tag:theconversation.com,2011:/id/topics/meles-zenawi-28755/articlesmeles zenawi – The Conversation2021-07-20T14:42:30Ztag:theconversation.com,2011:article/1647142021-07-20T14:42:30Z2021-07-20T14:42:30ZAs Ethiopia and Tigray face tough options, the West needs to be even-handed<figure><img src="https://images.theconversation.com/files/412109/original/file-20210720-17-1jukg29.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ethiopian Prime Minister Abiy Ahmed arrives to cast his vote during the country's parliamentary elections in Beshasha, Oromia, in June.</span> <span class="attribution"><span class="source">Photo by Stringer/Anadolu Agency via Getty Images</span></span></figcaption></figure><p>War broke out in <a href="https://www.aljazeera.com/news/2020/11/19/ethiopia-says-its-forces-closing-in-on-tigray-capital">Tigray in November 2020</a>, pitting the Ethiopian National Defence Force alongside Eritrea against the Tigrayan People’s Liberation Front. </p>
<p>The conflict has caused <a href="https://www.theguardian.com/world/2021/apr/02/ethiopia-1900-people-killed-in-massacres-in-tigray-identified">colossal damage </a> to human life, economy and the nation’s social fabric. Following the government’s recent <a href="https://www.aljazeera.com/news/2021/6/28/ethiopian-government-agrees-immediate-ceasefire-in-tigray">declaration of a unilateral ceasefire</a> the Tigrayan People’s Liberation Front has declared a <a href="https://www.nytimes.com/live/2021/06/29/world/tigray-ethiopia">victory</a>. </p>
<p>After two weeks of relative calm, another round of war <a href="https://www.bloomberg.com/news/articles/2021-07-14/ethiopia-s-tigray-conflict-deepens-as-abiy-s-cease-fire-fails">is on the horizon</a>. The Tigrayan People’s Liberation Front is claiming that it’s determined to “liberate” Tigray from the “occupation” of the Amhara and federal forces. For its part, the government has also declared that it will <a href="https://nation.africa/kenya/news/africa/ethiopia-s-abiy-vows-to-crush-tigray-fighters-3478012">vanquish</a> Tigrayan forces once and for all. </p>
<p>TPLF is emboldened by the support of the <a href="https://www.reuters.com/world/africa/us-official-warns-washington-will-not-stand-by-face-horrors-tigray-2021-06-29/">international community</a>. But it is already clear from how both sides are regrouping themselves that the second wave of war will open another – and perhaps more devastating – chapter in this tragic saga. The question is: what is the end game?</p>
<p>Several factors could be in play in charting out the next phase. This includes a constitutional arrangement which gives Tigray the right to self-determination including cessation – becoming an independent country. But they might have not achieved unanimity in the Tigrayan camp on this yet.</p>
<p>Another element that could influence the outcome is the continued palpable animosity between individual politicians in both isles. This could get in the way of any dialogue.</p>
<p>And lastly, many Tigrayans see themselves as an integral part – indeed a founding part – of Ethiopia. </p>
<p>So how could the future unfold?</p>
<h2>Secession</h2>
<p>The first possible scenario is secession. In his interview with The New York Times Debretsion Gebremichael, the Vice President of Tigrayan Regional State, cast doubt on Tigray’s future as a part of Ethiopia. He claimed that “<a href="https://www.nytimes.com/2021/07/03/world/africa/tigray-leader-interview-ethiopia.html">the trust has been broken completely</a>”. </p>
<p>If the Tigrayan People’s Liberation Front opts for this, it will have to get over several hurdles. The first is internal. It’s not clear all the members of the Tigrayan People’s Liberation Front leadership would endorse secession because there are some moderates among them. Influential figures – including the commander of rebel forces Tsadkan Gebretensae, and perhaps, Debretsion himself – might see this war as a means of finding a more favourable settlement for the Tigrayan People’s Liberation Front within Ethiopia rather than secession. </p>
<p>Secondly, Tigrayans pride themselves on being the birthplace of Ethiopia’s statehood, religion and civilisation. This would make walking away from the federation hard.</p>
<p>The third hurdle is political and economic. </p>
<p>Politically, if Tigray seceded it would be landlocked. It would also be surrounded by hostile nations in the north (Eritrea) and south (Ethiopia). It could, conceivably, open a corridor through Sudan to connect with more friendly countries. But, in the long run, Sudan would benefit more from a strong relationship with Ethiopia given the country’s resources. </p>
<p>The Tigrayan People’s Liberation Front has made it clear that it is determined to <a href="https://www.reuters.com/world/africa/ethiopias-amhara-region-vows-go-offensive-new-phase-civil-war-looms-2021-07-14/">reclaim disputed territory</a> in the west - which is fertile farmland - from Amhara regional forces. This might have to do with ensuring food security as a stepping stone for secession. However, the reclaiming process would be contentious, and possibly even bloody, if it happens at all, because the regional government of Amhara is as determined to retain it. </p>
