinea, says the fact that it was probably imported and not present in the environment sends an important message: the disease is not inevitable and it pays to put up those barriers.

[This report does not necessarily reflect the views of the United Nations]

MALARIA: Afghanistan, Diagnostic tests fine if confirm clinical diagnosis, else ignored

From:William Brieger

Date:Mon, Dec 31, 2012 11:07 am
In many malaria-endemic areas, including Afghanistan, overdiagnosis of malaria is common. Even when using parasite-based diagnostic tests prior to treatment, clinicians commonly prescribe antimalarial treatment following negative test results. This practice neglects alternative causes of fever, uses drugs unnecessarily, and might contribute to antimalarial drug resistance. We undertook a qualitative study among health workers using different malaria diagnostic methods in Afghanistan to explore perceptions of malaria diagnosis. Health workers valued diagnostic tests for their ability to confirm clinical suspicions of malaria via a positive result, but a negative result was commonly interpreted as an absence of diagnosis, legitimizing clinical diagnosis of malaria and prescription of antimalarial drugs. Prescribing decisions reflected uncertainty around tests and diagnosis, and were influenced by social- and health-system factors. Study findings emphasize the need for nuanced and context-specific guidance to change prescriber behavior and improve treatment of malarial and nonmalarial febrile illnesses.

MALARIA: Ghana: urban malaria, Accra

From:William Brieger

Date:Mon, Dec 31, 2012 11:08 am
Mapping Urban #Malaria and Diarrhea Mortality in Accra, Ghana: Vulnerabilities and Implications for Urban Health Policy


Historic increase in urban population numbers in the face of shrinking urban economies and declining social services has meant that a large proportion of the urban population lives in precarious urban conditions, which provide the grounds for high urban health risks in low income countries. This study aims to identify, investigate, and contrast the spatial patterns of vulnerability and risk of two major causes of mortality, viz malaria and diarrhea mortalities, in order to optimize resource allocation for effective urban environmental management and improvement in urban health. A spatial cluster analysis of the observed urban malaria and diarrhea mortalities for the whole city of Accra was conducted. We obtained routinely reported mortality data for the period 1998–2002 from the Ghana Vital Registration System (VRS), computed the fraction of deaths due to malaria and diarrhea at the census cluster level, and analyzed and visualized the data with Geographic Information System (GIS, ArcMap 9.3.1). Regions of identified hotspots, cold spots, and excess mortalities were observed to be associated with some socioeconomic and neighborhood urban environmental conditions, suggesting uneven distribution of risk factors for both urban malaria and diarrhea in areas of rapid urban transformation. Case–control and/or longitudinal studies seeking to understand the individual level factors which mediate socioenvironmental conditions in explaining the observed excess urban mortalities and to establish the full range of risk factors might benefit from initial vulnerability mapping and excess risk analysis using geostatistical approaches. This is key to evidence-based urban health policy reforms in rapidly urbanizing areas in low income economies

MALARIA: Africa progress

From:William Brieger

Date:Mon, Dec 31, 2012 11:30 am



Scientists across the world and in Africa are making vast advances on vaccinations and treatments for diseases like malaria and tuberculosis.

The University of Cape Town's Science Department is working on a single-dose cure for malaria that kills the parasite instantly.

It is due to complete trials of the aminopyridine-class drug in late 2013.

Professor Kelly Chibale hailed it as a first for African scientists working in Africa.

Tests of GlaxoSmithKline's RTS,S/AS01 malaria vaccine did not reveal the high rates of reliability desired, but showed that it may be possible to meet the World Health Organization's target of developing a malaria vaccine with an efficacy rate of 80% for severe forms of the disease.

The vaccine tested on toddlers aged 5-17 months had an efficacy rate of 56% on detectable malaria and 47% on severe malaria.

The vaccine is the result of more than 30 years of research that will cost $600-700m by the time the study is completed.

John Lusingu, a principal investigator of the third phase of the vaccine trial, said: "We don't have a cut-off point to say at this level the vaccine should be recommended for public health use.

"This is the first malaria vac-cine, we don't have any other to compare."

For the past 10 years researchers at Oxford University have been developing a vaccine – MVA85A – to combat tuberculosis.

It is the first of its kind since 1921 and has cost £30m ($48mn) so far.

The first trial involved the inoculation of 3,000 babies in South Africa. The results are set to be released in the first quarter of 2013●

MALARIA: Malaria Nexus weekly update -- Dec 31 2012

Elsevier's Global Malaria Resource

AnophelePhoto by James Gathany
/ The Public Health Image Library
Malaria Nexus is Elsevier’s Global Malaria Resource: A major hub for scientists working in all aspects of malaria research. The website aims to provide free access to some of the latest research on malaria published in Elsevier’s many journals. Articles are regularly uploaded on the site and made freely available to registered members for a period of 3 months. News items and podcast interviews with key leaders in the field are also frequently posted and available for free to registrants. A host of new areas will soon be introduced, so keep an eye on the new developments of the website!

Latest News

Malaria Nexus review of 2012: Top ten most popular news stories!Posted on 20 December 2012

Malaria Nexus review of 2012: Top ten most popular news stories!

