15% Now! Campaign: Africa Must Invest in Public Health

Masimba Biriwasha

According to the 15% Now Campaign, African governments must urgently implement their pledge to dedicate 15 percent or more of annual budgets to health care in order to stem the tide of deaths.

Imagine four African countries without any living soul — Botswana, Namibia, Lesotho and Swaziland — all because of deaths to preventable, treatable and manageable diseases.

Across Africa, public health systems are in a ramshackle state, as a result, over eight million African lives are being lost annually to diseases, because people have little or no access to public health services.

That figure of eight million people dying annually is easily the combined populations of Botswana, Namibia, Lesotho and Swaziland. At this rate, many countries will run out of burial space. Consequently Africa's fastest growing industry is the coffins and burial business. In 20 years the number of lives lost could be equivalent to the population of Nigeria — at 130 million — Africa's most populous country," said Rotimi Sankore, coordinator of the Africa Public Health Rights Alliance which is promoting the 15% Now! Campaign to push African governments to adopt appropriate health policies. "Investment in health is key to resolving this situation"

Maternal and child mortality, HIV/AIDS, malaria and tuberculosis are the main diseases affecting the populations, yet governments are doing little to reverse the tide of deaths.

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"It is clear that the vast majority of African governments have under-invested in health systems and there has been no long-term planning and understanding of health needs of citizens by government," said Sankore

The Heads of State African Union (AU) agreed to commit at least 15 percent of national budgets to health at their meeting in Abuja, Nigeria in 2001. But, six years later, only two out of 53 AU member countries (Botswana and Seychelles) have clearly met that pledge.

"To say it is tragic that in 2007 only two out of 53 AU member countries have clearly met that pledge does not even begin to describe the situation. It is beyond tragedy," said Sankore.

Since the pledge was signed in 2001, Africa has lost a staggering 40 million lives due to a failure by African governments to develop, implement and fund comprehensive public health policies.

Worryingly, many of the governments are relying mainly on external efforts and donor funding to resolve their numerous public health problems.

"The leadership of most of the governments have not had to depend on the health systems of their countries for treatment and are therefore not committed to resolving the problem," said Sankore.

According to the 15% Now Campaign, African governments must urgently implement their 2001 Abuja Declaration pledge to dedicate 15 percent or more of annual budgets to health care within three years. Commensurate to this must be a commitment to dedicate a significant chunk of the money to resolving the brain drain of health care workers, and addressing key concerns such as reproductive health, child mortality, HIV and TB.

"If you look at countries where health systems can meet the needs of citizens, anything from 15 to 30 percent of budgets have been spent on public health. In Africa, the lion's share of budgets goes to military and defense spending," said Sankore. "The consequence is that once a higher percentage of citizens need health services, it becomes impossible for grants to deliver services."

Currently, the doctor per patient ratio in Africa is appalling. For example, the Democratic Republic of Congo (DRC), with a population of 57 million (roughly equivalent to the populations of the United Kingdom, France and Italy), has only 5,827 doctors compared to the France's 203,000, Italy's 241,000 and the UK's 160,000.

Cuba, with a population of about 11 million, has roughly the same population as Malawi, Zambia or Zimbabwe. But Cuba has 66,567 Doctors compared with Malawi's 266, Zambia's 1,264 and Zimbabwe's 2,086. Not surprisingly, Cuba has roughly the same life expectancy (77 years) as developed countries while the average life expectancy for these African countries is 37 to 40 years.

"To come anywhere near meeting the WHO recommended health worker to patient ratio or meeting the health based millennium development goals (MDG), these African countries compared to Cuba will need to train and retain roughly 59,000 Doctors each in 8 years," states the 15% Now! petition. "This is Africa's priority."

The 15% Now! Campaign urges African governments to make the adoption of comprehensive health strategies a top priority, including the involvement of health care workers and civil society in setting measurable targets of progress.

Some people argue that funding the health sector is not the solution, but if all the people are dead, what will the other sectors be for, said Sankore.