<p>The West seems to be on their side for now. But, for one, it is not clear for how long the support from the West will last. For another, the disintegration of the federation that makes up Ethiopia might not be the best outcome for the West because it could have a catastrophic impact on the region. Full-blown political chaos in <a href="https://www.theafricareport.com/81417/ethiopia-eritrea-somalia-djibouti-the-constant-instability-in-the-horn-of-africa/">an already volatile Horn of Africa</a> means that the region would become fertile ground for extremist groups. </p>
<p>Nevertheless, cessation is an extreme scenario, but it is not far-fetched. </p>
<h2>Controlling the centre</h2>
<p>Controlling the centre of power in Ethiopia might be another bridge that’s too far for the Tigrayan People’s Liberation Front, which, they might think, can be realised through Western <a href="https://www.aljazeera.com/news/2021/5/27/us-official-condemns-violence-in-tigray-warns-of-new-sanctions">support</a>. This is rooted in the <a href="https://www.bbc.com/news/world-africa-19332646">West’s historical alliance</a> with former Ethiopian Prime Minister Meles Zenawi. The intellectual legacy and the diplomatic network he left behind has proven to be very beneficial to the Tigrayan People’s Liberation Front in garnering support from the West. </p>
<p>It is becoming <a href="https://euobserver.com/world/152370">increasingly clear</a> that Western powers want the Tigrayan People’s Liberation Front as part of Ethiopia’s future. It is not clear, however, if they envisage this within Ethiopian Prime Minister Ahmed Abiy’s administration or without it. </p>
<p>But at what cost? </p>
<p>If the West is determined to resurrect its trusted client to control the centre of Ethiopian politics it could unleash other ethno-federalist forces – especially in Oromia – who might be willing to forge an alliance with the Tigrayan People’s Liberation Front. In addition, former satellite groups embedded in each ethnic group could be reactivated, increasing tension and possibility of conflict.</p>
<p>Another related risk is if the Tigrayan People’s Liberation Front comes back riding on foreign support. This could create a sense of resentment. Abiy Ahmed, is still popular in some regions, including in parts of Oromia, Amhara region and the capital Addis Ababa. The recent <a href="https://www.theguardian.com/world/2021/jul/10/prosperity-party-declared-winners-of-ethiopian-election">elections </a>, however imperfect, are a testament to the fact he has the popular mandate. </p>
<p>However, the government in Addis Ababa remains vulnerable despite winning the elections. This war has been riddled with miscalculations and blunders on both sides. The government promised to end the military campaign in weeks. It hasn’t done so.</p>
<h2>A constructive option – dialogue</h2>
<p>Violence has brought tremendous loss. People need peace, security and a return to normal life. </p>
<p>It would, therefore, be wise for both sides to pursue a more fruitful direction.</p>
<p>Both parties need to commit to a ceasefire. This should start with putting an end to branding each other as “<a href="https://foreignpolicy.com/2021/04/28/ethiopia-tigray-war-amhara-abiy-ahmed-expansionism/">expansionist</a>” or “<a href="https://www.youtube.com/watch?v=nnLD9QB01kA">terrorist</a>. Such narratives create excuses for violence”. </p>
<p>A settlement only happens when politicians put their egos aside and heed the plight of the <a href="https://www.ft.com/content/194a494a-e596-4dbe-a21e-f7e9d8daed92">suffering people</a> – the big losers in this tragic war. </p>
<p>This should lead to dialogue as to how to reconfigure the union of the nation. More importantly, the Tigrayan People’s Liberation Front would be wise to reinvent itself as an opposition party that leads a peaceful struggle. The only choice should not be between either taking the control of the government or leading the whole nation to an endless abyss. The voice of Tigrayans need to be represented - Ethiopia without Tigrayans is not complete. Leaders of the central government should do away with dehumanising rhetoric.</p>
<p>For its part, instead of fanning the flames, the West needs to be even-handed in bringing the warring sides to the table.</p><img src="https://counter.theconversation.com/content/164714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mohammed Girma is affiliated with International Bible Advocacy Centre (IBAC).</span></em></p>Instead of fanning the flames, the West needs to be even-handed in bringing the warring sides to the table.Mohammed Girma, Visiting Lecturer, University of RoehamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1510422020-11-30T09:24:17Z2020-11-30T09:24:17ZConflict between Tigray and Eritrea – the long standing faultline in Ethiopian politics<figure><img src="https://images.theconversation.com/files/371758/original/file-20201127-24-m81m1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An Ethiopan soldier mans a position near Zala Anbesa in the northern Tigray region of the country, about 1,6 kilometres from the Eritrean border.