As 2012 comes close to its end, the Malaria Nexus team looks back on the most popular news stories covered in 2012.

Other News

Posted on 20 December 2012

Malaria Nexus review of 2012: Top ten most popular articles!

The Malaria Nexus team assembled the list of the most popular articles posted on the webportal in 2012. All articles from the list will be freely available for the coming 3 months.
Posted on 19 December 2012

The World Health Organization (WHO) publishes its World Malaria Report 2012.

The WHO recently announced the publication of its World Malaria Report 2012 which summarizes information received from 104 malaria-endemic countries.
Posted on 13 December 2012

Application deadline for the Gordon Research Conference (GRC) on Tropical Infectious Diseases: From Bench to Field is fast approaching!

The application deadline for the GRC on Tropical Infectious Diseases: From Bench to Field is January 13, 2013.
Posted on 13 December 2012

A novel tetracycline-repressible system allows the study of essential genes in Plasmodium sp

A study published in the latest issue of Cell Host & Microbe describes a novel inducible gene expression system that allows the generation of conditional knockouts in Plasmodium sp.

Feature Articles

Posted on 20 December 2012

MALARIA NEXUS TOP TEN MOST POPULAR ARTICLES IN 2012: # 1 Malaria's deadly secret: a skin stage

Trends in Parasitology, Volume 28, Issue 4, April 2012, Pages 142-150
D Lys Guilbride, Patrick DL Guilbride, Pawel Gawlinski
Posted on 20 December 2012

MALARIA NEXUS TOP TEN MOST POPULAR ARTICLES IN 2012: # 2 Global challenges of changing epidemiological patterns of malaria

Acta Tropica, Volume 121, Issue 3, March 2012, Pages 158-165
Walther H. Wernsdorfer
Posted on 20 December 2012

MALARIA NEXUS TOP TEN MOST POPULAR ARTICLES IN 2012: # 3 Global malaria mortality between 1980 and 2010: a systematic analysis

The Lancet , Volume 379, Issue 9814, 4–10 February 2012, Pages 413-431
Christopher JL Murray, Lisa C Rosenfeld, Stephen S Lim, Kathryn G Andrews, Kyle J Foreman, Diana Haring, Nancy Fullman, Mohsen Naghavi, Rafael Lozano, Alan D Lopez
Posted on 20 December 2012

MALARIA NEXUS TOP TEN MOST POPULAR ARTICLES IN 2012: # 4 High resolution 3D perspective of Plasmodium biology: advancing into a new era

Trends in Parasitology, Volume 27, Issue 12, December 2011, Pages 548-554
Shiri Eshar, Noa Dahan-Pasternak, Allon Weiner, Ron Dzikowski

POVERTY: Mali: The situation in the north

Dar es Salam, northern Mali - We make a flashing signal with our headlights to let them know our car is in trouble.

They drive a wide berth around us at high speed. Unsure who we are, they fear an ambush on their caravan. It is late at night and there are many forces in this Sahara.

After some hesitation, a group of men get out and in a staggered V-shape military formation, guns at the ready, start walking toward us in the dark.

"Al Sallam alaykum." "Wa alaykum sallam."

"Are you from Ansar Dine?" we ask referring to the local Malian Islamist armed group.

They do not say yes.

"We are mujahideen in the cause of Allah."  
Exclusive:  Al Qaeda urges Mali to reject foreign intervention.
The hair on our necks stands on end. 
The fighters look like desert military preachers - members of some stoical sect that took a vow of poverty and jihad. They wear double bandolier ammo belts over austere beige cotton smocks and matching high cropped pants - like inhabitants of Tatooine, the desert planet inStar Wars. These are not outfits one buys at the market, or inherits from a brother or friend. They are uniforms tailor-made to send a message of simplicity.

The men, mostly Mauritanians, are escorting a caravan of trucks loaded with food and medical aid for the people of Timbuktu - a gift from the Higher Islamic Council of Mali.  
One picks up a walkie talkie and relays: "They're just civilians. Their car is stuck in the sand." A voice in Arabic comes over the line: "My brother, why didn't you tell us this before?"

The mujahideen set about helping us extricate our car - its wheels churning deeper and more hopelessly into the sand. One enters the driver's seat to manoeuvre while the others help us push from behind. The effort drags on for an hour.

They banter easily with our team in Tamasheq, the Tuareg language - evidence that they have spent years living in northern Mali where al-Qaeda in the Islamic Maghreb (AQIM) had a mountain base and a tacit agreement with the Malian state.

They do not have to spend all night stuck in the sand with us. Their generosity is impressive, their faces luminous, their voices soft, their manners exquisite. And they have given us the satisfying feeling that we are more important to them than time, or anything else.

Omar, a local Arab travelling with us in his old pick-up truck, is impressed.

"Look my brother," the mujahideen tell him, "your car is very old, it can't work. You need to buy a new car." It is an ingeniously subtle flag - and it elicits the intended response. "I wish you would buy me a new car because I have no money," Omar says.

The fighters barely need to signal what everyone in this impoverished Sahara long ago came to know: al-Qaeda has money and they can help you with it.