The loss of health care workers to developed nations is also a major factor contributing to the poor state of health care system in Africa. Some developed countries maintain domestic public health policies that promote the recruitment of health care workers from Africa.

Improving health care systems in Africa will require developed nations to abandon such practices. Because developed countries have benefited from poaching African health care workers, they have a moral responsibility to promote the training of healthcare workers to improve Africa's health care workforce.

However, ordinary citizens in Africa are not informed enough to lobby their governments to adopt proper public health policies.

"The citizens are not adequately informed and it's the job of organized civil society to inform and mobilize ordinary people to campaign for their right to health and life," said Sankore.

Given the critical importance of good health to national development, an obvious question is why African governments pay little attention to the matter.

"There's phenomena that health is a private matter, but the truth is every single citizen's health issue when brought together presents a collective challenge. We may die individually of TB or HIV, but collectively our deaths impact society as a whole," Sankore commented. "Ordinary citizens in Africa have two choices — either they campaign for governments to accord their right to health, or they will die."

But the fact is that if African governments do not meet their obligations, they will soon find themselves presiding over countries without people, added Sankore.

Implementing the agenda of the 15% Now! Campaign, coupled with international donor support and policy change, offers the best chance for African governments to address the health needs of ordinary citizens.

"Doing nothing is not an option because if the situation persists, some countries in Africa will cease to function," said Sankore.

Analysis Human Rights

ICE Releases Reports for 18 Migrants Who Died in Detention, Medical Neglect Is Suspected

Tina Vasquez

Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don't know.

A new report from Human Rights Watch (HRW) documents the deaths of 18 migrants in Immigration and Customs Enforcement custody from mid-2012 to mid-2015. In some cases, the deaths were likely preventable and the result of “substandard medical care and violations of applicable detention standards.”

These are not the only deaths that occurred, however. ICE acknowledges on its website that 31 deaths have occurred between May 2012 and mid-June of this year. It is unclear whether ICE intends to release information about the additional 13 deaths that have occurred.

Even so, these new findings add to a growing body of evidence showing what HRW calls “egregious violations” of medical care standards in detention centers. A February report found such violations contributed to at least eight in-custody deaths over a two-year period.

The public is just beginning to learn more about the deeply rooted problem, Clara Long, a researcher with Human Rights Watch and the lead researcher on the report, explained to Rewire. Long referenced an ongoing investigation by reporter Seth Freed Wessler at the Nation, which explores the numerous deaths that have occurred inside immigrant-only prisons.

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Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don’t know. For example, HRW worked with two independent medical experts to review the 18 death reviews released by ICE. The experts concluded that substandard medical care “probably contributed to the deaths of seven of the 18 detainees, while potentially putting many other detainees in danger as well.” Long told Rewire that the information provided by ICE simply wasn’t enough for their independent medical experts to determine that all 18 deaths were related to inadequate medical care, but that it was “likely.”

So there is the larger, systemic issue of inadequate medical care. Researchers at HRW also don’t know exactly how ICE collects information or why the agency releases information when it does. There’s also the core of the issue, as Long noted to Rewire: that the United States “unnecessarily” detains undocumented immigrants in “disturbing conditions” for prolonged periods of time.

Major Failures Lead to Death

The new HRW report identified two of the most dangerous ways ICE is failing migrants in detention: not following up on symptoms that require assistance and not responding quickly to emergencies. Both failures are illustrated by the case of 34-year-old Manuel Cota-Domingo, who died of heart disease, untreated diabetes, and pneumonia after being detained at the Eloy Detention Center in Eloy, Arizona.

ICE’s death review for Cota-Domingo suggests there was a language barrier and that Cota-Domingo was worried about having to pay for health care, which isn’t surprising given that detention centers make migrants pay for things like phone calls to their attorneys and family members. HRW asked Corrections Corporation of America, the company that runs the Eloy Detention Center, about potential fees for medical care, and it said there are no fees for such services at Eloy. For whatever reason, Cota-Domingo was not aware he had a legal right to access the medical care he needed.