</span> <span class="attribution"><span class="source"> Marco Longari/AFP via Getty Images</span></span></figcaption></figure><p>The <a href="https://www.france24.com/en/africa/20201115-rockets-fired-from-ethiopia-s-tigray-region-hit-eritrea-capital-govt-source">missile attack</a> by the Tigray People’s Liberation Front on Eritrea in mid-November transformed an internal Ethiopian crisis into a transnational one. In the midst of escalating internal conflict between Ethiopia’s northernmost province, Tigray, and the federal government, it was a stark reminder of a historical rivalry that continues to shape and reshape Ethiopia.</p>
<p>The rivalry between the Tigray People’s Liberation Front and the movement which has governed Eritrea in all but name for the past 30 years – the Eritrean People’s Liberation Front – goes back several decades. </p>
<p>The histories of Eritrea and Ethiopia have long been closely intertwined. This is especially true of Tigray and central Eritrea. These territories occupy the central massif of the Horn of Africa. Tigrinya-speakers are the predominant ethnic group in both Tigray and in the adjacent Eritrean highlands. </p>
<p>The enmity between the Tigray People’s Liberation Front and the Eritrean People’s Liberation Front dates to the mid-1970s, when the Tigrayan front was founded in the midst of <a href="https://www.cambridge.org/core/books/peasant-revolution-in-ethiopia/E3B7988793DC3063511E3765B026EE16">political turmoil in Ethiopia</a>. The authoritarian Marxist regime – known as <a href="https://www.globalsecurity.org/military/world/ethiopia/history-dergue.htm">the Derg</a> (Amharic for ‘committee’) – inflicted violence upon millions of its own citizens. It was soon confronted with a range of armed insurgencies and socio-political movements. These included Tigray and Eritrea, where the resistance was most ferocious.</p>
<p>The Tigrayan front was at first close to the Eritrean front, which had been founded in 1970 to fight for independence from Ethiopia. Indeed, the Eritreans helped train some of the first Tigrayan recruits in 1975-6, in their shared struggle against Ethiopian government forces for social revolution and the right to self-determination. </p>
<p>But in the midst of the war against the Derg regime, the relationship quickly soured over ethnic and national identity. There were also differences over the demarcation of borders, military tactics and ideology. The Tigrayan front eventually recognised the Eritreans’ right to self-determination, if grudgingly, and resolved to fight for the liberation of all Ethiopian peoples from the tyranny of the Derg regime.</p>
<p>Each achieved seminal victories in the late 1980s. Together the Tigrayan-led Ethiopian People’s Revolutionary Democratic Front and the Eritrean front overthrew the Derg in May 1991. The Tigrayan-led front formed government in Addis Ababa while the Eritrean front liberated Eritrea which became an independent state.</p>
<p>But this was just the start of a new phase of a deep-rooted rivalry. This continued between the governments until the recent entry of prime minister Abiy Ahmed. </p>
<p>If there’s any lesson to be learnt from years of military and political manoeuvrings, it is that conflict in Tigray is unavoidably a matter of intense interest to the Eritrean leadership. And Abiy would do well to remember that conflict between Eritrea and Tigray has long represented a destabilising fault line for Ethiopia as well as for the wider region. </p>
<h2>Reconciliation and new beginnings</h2>
<p>In the early 1990s, there was much talk of reconciliation and new beginnings between Meles Zenawi of Ethiopia and Isaias Afeworki of Eritrea. The two governments <a href="http://africaworldpressbooks.com/eritrea-even-the-stones-are-burning-by-roy-pateman/#:%7E:text=In%20Eritrea%3A%20Even%20the%20Stones%20Are%20Burning%2C%20Professor,and%20other%20developments%20in%20the%20last%20two%20decades.">signed</a> a range of agreements on economic cooperation, defence and citizenship. It seemed as though the enmity of the liberation war was behind them. </p>
<p>Meles <a href="https://books.google.co.uk/books/about/The_Eritrean_Struggle_for_Independence.html?id=ee6nFgq4-TkC&redir_esc=y">declared as much</a> at the 1993 Eritrean independence celebrations, at which he was a notable guest. </p>
<p>But deep-rooted tensions soon resurfaced. In the course of 1997, unresolved border disputes were exacerbated by Eritrea’s introduction of a new currency. This had been anticipated in a 1993 economic agreement. But in the event Tigrayan traders often refused to recognise it, and it caused a collapse in commerce.</p>
<p>Full-scale war <a href="https://www.ohioswallow.com/book/Brothers+at+War">erupted</a> over the contested border hamlet of Badme in May 1998. The fighting swiftly spread to other stretches of the shared, 1,000 km long frontier. Air strikes were launched on both sides. </p>