"We can bring you to a path that is even better than money," they tell Omar, "the path to paradise."

"I love the idea of jihad," says Omar, "but I have children and elderly people relying on me. I have to support them and I can't leave them behind."

At this moment two of the fighters say almost simultaneously: "If you tasted jihad you would leave all of this and come with us."

Omar decides to stay the night with the mujahideen who are bedding down in the sand. It will not be possible to reach Timbuktu tonight.

The suffering of Timbuktu

The barge crosses slowly, silently - making its way over the river to Timbuktu. On board: a fleet of shiny new 4x4 Land Cruiser trucks, bristling with communications gear, black jihad flags flying.

The ship driver chews his siwak and concentrates on the bigger picture: the water and sandy yellow shore he will get to. All kinds of people cross here. In the absence of a state, the default position is to mind one's own business.
"Recognise us as a state, and then we can talk about fighting al-Qaeda."
- Bilal Ag Cherif, the head of the MNLA
Timbuktu is the gateway to the Sahara desert. North of here are vast seas of sand believed to be filled with oil and gas. Algeria, France and Qatar are exploring the Mauritanian side of the massive Taoudeni Basin, while Algeria holds exploration concessions on northern Mali's side. The region's indigenous Tuaregs believe this land also contains a mother lode of uranium, gold and more.

But northern Mali is only rich in theory - it is one of the poorest regions on Earth, which the government of Mali has done little to develop.

That is one of the reasons why the secular Tuareg rebel movement - the National Movement for the Liberation of Azawad (MNLA) - rose up in January 2012 and swept the northern two-thirds of Mali, declaring an independent state called Azawad. 
But the MNLA rebels were soon sidelined by al-Qaeda and its local offshoots, which pushed them from the cities and took over the region, imposing Sharia. The MNLA declined to fight al-Qaeda and beat a tactical retreat. They say their primary enemy is Mali, and until the world recognises them, they cannot lose blood and treasure opening a second front.

"We should fight al-Qaeda in exchange for what?" asks Bilal Ag Cherif, the head of the MNLA and president-in-waiting of the Tuaregs' hoped-for Azawad state.

"Will they recognise Azawad?" asks Bilal. "Provide clear political, economic, security and military assistance to the Azawadis? Those are the requirements of war. So give us those things, recognise us as a state, and then we can talk about fighting terrorism."

In the meantime, Timbuktu is being run by AQIM in partnership with local Islamist armed group Ansar Dine - an organisation of mostly Malian Tuaregs and Arabs which serves as an umbrella and host for the foreign fighters of al-Qaeda, much as the Taliban did in Afghanistan. The two groups work hand-in-glove managing the Islamic police and distributing charity.

Many here are afraid of the mujahideen and say so quietly - they feel sad and confused by the imposition of unfamiliar interpretations of Islam and the destruction of their heritage.

"Aren't we Muslims?" asked one old man in the street. "By God this is the land of Islam. We have many good Islamic scholars here. We don't understand their ways. We feel like we're in prison." 
Exclusive:  Humanitarian Crisis in Timbuktu
Timbuktu is now a city of the hungry, where food staples like millet have tripled in price and no one has money to buy them anyway. 

In the slums where Tuareg families who have lost their animals scratch a living from garbage heaps, the mujahideen are playing the role of humanitarians.

"When the Salafis came with millet and rice, we got some of it," says Fatimatou, who is now dependent on the groups to survive.

"I can't lie before God. They came to us and paid their respects. At the time these little girls were not wearing hijab. They put hijabs on them and gave us a dress code."

At Timbuktu hospital where starving babies are beginning to appear, Ansar Dine spokesman Sanda Ould Boumana stalks the halls worrying about the hungry children.

"Any humanitarian aid to assist people here, regardless of who it comes from or under what name, we have no problem with it," says Sanda, adding that the only aid they would reject is evangelical aid.

Sanda's mobile erupts with the sound of a laughing baby - the preferred ringtone of the mujahideen because it is family-friendly and is not music.

"We call upon the world," he resumes, "we ask them to please give aid to this poor and suffering people."

Sanda, who did hard jail time in Mauritania for being an alleged member of al-Qaeda, does not understand why almost no one is giving.

Amidst the whimpers of children too hot or sick to cry, the beleaguered director of this hospital, Saidou Bah Salloum, looks like he is going to explode from suppressed grief or anger, or both.

"I am a committed Muslim," he says choosing his words carefully to protect the hospital, which receives aid from the armed groups. But his eyes contradict the calm tone, telegraphing a message of desperation.

"For all the people of Timbuktu, as a native of Timbuktu, I hope that God will accord us a better tomorrow and that he will really help us. We are Muslims. And the only reason we are still alive is because of our faith."

How did al-Qaeda get here?