When it became clear to his cellmate that Cota-Domingo was in serious need of medical attention and was having trouble breathing, the cellmate “banged on a wall to get a guard’s attention. His cellmate said he did that for three hours before anyone came to help,” Long said. The researcher told Rewire the death report outlines how investigators checked to see if the banging would have been audible to correctional officers.  It was. “Once [the cellmate] got their attention, our medical experts said this was something that should have been followed up on immediately, but the nurse decided to wait several hours before doing anything. All of these sluggish responses went on for eight hours. This is not how you treat an emergency,” Long said.

As Human Rights Watch noted in the report, “When officers finally notified medical providers of his condition, they delayed evaluating him and finally sent him to the hospital in a van instead of an ambulance. Both medical experts concluded that the combination of these delays likely contributed to a potentially treatable condition becoming fatal.”

In other death reviews by ICE, the agency’s own records show “evidence of the misuse of isolation for people with mental disabilities, inadequate mental health evaluation and treatment, and broader medical care failures.” Tiombe Kimana Carlos, Clemente Mponda, and Jose de Jesus Deniz-Sahagun all committed suicide in ICE detention after showing signs of “serious mental health conditions.” HRW’s independent experts determined that “inadequate mental health care or the misuse of isolation may have significantly exacerbated their mental health problems.”

It’s important to note that none of the death reviews released by ICE admit any wrongdoing, and that’s primarily because they don’t seek to examine whether medical negligence was at play. The reports simply present information about the deaths.

“There is no conclusion drawn, really,” Long told Rewire. “There’s one [report] in particular that even goes beyond that; it doesn’t even take into account the quality of care that led to the death, even though it’s clearly an issue of quality of care. That raises the question: What is the report for? ICE doesn’t conclude the cause. If you read [the death reviews], you can see there’s a lot of detailed information included in them that allows someone with expertise in correctional health care and who is familiar with how these systems should work, to make an assessment about whether care contributed to death, but that’s not something ICE doesat least not in the information we are able to access.”

ICE’s Murky Death-Review Process 

In a statement to Rewire, ICE explained that when a person dies while in the agency’s custody, their “death triggers an immediate internal inquiry into the circumstances.” The summary document ICE releases to the public is “the result of exhaustive case reviews conducted by ICE’s own Office of Detention Oversight (ODO), which was established in 2009 as part of the agency’s comprehensive detention reforms,” Lori K. Haley, a spokesperson with ICE, told Rewire in a prepared statement.

In fact, the ODO was created as a direct result of a series of reforms from the Obama administration after reports of human rights abuses and deaths in detention centers. The death review it produces includes a mix of findings from ICE’s own investigators and from a Beaumont, Texas-based company called Creative Corrections.

According to its website, Creative Corrections serves “local, state and federal government agencies,” offering “training, advising, professional management and consulting services” in “correctional, law enforcement, rule of law, and judicial systems.” The company contracts include the Department of Homeland Security (DHS).

“From what we can see from the documents, both ICE and Creative Corrections interview various people involved, check records, do what seems to be a pretty robust investigation for the death review,” Long said. “Unfortunately, in the set of death reviews that we used for this investigation, [the public doesn’t] have access to the Creative Corrections reports or any of the exhibits that go along with them.”

As the ICE spokesperson noted, the summary documents are typically written by ICE staff. The documents released to the public do not include medical records, full reports from Creative Corrections, or any exhibits that would provide more insight into the apparent medical neglect resulting in an estimated 161 people dying in ICE custody since October 2003. Six migrants have died in ICE custody since March 2016, two of whom died at two different detention centers in the same week. The causes of these most recent deathsand whether they can be attributed to medical neglect—is still unknown.

“If we had access to all of the information gathered during these investigations, including the reports from Creative Corrections, they would be very rich sources of information,” Long said.

Long and other researchers are also hoping for more information regarding the deaths that happen just after migrants are released from ICE custody. Teka Gulema, an Ethiopian asylum seeker detained at Etowah County Detention Center in Gadsden, Alabama, was released from ICE custody in November 2015 while in the hospital after becoming paralyzed from a bacterial infection acquired in detention. He died in January.