<p>It was quickly clear, too, that this was only superficially about borders. It was more substantively about regional power and long standing antagonisms that ran along ethnic lines. </p>
<p>The Eritrean government’s indignant anti-Tigray front rhetoric had its echo in the popular contempt for so-called Agame, the term Eritreans used for Tigrayan <a href="https://www.hurstpublishers.com/book/shallow-graves/">migrant labourers</a>.</p>
<p>For the Tigray front, the Eritrean front was the clearest expression of perceived Eritrean arrogance. </p>
<p>As for Isaias himself, regarded as a crazed warlord who had led Eritrea down a path which defied economic and political logic, it was hubris personified. </p>
<p>Ethiopia deported tens of thousands of Eritreans and Ethiopians of Eritrean descent. </p>
<p>Ethiopia’s decisive final offensive in May 2000 forced the Eritrean army to fall back deep into their own territory. Although the Ethiopians were halted, and a ceasefire put in place after bitter fighting on a number of fronts, Eritrea had been devastated by the conflict.</p>
<p>The <a href="https://www.refworld.org/docid/3df4be2e14.html">Algiers Agreement of December 2000</a> was followed by years of standoff, occasional skirmishes, and the periodic exchange of insults. </p>
<p>During this period Ethiopia consolidated its position as a dominant power in the region. And Meles as one of the continent’s representatives on the global stage. </p>
<p>For its part Eritrea retreated into a militaristic, authoritarian solipsism. Its domestic policy centred on open-ended national service for the young. Its foreign policy was largely concerned with undermining the Ethiopian government across the region. This was most obvious in Somalia, where its alleged support for al-Shabaab led to the imposition of sanctions on Asmara.</p>
<p>The ‘no war-no peace’ scenario continued even after Meles’s sudden death in 2012. The situation only began to shift with the resignation of Hailemariam Desalegn against a backdrop of mounting protest across Ethiopia, especially among the Oromo and the Amhara, and the rise to power of Abiy. </p>
<p>What followed was the effective overthrow of the Tigray People’s Liberation Front which had been the dominant force in the Ethiopian People’s Revolutionary Democratic Front coalition since 1991. </p>
<p>This provided Isaias with a clear incentive to respond to Abiy’s overtures.</p>
<h2>Tigray’s loss, Eritrea’s gain</h2>
<p>A <a href="https://www.bbc.com/news/topics/cen5x5l99w1t/ethiopia-and-eritrea-peace-agreement">peace agreement between Ethiopia and Eritrea,</a> was signed in July 2018 by Abiy and Eritrean President Isaias Afeworki. It formally ended their 1998-2000 war. It also sealed the marginalisation of the Tigray People’s Liberation Front. Many in the Tigray People’s Liberation Front were unenthusiastic about allowing Isaias in from the cold.</p>
<p>Since the 1998-2000 war, in large part thanks to the astute manoeuvres of the late Prime Minister Meles Zenawi, Eritrea had been exactly where the Tigray People’s Liberation Front wanted it: an isolated pariah state with little diplomatic clout. Indeed, it is unlikely that Isaias would have been as receptive to the deal had it not involved the further sidelining of the Tigray People’s Liberation Front, something which Abiy presumably understood. </p>
<p>Isaias had eschewed the possibility of talks with Abiy’s predecessor, Hailemariam Desalegn. But Abiy was a different matter. A political reformer, and a member of the largest but long-subjugated ethnic group in Ethiopia, the Oromo, he was determined to end the Tigray People’s Liberation Front’s domination of Ethiopian politics. </p>
<p>This was effectively achieved in December 2019 when <a href="https://theconversation.com/ethiopias-new-party-is-welcome-news-but-faces-big-hurdles-128551">he abolished</a> the Ethiopian People’s Revolutionary Democratic Front and replaced it with the Prosperity Party.</p>
<p>The Tigray People’s Liberation Front declined to join with the visible results of the current conflict.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/residual-anger-driven-by-the-politics-of-power-has-boiled-over-into-conflict-in-ethiopia-150327">Residual anger driven by the politics of power has boiled over into conflict in Ethiopia</a>
</strong>
</em>
</p>
<hr>
<p>Every effort to engage with the Tigrayan leadership – including the Tigray People’s Liberation Front – in pursuit of a peaceful resolution must also mean keeping Eritrea out of the conflict. </p>