Al-Qaeda has based itself in northern Mali for 10 years, as part of an alleged secret agreement with Amadou Toumani Toure (ATT), the president of Mali who was deposed in a military coup in March 2012 as northern cities were falling to Tuareg rebels.  
During ATT's presidency, AQIM amassed an outrageous fortune in Mali – collecting up to $250m in hostage ransoms from Western governments for more than 50 European and Canadian hostages kidnapped over the past decade, usually from neighbouring Niger.  
At this moment there are still European hostages being held by al-Qaeda in northern Mali pending delivery of a $132m ransom.  
The ransom negotiations, which were carried out under the auspices of the presidency, were confirmed by the Wikileaks cables to be a goldmine for the Malian VIPs involved - with each receiving his cut of the jackpot including, according to a former Malian official with knowledge of the deals, the president himself.  
Another powerful individual alleged to have enriched himself from hostage ransoms was ATT's close political and business associate Iyad Ag Ghali who has been involved in nearly every al-Qaeda hostage negotiation since the first one in 2003.  
Iyad Ag Ghali is the head of al-Qaeda offshoot Ansar Dine, and the closest thing Mali has to a Mullah Omar.  
Now Mali's closest neighbour seems to be confirming the deal.  
Niger's foreign minister Mohamed Bazoum recently told the French National Assembly: "ATT was very proud to appear on the steps of his palace trying to return former hostages to their country. But there was a deal with AQIM, which kidnapped the hostages in Niger and Mauritania before taking them into Malian territory. The hostages were then released through the mediation of the Malian president. And his emissary was often Iyad Ag Ghali."
For years Malian Tuaregs have been complaining that their government was in bed with al-Qaeda, but their cries fell on deaf ears.
"Mali opened the field to Al Qaeda- to roam among the camps and villages, to build relationships with the people… Mali facilitated Al Qaeda."
-Colonel Al Salat Ag Habi,Commander  MNLA
According to numerous northern residents, AQIM fighters have been circulating openly in Tuareg towns, not for the past year, but for the past 10 years; shopping, attending weddings, and parading fully armed in the streets, in front of police stations and military barracks.  
Colonel Habi ag Al Salat, a Malian army commander who defected in 2011 to join the MNLA, was one of the first to notice the Algerian fighters from the Salafi Group for Preaching and Combat (GSPC) entering Tuareg towns of the far north such as Aguelhoc, which was under his command.  
But when Habi warned his army superiors they told him to stand down and leave the men alone because they were "not enemies" of Mali. When the GSPC changed its name to al-Qaeda in the Islamic Maghreb, following a pact announced by Ayman Al Zawahiri, that policy did not change.

"Mali opened the field to al-Qaeda - to roam among the camps and villages, to build relationships with the people," says Habi.

"Local people benefitted up to a point from the trickle down of money flowing to al-Qaeda by way of Mali. And this ensnared many of our youths who are unemployed. Mali facilitated al-Qaeda, providing them complete freedom of movement among our families because they believed the presence of this group would impact the Tuareg struggle against the governing regime which has been going on for 50 years."

Yet for all the huge sums of money, most Tuaregs in northern Mali dislike Salafism and remain un-seduced by al-Qaeda. Most still cling to dreams of independence and find old-school national liberation groups like the MNLA attractive, in spite of the fact that it cannot even afford to feed its troops.

"We are Muslims but we can't stand the Salafi way," says Bukhadu, a 22-year-old Tuareg herder who likes the MNLA. "We want our sisters to feel the wind in their hair."

Were it not for legendary Tuareg warrior-turned-Salafi Iyad Ag Ghali, who led Mali's Tuareg rebellion in the 1990s and who has used all his political and tribal capital to press his followers into the cause of jihad, al-Qaeda would have little support in northern Mali, and the Tuareg push for independence would have been hard to stop.

Now, thanks to his alliance with al-Qaeda, Iyad Ag Ghali has muscled Ansar Dine to a place at the negotiating table with a prize bargaining chip in hand - much to the relief of regional negotiators who prefer dealing with Ansar Dine, which unlike the MNLA, does not want an independent state.

The forbidden state

Can the welcome mat Mali extended to AQIM be understood only as a case of greed?

This region has been dealing with Tuareg rebellions and Tuareg separatism for 50 years. Not a single country in the Sahel or Sahara supports the notion of a new state, especially not one that might fuel Berber aspirations in Algeria, or more seriously, spark Tuareg irredentism on the part of oil-rich southern Algeria's Tuareg populace, or oil-rich southwest Libya's Tuaregs, or uranium-rich northern Niger's Tuaregs.

The major existential threat to states like Mali, Niger and Algeria is Tuareg/Berber rebellion and separatism.
 Exclusive:  Al Qaeda linked groups take over northern Mali
The fact that Tuaregs are one of the world's poorest and most isolated people living atop some of the world's richest resources only fuels the fear, and the desire.

Of the millions of dollars in US and EU support allocated to help the Malian army fight al-Qaeda, much of it was diverted to fight the Tuareg insurgency.

Ighlas Ag Offin, a national security official in the Office of the President witnessed ATT ordering 55 military vehicles and a massive weapons cache to equip an Arab militia during the 2008 rebellion.  

"Those weapons had come to Mali as foreign aid to fight terrorism.  All of it went north to fight the Tuaregs," says Offin, "and to this day they are still in the hands of that militia."
Profits and kickbacks from drug smuggling were also allegedly thrown into the fight.

