Among personnel trained in Africa, one in every four doctors and one in every 20 nurses are now working in the 30 most industrialised countries of the world. For example, 29 per cent of Ghanaian physicians are working abroad, as are 34 per cent of Zimbabwean nurses. Reportedly, there are more Sierra Leonean doctors living in the Chicago area of the United States than there are in Sierra Leone. At the same time, around 17 sub-Saharan countries have less than half of the WHO minimum standard of 100 nurses per 100,000 population (for example, Malawi has only 17 nurses per 100,000 people). In contrast, many western countries have more than 1,000 nurses per 100,000. The minimum standard set by WHO to ensure basic health care services is 20 physicians per 100,000 people: while Western countries boast an average of 222 physicians per 100,000, 38 countries in sub-Saharan Africa fall short of the minimum standard, and 13 countries have five or fewer physicians per 100,000 people.
All of these situations have more pronounced effects among poor children than among their non-poor counterparts. Children who are poor are more likely fall sick, get no treatment and die than their rich counterparts. A study shows that the mortality rate of the poorest 20 per cent of children in a given country is more than twice that of the richest 20 per cent in the same country.
According to The Economist Magazine, a typical civil war leaves a country 15 per cent poorer, with around 30 per cent more people living in absolute poverty.
Military expenditures have the potential to crowd out investment in social sectors. In 1999, South Africa agreed to buy armaments worth 6 billon dollars, sufficient to provide combinations therapy treatment for five million AIDS patients for two years (Amnesty International and Oxfam (2003).57
On top of the unbearable disease burden, armed conflicts pose a huge health challenge in Africa. The toll on human lives inflicted by conflicts has been enormous: conflict causes as many deaths in Africa each year as epidemic diseases, and is responsible for more death and displacement than famine or flood. Between 1998 and 2002, some four million people died in the civil war in the DRC alone.
Countries with the highest infant and maternal mortality are those which have experienced war in their recent history. In a typical five-year war, the under-5 mortality rate in a country increases by 13 percent, and adult mortality by even more.
Sierra Leone is an example of a country devastated by a civil war, in this case one that lasted more than a decade, between 1991 and 2001. In 2006, the country had the highest under-5 mortality rate in the world: 270 deaths per 1,000 live births.
The country also had the highest maternal mortality ratio in the world, with 2,000 deaths per 100,000 live births in 2002. It also had a stillborn rate of 50 per 1,000 births, and a neonatal mortality rate of between 42 and 56 per 1,000 live births.
Since 2000, Sierra Leone has been at the top of the list of the 20 countries worldwide with the highest maternal mortality ratios.
Even after the guns fall silent and the makeshift camps for the displaced are dismantled, the repercussions of war and conflict continue to undermine child survival. One study has shown that during the first five years of post-conflict peace, the average under-5 mortality rate remains 11 per cent higher than its corresponding level before the conflict.
The lingering legacies of war
The effect of the civil war in Angola continued to be felt years after it had finished. In April 1999, the country suffered one of the largest polio outbreaks ever recorded in Africa. The outbreak came after 30 years of war and destruction of health services, and massive population displacement that had resulted in overcrowding, poor sanitation, and inadequate water supply – an ideal environment for the spread of the poliovirus. In March 2005, an outbreak of Marburg haemorrhagic fever in Angola led to 329 deaths, the most deadly outbreak of Marburg fever to date. There is no cure or vaccine for Marburg.
Neither the source of the outbreak nor the reservoir has been identified to date.
On the malnutrition front, in sub-Saharan Africa more than one-quarter of all children under five are underweight. Poor children are more likely to be underweight than non-poor children. A study by IFPRI showed a strong overlap between hunger and poverty in sub-Saharan Africa, where more than 80 per cent of the poor are food energy deficient. In Rwanda, a 2000 survey showed that the incidence of poverty among the hungry and the incidence of hunger among the poor both stood at 84 per cent, sharply underlining the overlap between poverty and hunger.
Nutritional deficiencies during childhood lead to poorer learning outcomes, with consequent further inter-generational effects (the education of mothers has been shown to be particularly important for children’s wellbeing). There is also a strong correlation between child poverty and malnutrition and stunting; malnourished girls are particularly affected, as they have a greater likelihood of later giving birth to low birth-weight babies, in turn jeopardising those babies’ life chances.
In 2006 over a third of children in Africa under five were suffering from moderate to severe stunting64; Nigeria and Ethiopia alone account for more than a third of all underweight children in Africa.65 In countries such as Niger, Madagascar, Sudan and Eritrea, two in every five children were malnourished in the 2000–2006 period.
Climate change, long spells of drought, increased demand for food, diminishing supply, changing consumption patterns in major developing countries like China, and the planting of crops for biofuel are all behind this poor state of nutrition and food security on the continent. The unprecedented recent surge in biofuel production has particularly contributed to the changing world food equation, and currently adversely affects the poor through price-level and price-volatility effects.
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By Shimelis Tsegaye,