“One concern we have, and it’s a very big fear, is that there are multiple reports of folks who are released from ICE custody while in critical condition,” Long said. “When they die, they are no longer counted as in-custody deaths [by ICE]. We’re worried that’s a loophole being exploitedand for obvious reasons, we don’t have a number in terms of how often this is happening.”

The researcher said she has “no idea” when or why ICE decides to release information, including death reviews.

ICE did not respond to Rewire‘s request for information about its schedule or process for releasing such information.

“Maybe they released the 18 reports because they were cleared for release. Maybe a congressional office asked for them. Maybe they decided to be transparent. It could have been a [Freedom of Information Act] request from the ACLU. I wish I knew, but we really have no idea who decides—or why they decide—to release information, especially without making anyone aware that it’s been released,” the researcher told Rewire.

In April, ICE posted a series of spreadsheets about the inner workings of the detention system on their website that Long said provided a lot of information about how detention operates. The spreadsheets were removed from the site in a matter of days, too soon for many researchers—including HRW—to download them all.

“It’s a big system. We still don’t totally know how it works, which in itself is a major problem,” Long said. “One of the biggest lessons we’ve learned is to always check the ICE website. You never know what you’ll find.”

Rethinking Detention

DHS secretary Jeh Johnson is engaging in what some advocates are calling an “enforcement overdrive,” by funneling more undocumented immigrants into an already overcrowded detention system thanks to the detention bed quota established in 2009. This quota requires 34,000 undocumented migrants be locked up each day. It is in place to ensure more people get deported, though it’s costing taxpayers $2 billion a year while also creating “a profitable market for both private prison corporations and local governments,” the National Immigration Forum has said.

Reporting for the Nation, Michelle Chen recently noted that “migrants are warehoused under convoluted partnerships involving private vendors and state, local, and federal agencies. Homeland Security may contract out security duties to, or use facilities owned by, private vendors—dominated by Corrections Corporation of America (CCA) and GEO Group—with preordained headcount distributions ranging from 285 in Newark to more than 2,000 in San Antonio.”

Long told Rewire that 80 percent of migrants currently in detention are in what is considered “mandatory detention,” which, according to the Immigrant Legal Resource Center, means that “non-citizens with certain criminal convictions must be detained by ICE. People who are subject to mandatory detention are not entitled to a bond hearing and must remain in detention while removal proceedings are pending against them.” This also means that those in mandatory detention aren’t allowed to have an individual assessment by ICE of their case, “so they just sit in immigration detention indefinitely,” Long said.

“This system doesn’t work. We’re detaining far too many people for far too long and not determining on an individual level if they should be detained in the first place, taking into account all of the options available,” Long said. Options include being monitored by ICE using telephonic and in-person reporting, curfews, and home visits.

Long joins a long list of undocumented community members, researchers, organizers, activists, and other advocates pushing for the Obama administration—and whoever comes after it—to see detention as a last resort, rather than the only resort.

“We spend a lot of time talking about the disturbing conditions in detention centersthat’s what our report is about. But step one requires taking a step back and rethinking this system and how it’s unnecessary and also abuses vulnerable peoples’ rights,” Long said. “In terms of the legality of treating people this way, under U.S. and international law, people who are detained are entitled to medical treatment. The state has an obligation to provide care to this population. They are failing, and people are dying.”

Commentary Race

Black Lives Matter Belongs in Canada, Despite What Responses to Its Pride Action Suggest

Katherine Cross

Privileging the voices of white LGBTQ Canadians who claim racism is not a part of Canada's history or present ignores the struggles of Canadians of color, including those who are LGBTQ.

As I walked the streets of Toronto last month, it occurred to me that Pride Week had become something of a national holiday there, where rainbow flags and the Maple Leaf banners flying in honor of Canada Day on July 1 were equally ubiquitous. For the first time in my many years visiting the city—the place where I myself came out—the juxtaposition of Pride and the anniversary of Confederation felt appropriate and natural.