"The president was surrounded by drug smugglers," says Offin, "every single day drug smugglers were coming and going from the presidency."

According to the UN Office on Drugs and Crime (UNODC), northern Mali is a major drug trafficking corridor for the       $1.8bn to $2bn worth of cocaine that is moved from West Africa to European and Middle Eastern markets every year.

Ibrahim Ag Al Saleh, a former MP from Bourem, which is the epicentre of northern Mali's cocaine traffic, says ATT and his wife were deeply involved in the business.

"The president used the profits from drug smuggling and al-Qaeda hostage ransoms to help fund northern militias to protect the drug traffic and fight the Tuareg rebellion," says Ibrahim, whose home area is now under the control of the Movement for Unity and Jihad in West Africa (MUJAO), another al-Qaeda offshoot.

"Today it is those very same drug smuggling protection militias who are raising the black flag with the words upon it ‘No God but Allah' in Gao and in Bourem. They no longer have ATT to protect them. Now they are hiding behind the Salafists."
"I invite the Muslim people of Mali of all its tribes to put their hands together with their brothers Ansar Dine… and save the country from break up." 
- Abdul Malek Droukdel, Emir of Al Qaeda in the Islamic Maghreb.
While ATT relied increasingly on ethnic militias and special units to crush Tuareg insurgency, the Malian army was starved and demoralised, its hungry soldiers forced to sell their weapons to eat, to watch AQIM parade before their barracks, and planes filled with cocaine landing near their bases. The system was rotten. Could they be blamed for overthrowing it?

The most interesting testimony on the relationship between AQIM and Mali comes from the organisation itself.

The emir of AQIM, the Algerian Abdelmalek Droukdel a.k.a. Abu Musab Abdel Wadoud, seen earlier this year by Al Jazeera touring Timbuktu's main souq, recently addressed the people of Mali.

Reading from a teleprompter in a television studio, Droukdel begged Malians to reject the MNLA and to preserve the territorial integrity of Mali.

"France lies to you," he implored, "when they pretend that they want to protect the unity of Mali while all the evidence proves their intentions are otherwise and confirm they want to divide the country. Are they not the ones who supported MNLA in order to put them in charge of northern Mali and make an independent state there? But thanks to Allah, your brothers, the mujahideen, your brothers in the north, the Islamists, they are the ones who stopped this satanic plan and corrupted their steps …. I invite the Muslim people of Mali of all its tribes to put their hands with the hands of their brothers Ansar Dine and to come to a mutual understanding with them that they become one hand and one cohesive group and save the country from break up."

It is an unusual plea from a group professing only to defend Islam, and to have no interest in the preservation of secular states and their borders. It sounds almost nationalistic.

"We know the intelligence agencies of a number of countries have been working with the leadership of these groups," says MNLA chief Bilal Ag Cherif.
"Where are the resources and capabilities these groups enjoy coming from? Why are the leaders of these groups able to enter the capital cities of neighbouring countries and then return here, while they have been declared 'terrorist' organisations? Why do they not arrest them in those capitals, whereas the minute they return to Azawad they say: ‘Fight them'?"
Bilal stares amazed. "This game of chess should not be played."
The one armed force that has both the numbers and local knowledge to credibly expel al-Qaeda from a wide swath of the Sahara and keep them out over the long term would be the region's indigenous Tuareg fighters. 

But giving them a mandate to do that would mean recognising and empowering them as a force with legitimate demands, which neither Mali, nor any neighbouring country wants to do.

Meanwhile the Tuaregs have a sinking feeling: The fear that they are the ones who will be killed in any coming war, in the name of fighting al-Qaeda.