<p>Unless Isaias is willing to play a constructive role – he does not have a good track record anywhere in the region in this regard – he must be kept at arm’s length, not least to protect the 2018 peace agreement itself.</p><img src="https://counter.theconversation.com/content/151042/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Reid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Conflict between Eritrea and Tigray has long represented a destabilising fault line for Ethiopia as well as for the wider region.Richard Reid, Professor of African History, St Cross College, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827712017-08-24T19:29:16Z2017-08-24T19:29:16ZAfrican politicians seeking medical help abroad is shameful, and harms health care<figure><img src="https://images.theconversation.com/files/183316/original/file-20170824-18746-orpi5c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigerian President Muhammadu Buhari is one of many African leaders to have gone abroad for medical treatment.</span> <span class="attribution"><span class="source">Reuters/Afolabi Sotunde</span></span></figcaption></figure><p>There is an African idiom that if a man does not eat at home, he may never give his wife enough money to cook a good pot of soup. This might just be true when applied to politicians on the continent seeking medical help anywhere but home.</p>
<p>Africa’s public health systems are in a depressing condition. Preventable diseases <a href="http://www.un.org/africarenewal/magazine/special-edition-women-2012/investing-health-africa%E2%80%99s-mothers">still kill a large number of women and children</a>, people <a href="https://www.aho.afro.who.int/en/ahm/issue/14/editorial/health-systems-and-primary-health-care-african-region">travel long distances</a> to receive health care, and across the continent <a href="https://www.iol.co.za/news/south-africa/western-cape/where-patients-sleep-on-the-floor-1268243">patients sleep on hospital floors</a>. On top of this, Africa’s health professionals emigrate in droves to search for <a href="http://www.un.org/africarenewal/magazine/december-2016-march-2017/diagnosing-africa%E2%80%99s-medical-brain-drain">greener pastures</a>.</p>
<p>It’s therefore not surprising that people from Africa travel abroad – mainly to Europe, North America and Asia – for their medical needs. In 2016, Africans spent over <a href="http://uncova.com/african-leaders-and-medical-tourism">USD$6 billion</a> on outbound treatment. Nigeria is a major contributor. Its citizens spend over <a href="https://www.imtj.com/news/nigeria-spends-1-billion-outbound-medical-tourism/">USD$1 billion annually</a> on what’s become known as <a href="https://www.cdc.gov/features/medicaltourism/index.html">medical tourism</a>.</p>
<p>It can be argued that private citizens opting to seek medical help in other countries don’t owe the public any explanation, because it’s their own affair. But medical tourism among Africa’s political elite is a completely different kettle of fish and a big cause for concern, because they are responsible for the development of proper health care for the citizens of their countries. </p>
<h2>The shame</h2>
<p>It’s well documented that politicians from across the continent go abroad for <a href="http://uncova.com/african-leaders-and-medical-tourism">medical treatment</a>. The reasons for exercising this choice are obvious: <a href="http://www.bbc.co.uk/news/world-africa-40685040">they lack confidence</a> in the health systems they oversee, and they can <a href="https://www.voanews.com/a/nigerian-health-care/3726922.html">afford</a> the trips given that the expenses are paid for by taxpayers. </p>
<p>The result is that they have little motivation <a href="http://www.bbc.co.uk/news/world-africa-40685040">to change the status quo</a>. Medical tourism by African leaders and politicians could therefore be one of the salient but overlooked causes of Africa’s poor health systems and infrastructure.</p>
<p>Since the beginning of 2017, President Muhammadu Buhari of Nigeria has spent more time in the UK for <a href="https://citifmonline.com/2017/08/14/buhari-feels-ready-to-go-home-after-treatment-in-uk/">medical treatment</a> than he has in his own country. By seeking treatment abroad, Buhari broke one of his own electoral promises – to <a href="http://www.bbc.co.uk/news/business-36468154">end medical tourism</a>. </p>
<p>Buhari is just one of many heads of state to find help elsewhere. Patrice Talon, the President of the Republic of Benin, underwent <a href="http://www.africanews.com/2017/06/19/benin-president-patrice-talon-underwent-surgery-while-in-paris/">surgery in France</a> a few months ago.</p>
<p>The cases of Buhari and Talon, however, aren’t as bad as other presidents who have had decades to fix their countries’ health care systems, but haven’t. Robert Mugabe, President of Zimbabwe for the past 37 years, frequently seeks <a href="http://www.reuters.com/article/us-zimbabwe-mugabe-idUSKBN18711B">eye-related treatment</a> 8,240 kilometres away in Singapore. Jose Eduardo dos Santos who has just stepped down as Angola’s leader after 38 years, also <a href="https://www.reuters.com/article/us-angola-president-spain-idUSKBN19O1SK">travels to Spain for treatment</a>.</p>