For some, however, this crescendo of inclusive celebration was threatened by the Black Lives Matter Toronto (BLMTO) protest at the city’s Pride March, often nicknamed PrideTO. The group’s 30-minute, parade-stopping sit-in has since come in for predictable condemnation. The Globe and Mail’s Margaret Wente dubbed BLMTO “bullies,” sniffed that its tactics and concerns belonged to the United States, and asked why it didn’t care about Black-on-Black crime in Canada. The Toronto Sun’s Sue-Ann Levy, meanwhile, called BLMTO “Nobody Else Matters,” also saying it “bullied” Pride’s organizers and suggesting we all focus on the real object of exclusion within the LGBTQ community: gay members of the recently ousted Conservative Party.

There is a lot to learn from this Torontonian incident, particularly around managing polite liberal racism—an especially important civics lesson in light of the past month’s tragedies in the United States. Privileging the voices of white LGBTQ Canadians who claim racism is not a part of Canada’s history or present means ignoring the struggles of hundreds of thousands, many of whom are LGTBQ themselves.

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Pride has always been a thoroughly political affair. It is, thus, hardly an “inappropriate time and place” for such a protest. It began as, and remains, a public forum for the unapologetic airing of our political concerns as a community in all its diversity. We may have reached a new phase of acceptance—the presence of Prime Minister Trudeau at Pride was a beautiful milestone in both Canadian and LGBTQ history—but Pride as a civic holiday must not obscure the challenges that remain. It is not a coincidence that the majority of transgender people murdered worldwide by the hundreds every year are Black and Latina, and that many of them are sex workers. That is part of the reality that BLMTO was responding to—the fact that racism amplifies homophobia and transphobia. In so doing, it was not just speaking for Black people, as many falsely contended, but advocating for queer and trans people of many ethnicities.

Even so, one parade-goer told the Globe and Mail: “It’s not about them. It’s gay pride, not black pride.” The very fact that Black LGBTQ people are asked to “choose” validates BLMTO’s complaint about Pride’s anti-Blackness, suggesting a culture where Black people will be thinly tolerated so long as they do not actually talk about or organize around being Black.

Indeed, BLMTO’s much-criticized list of demands seems not to have been read, much less understood. While drawing attention to the Black Lives Matter collective, it also advocated for South Asian LGBTQ people and those in First Nations communities, whose sense of not-entirely-belonging at an increasingly apolitical PrideTO it shares.

In each paint-by-numbers editorial, there was lip service paid to the “concerns” BLMTO has about Canadian police forces and racial discrimination, but the inconvenience of a briefly immobilized parade generated more coverage. Throughout, there has been a sense that Black Lives Matter didn’t belong in Canada, that the nation is somehow immune to racist law enforcement and, in fact, racism in general.

Yet to listen to the accounts of Black Canadians, the reality is rather different.

Janaya Khan, one of the co-founders of BLMTO, recently spoke to Canadian national magazine MacLean’s about the activist’s views on structural racism in the country. As a native of Toronto, they were able to speak quite forthrightly about growing up with racism in the city—up to and including being “carded” (a Canadian version of stop-and-frisk, wherein officers have the right to demand ID from random citizens) at Pride itself. And last year in Toronto Life, journalist and writer Desmond Cole talked about his experiences being raised throughout Ontario. He told a story of a traffic stop, none too different from the sort that killed Philando Castile earlier this month, after a passenger in his father’s car, Sana, had tossed a tissue out the window onto the highway. The officer made the young man walk back onto the highway and pick it up.

Cole wrote, “After Sana returned, the officer let us go. We drove off, overcome with silence until my father finally exploded. ‘You realize everyone in this car is Black, right?’ he thundered at Sana. ‘Yes, Uncle,’ Sana whispered, his head down and shoulders slumped. That afternoon, my imposing father and cocky cousin had trembled in fear over a discarded Kleenex.”

This story, of narrowly escaping the wrath of a white officer on the side of a motorway, could have come from any state in the Union. While Canada has many things to be proud of, it cannot claim that scouring racism from within its borders is among them. Those of us who have lived and worked within the country have an obligation to believe people like Cole and Khan when they describe what life has been like for them—and to do something about it rather than wring our hands in denial.