Sunday, 30 December 2012

POVERTY: Canadian aboriginal problems

 December 29, 2012Share on facebook
SPENCER WYNN/TORONTO STARRosie Koostachin has raised children and grandchildren in Attawapiskat, almost left the reserve once when times were bleak. But she stayed, citing her love for her wilderness home.
1 of 6
Raveena Aulakh
Staff Reporter 
ATTAWAPISKAT, ONT.—If she had a magic wand, Rosie Koostachin would change many things in her community. There would be better housing, health care and education. There would be more jobs and there would be no drug and alcohol abuse. Oh, and the reserve would be better run.
But there is no magic wand. Neither is one on its way.
Koostachin, the wise 42-year-old mother of four and grandmother of one, knows that.
Attawapiskat hasn’t changed in decades ... I don’t think it ever will. It can’t. I was born here, I was raised here and I have raised all my kids here. The problems I saw four decades ago ... they are problems we still face.”
Health care and education will always be a challenge. The dropout rate at the local high school will stay at more than 50 per cent. So will poverty. There will be no employment opportunities. Entertainment will at best be non-existent except around Christmas. The local cost of living will always be expensive (a single red pepper costs $3.99 and half dozen bananas $2.89).
It is the truth.
Koostachin is not the only one who says so. She may be brave enough to talk openly about it but others say the same thing privately: Attawapiskat, home to about 1,900 people, can likely never be fixed. In the long run it is unsustainable.
“But this is also our home,” says Koostachin, throwing her hands in the air.
It is a conundrum.
ATTAWAPISKAT HAS a long list of problems.
The community was founded in 1893 by Catholic missionaries. The steepled church, an aging grey structure next to the Attawapiskat River, remains the most striking structure.
In 1901, the Hudson’s Bay Co. built a store here. Most natives lived in the bush at the time, hunting, trapping and fishing, and it was only in the 1930s that the settlement began to grow. Housing came in the 1970s, running water and sewage treatment arrived in the 1990s.
It’s been unravelling since it all began.
The isolated Cree reserve’s problems exist, and persist, mostly due to its location.
For much of the year, it is accessible only by air, which complicates life here terribly. For example, home repairs are near impossible because neither materials nor skills are available locally. There is no permanent doctor at the local hospital. Pregnant women must be flown either to Moosonee, a larger reserve on nearby James Bay, or to Timmins, Ont. Teachers and nurses, almost all non-aboriginal, feel marooned and don’t stick around too long.
The one non-aboriginal who has remained in the community is, perhaps, also its most loved.
Father Rodrigue Vezina first came here 39 years ago. He has never left, except to spend a couple of weeks every summer with his family in Quebec City.
The Oblate priest says he has spent a lot of time, especially during the long dark winters, thinking about the reserve’s future and how it can be improved. The answer eludes him.
“Problems are not being solved ... I wonder if they ever can be,” he says.
Vezina believes the only way that things may change here is by extensive job training so that locals can provide services in such areas as health care, construction and education.
Jobs are the key to shaking up the reserve, he says. “People need to have a reason to wake up every morning.”
(The reserve has almost no economy; as a result unemployment is at 70 per cent. Most people live on social assistance.)
But Vezina, frail and thoughtful, understands it’s easier said than done. He is familiar with the difficulties faced by the elementary and high schools, where teachers usually don’t stay for more than a year or two and students don’t attend class regularly.
The children feel no obligation to attend because they wake up in households where they have never seen their parents go to work. “What is the point, they think,” says Vezina.
No education, no employment. It’s that simple, he sighs.
But it’s the hopelessness among the youth that really bothers Willie Sprule, who works at the Northern, the lone grocery store in Attawapiskat.
He sees them hang around aimlessly at the store during school hours and tries to shoo them back to class. “It bothers me,” he says. “You know, we think more about these problems than you think we do.”
SOME PEOPLE IN the south tend to dismiss the plight of the Cree-speaking people of this reserve — and other isolated communities in the north — as the self-inflicted fate of people unable to shift for themselves and unwilling to let go of the past.
It’s easy to pass judgment from hundreds of kilometres away — but it’s also tough to understand their love of this land, which can be harsh and unforgiving.
Mornings are quiet and cold. One hour blurs into another, as does one day into another. The only sound, most times, is of snowmobiles whizzing by or dogs playing with each other. This world is a dozen or so blocks of single-storey homes and little else.
Why would anyone choose to live here, in this stark wilderness?
It’s a question that Heather Kooiman, who’s from the Hamilton area, up the wall. She is fiercely protective of the reserve and its people.
“Because it’s their land, where they belong,” she says.
Kooiman, a McGill University graduate, is one of the nurses at the local hospital, which she admits really is just a clinic.
She was here for a few months last winter and liked the work enough to return this winter. She says living here has made her realize that “issues between native and non-native people are so broken. It is so important to build the relationship between the two.”
This is their land, this is how they live and this is how they want to live, she says. “It may be difficult for us to understand why they have this tie, but this is their world and we have to respect it instead of imposing our opinions on them.”
THE WORLD IN Attawapiskat is small but it’s the only one residents know, the one they are comfortable in.
It’s not as if people have not tried to leave, says Serena Koostachin, chief of the youth council. They have, and it hasn’t gone well in many cases.
Young people are terrified of leaving the reserve, says Koostachin (who is not related to Rosie Koostachin). “They have seen others leave (for college) but eventually return because either they couldn’t cope with education in a new place or feel insecure without their families.”
She knows the feeling. She left the reserve after Grade 10 to attend a non-aboriginal high school in New Liskeard, Ont. Koostachin says she did miserably there and couldn’t wait to return to the reserve.
She says most high school graduates who leave to go to college or university return within a year or so.
Rosie Koostachin says it is not just people in their teens or in their 20s who come back. Families have moved away to get jobs or provide a better education for their kids but 95 per cent of them end up back in Attawapiskat.
The family structure is very sound here, she says. “People help each other with clothes, food ... When they move out, they find it hard to survive without it.”
Koostachin almost left the reserve once. It was in 2005, when she and her family were homeless and they were living in a house with a collapsed floor. In one of her bleakest moments, she thought of moving off the reserve.
But she didn’t.
She, like everyone else here, talks earnestly about how much she loves nature and the land and what it means to her. “When I go to the James Bay, it is a spiritual moment,” she says. “I’m the happiest then.”
In most beleaguered communities, happiness is a ghost. Not here.
Even though hardships are piled one over the other, Attawapiskat hasn’t become desolate and tired. The suffering is real, so is the gentle acceptance of life the way it is. Despite the cold, people laugh, joke and go about their life.
This is our life, says Koostachin.
“We will be poor. We will always live in poverty. We know that,” she says. “But as long as we live on this land, we will always be OK.