<p>In the recent past, some African leaders died abroad while seeking treatment. Zambia’s <a href="https://www.theguardian.com/world/2008/aug/19/zambia">Levy Mwanawasa</a> died in France while the country’s <a href="http://www.bbc.co.uk/news/world-africa-29813612">Michael Sata</a> passed away in the UK. Then there was Guinea Bissau’s <a href="http://www.bbc.co.uk/news/world-africa-16473457">Malam Bacai Sanha</a> who died in France, Ethiopia’s Meles Zenawi who <a href="http://www.bbc.co.uk/news/world-africa-19328356">died in Belgium</a>, and Gabon’s Omar Bongo who <a href="https://www.theguardian.com/world/2009/jun/08/gabon-omar-bongo-death-reports">died in Spain</a>.</p>
<p>A few fortunate ones made it home, but died shortly afterwards. They include Nigeria’s Musa Yar’Adua who died in Abuja after returning from <a href="http://www.telegraph.co.uk/news/worldnews/africaandindianocean/nigeria/7683904/Nigerian-president-Umaru-YarAdua-dies-after-months-of-illness.html">treatment in Saudi Arabia</a>, and Ghana’s Atta Mills who died in Accra after returning from a <a href="http://www.bbc.co.uk/news/world-africa-18972107">brief medical spell in the US</a></p>
<p>The picture painted above is shameful. As long as Africa’s leaders keep going abroad for medical reasons, the ambition for better health infrastructure will remain an <a href="http://www.bbc.co.uk/news/world-africa-40685040">illusion</a>.</p>
<h2>Costs and risks</h2>
<p>Countries pay a heavy cost for this behaviour. It’s estimated that in Uganda, the funds spent to treat top government officials abroad every year could <a href="http://www.monitor.co.ug/News/National/688334-1394344-9hmafbz/index.html">build 10 hospitals</a>.</p>
<p>Not only do the leaders travel with elaborate entourages, but they also travel in expensive chartered or presidential jets. For example, the <a href="http://sunnewsonline.com/nigeria-not-paying-4000-daily-for-presidential-jet-in-london-presidency/">cost of parking</a> Buhari’s plane during his three month spell in London is estimated at £360,000. That’s equivalent to about 0.07% of Nigeria’s <a href="http://www.financialnigeria.com/nigeria-s-health-budget-grossly-inadequate-feature-121.html">N304 billion budget allocation for health</a> this year. And there would have been many other heavier costs incurred during his stay.</p>
<p>The failure of leaders to improve health care and stem <a href="http://www.bbc.co.uk/news/health-11327505">brain drain</a> also carries a heavy price. A 2011 report estimated that nine African countries – including Nigeria and Kenya - had lost <a href="http://www.bmj.com/content/343/bmj.d7031">USD$2.17 billion</a> of their investment in health care professionals. This figure might be higher now.</p>
<p>On top of this, African hospitals that were previously world class have been reduced to symbolic edifices due to political negligence. For example, Lagos University Teaching Hospital was once deemed to be one of the <a href="https://guardian.ng/opinion/african-leaders-and-medical-tourism/">best on the continent</a>. Recently, it was criticised for <a href="http://saharareporters.com/2017/04/11/jaf-condemns-lagos-university-teaching-hospital-decadence">decadence</a>. Not far away, Ghana’s flagship national health insurance scheme is <a href="http://www.myjoyonline.com/news/2017/April-13th/ghanas-health-insurance-on-the-brink-over-12-billion-debt.php">ailing</a>.</p>
<p>Essentially, when people charged with responsibility feel they have no need for public health systems because they can afford private health care at home or abroad, ordinary citizens bear the brunt. </p>
<h2>The way forward</h2>
<p>The effective health systems in western and Asian countries that are being patronised by African leaders only exist because they were developed, and are consistently maintained, through political commitment and visionary leadership, qualities that are clearly <a href="https://theconversation.com/african-citizens-have-good-reasons-to-be-fed-up-with-their-politicians-81053">lacking in Africa</a>.</p>
<p>To bring change, African citizens must start condemning political medical tourism. They must also push for regulations to curb the shameful practice. Taxpayer funded medical trips should be banned and criteria set detailing what sicknesses that can be covered by the public purse. Though a <a href="http://nigeriahealthwatch.com/wp-content/uploads/bsk-pdf-manager/1189__2014_Official-Gazette-of-the-National-Health-Act-,_FGN_1272.pdf">law</a> to this effect exists in Nigeria, it appears to be <a href="https://www.imtj.com/news/missing-healthcare-law-nigeria/">ineffective</a>. It must, and should work.</p>