We should hardly be surprised that the United States and Canada, with parallel histories of violent colonial usurpation of Native land, should be plagued by many of the same racist diseases. There are many that Canada has shared with its southern neighbor—Canada had a number of anti-Chinese exclusion laws in the 19th and early 20th centuries, and it too had Japanese internment camps during the Second World War—but other racisms are distinctly homegrown.

The Quebecois sovereignty movement, for instance, veered into anti-Semitic fascism in the 1930s and ’40s. In later years, despite tacking to the left, it retained something of a xenophobic character because of its implicit vision of an independent Quebec dominated by white francophones who could trace their ancestry back to France. In a blind fury after narrowly losing the 1995 referendum on Quebecois independence, Premier Jacques Parizeau, the then-leader of the independence movement, infamously blamed “money and ethnic votes” for the loss. More recently, the provincial sovereigntist party, the Parti Quebecois, tried to impose a “Values Charter” on the province aimed at criminalizing the wearing of hijab and niqab in certain public spaces and functions. Ask Black francophones if they feel welcome in the province and you’ll get mixed answers at best, often related to racist policing from Quebec’s forces.

Speaking of policing and the character of public safety institutions, matters remain stark.

A 2015 Toronto Star special investigation found hundreds of Greater Toronto Area officers internally disciplined for “serious misconduct”—including the physical abuse of homeless people and committing domestic violence—remained on the force. In 2012, the same outlet documented the excessive rate at which Black and brown Torontonians were stopped and “carded.” The data is staggering: The number of stops of Black men actually exceeded the number of young Black men who live in certain policing districts. And according to the Star, despite making up less than 10 percent of Toronto’s population, Black Torontonians comprised at least 35 percent of those individuals shot to death by police since 1990. Between 2000 and 2006, they made up two-thirds.

Meanwhile, LGBTQ and Native Ontario corrections officers have routinely complained of poisonous workplace environments; a recent survey found anti-Muslim attitudes prevail among a majority of Ontarians.

Especially poignant for me as a Latina who loves Canada is the case of former Vancouver firefighter Luis Gonzales. Gonzales, who is of Salvadoran descent, is now filing a human rights complaint against Vancouver Fire and Rescue Services for what he deemed a racist work environment that included anti-Black racism, like shining a fire engine floodlight on Black women in the street and joking about how one still couldn’t see them.

One could go on; the disparate nature of these abuses points to the intersectional character of prejudice in Canada, something that BLM Toronto was quite explicit about in its protest. While anti-Black racism is distinct, the coalition perspective envisaged by Black Lives Matter, which builds community with LGBTQ, Muslim, South Asian, and First Nations groups, reflects an understanding of Canadian racism that is quite intelligible to U.S. observers.

It is here that we should return again to Margaret Wente’s slyly nationalistic claim that BLMTO is a foreign import, insensitive to progressive Canadian reality. In this, as in so many other areas, we must dispense with the use of Canadian civic liberalism as a shield against criticism; the nation got this far because of sometimes intemperate, often loud protest. Protests against anti-LGBTQ police brutality in the 1980s and ’90s, for example, set the stage for a Toronto where the CN Tower would be lit up in rainbow colors. And any number of Native rights actions in Canada have forced the nation to recognize both its colonial history and the racism of the present; from Idle No More and the Oka Crisis to the 2014 VIA Rail blockade, that movement is alive and well. Indeed, the blockade was part of a long movement to make the government acknowledge that thousands of missing and murdered Indigenous women constituted a crisis.

If we must wrap ourselves in the Maple Leaf flag, then let us at least acknowledge that peaceful protest is a very Canadian thing indeed, instead of redoubling racist insults by insinuating that Black Lives Matter is somehow foreign or that institutional racism is confined to the United States. Canada has achieved little of worth by merely chanting “but we’re not as bad as the United States!” like a mantra.

Far from being a movement in search of a crisis, Black Lives Matter and its intersectional analysis is just as well-suited to Canada as it is to the United States. In the end, it is not, per the national anthem, God who keeps this land “glorious and free,” but its people.