Saturday, 29 December 2012

POVERTY: Haiti: ‘Most everything went wrong’: Three years after an earthquake devastated Haiti, the reconstruction has barely begun

Thony Belizaire / AFP / Getty ImagesNearly three years after the earthquake, which killed more than 200,000 people and left more than 1 million homeless, almost 360,000 people are still living in tents in Haiti.
On Jan. 10, 2010, Haiti was hit by a devastating earthquake. Lofty ambitions followed the disaster, when the world aspired not only to repair the country, but to remake it. Despite billions of dollars spent — and billions more allocated but unspent — rebuilding has barely begun and 357,785 people still languish in 496 tent camps. “When you look at things, you say, ‘Hell, almost three years later, where is the reconstruction?’ ” said Michèle Pierre-Louis, a former prime minister. “If you ask what went right and what went wrong, the answer is, ‘Most everything went wrong.’ There needs to be some accountability for all that money.” The New York Times’ Deborah Sontag examines Haiti’s many problems.
At least $7.5-billion in aid has been disbursed. More than half has gone to relief aid, which saves lives and alleviates misery, but carries high costs and has no permanent effect — tents shred; emergency food and water are consumed; short-term jobs expire; transitional shelters, clinics and schools are not built to last. Only a portion went to earthquake reconstruction strictly defined. Instead, much of the recovery aid was spent on costly programs, like new highways and HIV prevention, and projects far from the disaster zone, like an industrial park in the north and a teaching hospital in the central plateau. Meanwhile, just a sliver of the total disbursement — $215-million — has been allocated to the most obvious and pressing need: safe, permanent housing. “Housing is difficult and messy, and donors have shied away from it,” said Josef Leitmann, manager of the Haiti Reconstruction Fund (HRF).
Dieu Nalio Chery / The Associated Press
Dieu Nalio Chery / The Associated PressMileine Pierre, 34, combs the hair of her daughter Jessy Vila, 10, as she holds her other daughter Jesnove Vila, 3, outside their tent where they live in the Tapis Vert camp for people displaced by the 2010 earthquake in the Cite Soleil neighborhood of Port-au-Prince, Haiti.
Disbursed does not necessarily meant spent. Sometimes, the money has simply been shifted from one bank account to another as projects have bogged down. That is the case for nearly half the money for housing. The U.S., for instance, long ago disbursed $65-million to the HRF for the largest housing project planned for Port-au-Prince. The fund, which issued a January 2011 news release promising houses for 50,000 people, transferred the money to the World Bank, which is executing the project. And there almost all of it still sits, with contracts just signed. The U.S. still has more than $1-billion allocated for Haiti sitting in the Treasury, and the global Red Cross movement has more than $500-million. Spain has disbursed $100-million to Haiti’s water authority for infrastructure desperately needed during the continuing cholera epidemic, but only $15-million has been spent so far. Millions have been allocated to build and renovate 21 schools, but only one has been completed.
Almost all contracts have been awarded to foreign agencies, nonprofit groups and private contractors who, in turn, subcontract. Each layer adds 7% to 10% in administrative costs, says a paper by the Center for Global Development. “All the money that went to pay the salaries of foreigners and to rent expensive apartments and cars for foreigners while the situation of the country was degrading — there was something revolting about it,” Ms. Pierre Louis said. In a sentiment many Haitians share, Reginald Boulos, who runs a car dealership in the capital, said foreigners in Haiti “do everything at a cost five times higher.” Oxfam spent $96-million over two years, and devoted a third to management and logistics. Doctors Without Borders spent 58% of its $135-million in 2010 on staff and transportation.
More than two years ago, Hillary Clinton, the U.S. Secretary of State, and Bernard Kouchner, the then-French foreign minister, signed an agreement to reconstruct Haiti’s largest medical centre in the capital. The shattered General Hospital, with some temporary renovations keeping it functional, still awaits its $70-million overhaul. Meanwhile, Inter-American Development Bank (IADB) is spearheading a multi-year school rebuilding program being carried out by a Haitian public institution. The bank was hoping up to 21 new schools would open this fall. But a bank inspection last spring detected serious design flaws and construction errors. A fuller audit found the schools, despite being built after the earthquake, did not comply with anti-seismic or anti-hurricane standards. How much beyond the $15.4-million cost it will take to make them safe has yet to be determined, said Pablo Bachelet, a bank spokesman.
Tyler Anderson/ National Post Files
Tyler Anderson/ National Post FilesA man sits in front of a collapsed building as he watches a United Nations team remove bodies from the sidewalk in Port-au-Prince, Haiti.
In the months after the earthquake, foreigners, arriving by the planeload, took over. They did not mean to; nobody in the humanitarian world wanted to sharpen Haiti’s dependency on foreign help. But Haiti’s government was as shattered as its people, and old patterns of interaction are hard to break. Co-ordinating the disaster response, foreign humanitarians met on the isolated, gated United Nations logistics base and divided into clusters dealing with issues like shelter and health. Something was missing, though: “In the initial confusion and loss of life after the earthquake, the clusters effectively excluded their Haitian counterparts,” said Nigel Fisher, the UN’s humanitarian co-ordinator. “Little by little, we brought them in.” Still, many locals never shook off the feeling they were an afterthought and their institutions and businesses were being bypassed and undermined. Many of the best-educated Haitians were lured away from government and private-sector jobs by higher salaries offered by foreigners. “We called it the second earthquake,” said Jean-Yves Jason, mayor of Port-au-Prince at the time.