<p>Essentially, if the leaders do not experience the poor state of health care, they might never strive for any positive changes to it.</p><img src="https://counter.theconversation.com/content/82771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tahiru Azaaviele Liedong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Health care systems in many African countries are very poor. Instead of fixing them, many African leaders seek medical attention abroad incurring huge bills which are ultimately paid by taxpayers.Tahiru Azaaviele Liedong, Assistant Professor of Strategy, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/613072016-06-27T19:09:03Z2016-06-27T19:09:03ZHow Africa’s 1990s ‘poster boys’ use security fears to roll back democracy<figure><img src="https://images.theconversation.com/files/128077/original/image-20160624-28379-1iq1b8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the 1990s Paul Kagame of Rwanda, along with Yoweri Museveni of Uganda and Meles Zenawi of Ethiopia, were considered the democratic darlings of Africa. </span> <span class="attribution"><span class="source">Reuters/Hereward Holland</span></span></figcaption></figure><p>Hopes of progression along a reformist democratic path in some key sub-Saharan African states appear to be receding. Greater democracy, enhanced freedom of speech and the media have all suffered setbacks in some countries where hopes of long-term change were high. </p>
<p>A number of African political systems have appeared to slip back from the promise of the 1990s. Hopes of more democratic and accountable systems in which the people would be empowered and able to hold leaders to account have begun to fade. </p>
<p>That is what has become of the three 1990s poster boys of the new politics in Africa – Uganda, Rwanda and Ethiopia. For a period they were held up as the stars of the now increasingly <a href="https://theconversation.com/africas-rising-middle-class-time-to-sort-out-fact-from-fiction-59797">discredited “Africa Rising” narrative</a>. They became repositories of hope that decades of conflict and, in Rwanda’s case genocide, would be replaced by accountable governments and systems of rule. But today their political trajectories are clearly blocking the path to meaningful popular empowerment. </p>
<p>Over time their leaders have strengthened their hold on power, entrenched themselves and reduced accountability. In doing this, they have been able to play on Western security concerns in eastern and central Africa. This has replaced the earlier good governance mantras. The “War on Terror” and fear of instability are greater drivers of Western policy than encouraging the rule of law and democratic freedoms.</p>
<p>This trend is set out well in a new study of the links between insurgent authoritarianism and Western aid in Africa, and is captured well in the very interesting collection, “<a href="https://www.amazon.co.uk/Aid-Authoritarianism-Africa-Development-Democracy/dp/1783606282">Aid and Authoritarianism in Africa</a>”.</p>
<p>But the contributors also observe that it’s not all gloom and doom. There has been progress in empowerment and accountability in some areas. </p>
<h2>Playing the security card</h2>
<p>Take Uganda. Echoes of the good governance mantras of the late 1980s and 1990s can still be heard periodically in Western statements on aid to African states. But, in fact, the country’s President Yoweri Museveni and his supporters have militarised, centralised and personalised power. They have created a repressive system of government in which elections are held, fixed and used as just another way of entrenching power. State and informal coercive instruments have been used to</p>
<blockquote>
<p>intimidate, harass and terrorise perceived opponents of the state [<a href="https://www.amazon.co.uk/Aid-Authoritarianism-Africa-Development-Democracy/dp/1783606282">page 67</a>].</p>
</blockquote>
<p>David Anderson and Jonathan Fisher’s well-focused contribution sets out the success with which Museveni has deployed these various weapons. They explain how he has been able to play on Western fears of regional instability to retain budgetary and military aid that bolsters his ability to hold on to power. His <a href="http://af.reuters.com/article/topNews/idAFKCN0Z92QK">latest comments</a> on withdrawing Ugandan troops from Somalia by the end of 2017 may be part of a new attempt to put pressure on the West to maintain support for him, despite misgivings about the election and moves against opponents and the free press.</p>
<p>He wasn’t alone in doing this. The volume highlights the strategies that regimes in Rwanda and Ethiopia have also developed to deal with donors to ensure a range of favourable outcomes. These include:</p>
<ul>
<li><p>that conditionality is on paper only; </p></li>