Idealistic discussions were not just about building back better. Former president René Préval wanted to use the initial exodus to the countryside to decongest Port-au-Prince permanently. Decentralization became the second mantra, guiding early commitments to spend significant reconstruction money outside the disaster zone. “There were all sorts of fantasies about shutting down the mess that is Port-au-Prince before people started to understand that there is a huge amount of capital built up in the city and, chaotic as it is, you don’t throw it out,” said Mr. Leitmann. The largest new settlement under construction is a $48-million Haitian government initiative on a barren, isolated site 16 kilometres east of Port-au-Prince in Morne à Cabri. Ms. Pierre-Louis says the houses look like “little tombs in the desert.” Critics also questioned the location of the U.S.-subsidized settlement in rural Caracol, far from the disaster, as well as the high cost of its one-bedroom homes. They are being built by a Minnesota company on a site prepared by a Maryland firm for $31,400 a house. A small one-family house in Port-au-Prince can be built for $6,000. Although the Caracol houses were supposed to be occupied by December, only 70 of 750 had been finished by November because of bad weather and logistical problems.
Tyler Anderson/ National Post Files
Tyler Anderson/ National Post FilesA view of a temporary camp for homeless Haitians from a Canadian Forces helicopter in Port-au-Prince, Haiti.
New president Michel Martelly won international help to close six highly visible tent camps, repair 16 neighbourhoods and shut down the Champ de Mars settlement in downtown Port-au-Prince. Some Haitians felt he was trying to sweep the homelessness problem from view without resolving it — the neighbourhood repairs have lagged the camp closings . Others expressed relief he was taking action because a temporary solution was better than none at all. From the start, grand ambition had got in the way of tackling what was doable. “Early on, it seemed fairly clear that the only viable approach was to rebuild existing neighbourhoods,” said Priscilla Phelps, a U.S. consultant who advised the Interim Haiti Recovery Commission (IHRC) on housing. “But it took six to eight months to get the government used to that, and another four to six months to make the donors comfortable. Nobody wanted to think reconstruction might be a giant slum-upgrading project. They wanted little pastel houses and kids with ribbons in their hair to put on the cover of their annual report.” Mr. Boulos said, “I told the head of the American Red Cross, in front of Bill Clinton, ‘Let’s put the entire money in housing construction. Let’s repair the houses.’ But they had all kinds of reasons why not.”
In April 2010, Mr. Clinton was named co-president of the IHRC. Two months later, at a luxury hotel in the hills above Port-au-Prince, the commission had its first meeting. It would hold only six more, though, before the Haitian Parliament declined to renew its mandate and it faded into history, its website decommissioned and its public records erased. “As a tool for Bill Clinton, the commission was good; it helped him attract attention to Haiti,” said Mr. Boulos, a commission member. “As a tool to effectively coordinate assistance and manage the reconstruction, it was a failure.” Alexandre Abrantes, the World Bank’s special envoy to Haiti, disagreed: “Everybody badmouths it, but I miss it. It created a level of co-ordination, with everybody around the same table, which you find in few countries. I think people had unreasonable expectations that it would be an implementing agency.” But Ms. Phelps said, “It was like in a play — the facade of a reconstruction project. We never took a pro-active role in deciding what the country needed to get back on its feet and then asking the donors to finance those priorities instead of doing their own thing.”
Thony Belizaire / AFP / Getty Images
Thony Belizaire / AFP / Getty ImagesPeople work on houses being built by former US president Jimmy Carter's Habitat for Humanity foundation for victims of the January 2010 earthquake in Leogane, 33km south of Port-au-Prince, on Nov. 26, 2012.
Initially, Mr. Clinton and Haitian leaders thought the private sector would play a larger role in rebuilding Haiti’s devastated housing. One relic of those aspirations is the abandoned site of a 2011 exposition in Zoranje, where scores of colourful prototype homes now sit empty, some padlocked, others plundered and used as toilets. Dreamed up at a meeting at Mr. Clinton’s home in Chappaqua, N.Y., the expo cost millions in public and private money. By the time the exposition took place, the thinking about housing had changed and most contracts were going to be awarded for urban fix-it work instead. Next to the expo site is the only large new housing project completed. With $8.3-million in financing, mostly from IADB, most of its 400 small houses remained unoccupied for half a year, except in some cases by squatters, because authorities could not figure out how to connect the complex to water.
Mr. Fisher, the UN humanitarian co-ordinator, said current projections are 200,000 Haitians will still be living in camps a year from now, on the fourth anniversary of the earthquake.