<li><p>that the contribution of those countries to ensuring stability in a volatile region stretching from Congo to Eritrea to Somalia is paramount; and </p></li>
<li><p>in presenting an image of planned and controlled development the regimes can demonstrate – in technical terms – efficient use of some of the aid. </p></li>
</ul>
<p>The chapters on the three countries, along with Nicolas van der Walle’s well-argued conclusion, show how the good governance slogans and conditionality clauses were just paper tigers. They never had real bite, especially in the face of skilled and single-minded politicians like Museveni, Rwanda’s Paul Kagame and former Ethiopian Prime Minister Meles Zenawi. </p>
<p>They cottoned on from the start that lip-service was all that was really required. This was especially as they were restoring stability and security in their own states, and contributing to Western strategies for ending or limiting conflict in what had been a volatile region. They were <a href="http://www.hurstpublishers.com/book/africas-long-road-since-independence/">able to argue</a> that their non-party or ethnically inclusive approaches were long-term strategies for developing internal stability and indigenous democratic forms.</p>
<p>In fact they were using their political experiments to consolidate power. If this didn’t work, they would confront donors and in effect dare them to withdraw aid and see how far that got them.</p>
<p>Their ability to resist conditionality and continue to garner substantial budgetary and military support was bolstered by 9/11 and the launch of the War on Terror. They were able to argue that they were sources of stability and key military allies in a region that could provide a foothold for Islamist movements antagonistic towards Western interests.</p>
<p>The support they garnered enabled them to entrench power at home while being key links in the security chains the West wanted in place to shackle Islamist or other movements perceived as threats to regional stability. And to Western security.</p>
<h2>Not all doom and gloom</h2>
<p>But the book is not one bewailing the demise of democratic hopes in Africa or seeing all as gloom and doom. Van de Walle, as well as Nic Cheeseman in his <a href="http://www.cambridge.org/us/academic/subjects/history/african-history/democracy-africa-successes-failures-and-struggle-political-reform">nuanced look</a> at democratisation in Africa, stress that there is no gainsaying that the region today enjoys a higher level of political competition and popular participation than at any time since independence.</p>
<p>This has coincided with a general reduction in the number of violent conflicts in Africa. </p>
<p>In “<a href="http://www.cambridge.org/us/academic/subjects/history/african-history/democracy-africa-successes-failures-and-struggle-political-reform">Democracy in Africa. Successes, Failures, and the Struggle for Political Reform</a>” Cheeseman observes:</p>
<blockquote>
<p>In the 2000s, elections and term limits replaced death and coup d'état as the most common ways in which African presidents and prime ministers left office.</p>
</blockquote>
<p>This is important given that commentators and journalists writing about Africa are inclined to see all as gloom and doom. </p>
<p>What the volume and Cheeseman’s book do is once again emphasise that there is not a one-size-fits-all model. There is also no timeline for political change in Africa. Each state develops according to its own historical, political, economic and social factors, and not to one Western-ordained pattern and speed. </p>
<p>It should also be remembered, when there are comparisons of political systems in Africa with those in Europe or North America, that it took from Magna Carta in 1215 to the passing of the Representation of the People (Equal Franchise Act) of 1928 for Britain to move from the absolute power of a monarch to a fully inclusive system of electoral representation. </p>
<p>Too often commentators have a very ahistorical view of political development and try to apply timescales and models that are not appropriate. There is a tendency always to demonstrate some failing on the part of people or states in Africa. The books referred to in this article do not and are valuable additions to the literature on political evolution in Africa and the relationship to aid and donor-based development.</p><img src="https://counter.theconversation.com/content/61307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keith Somerville does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Africa’s democratic promise of the 1990s has lost its shine. Hopes for accountable rule have faded in Uganda, Ethiopia and Rwanda. All have blocked the path to meaningful popular empowerment.Keith Somerville, Visiting Professor, University of KentLicensed as Creative Commons – attribution, no derivatives.