By Patricia Vermeulen*
Africa is the most conflict-prone region in the world today. Over the last decade, conflict on the continent has spanned from the west, notably by the militant group Boko Haram in Nigeria to the central part of the continent by the Lord’s Resistance Army (LRA) in the central African republic, the civil wars in the Republic of South Sudan, the militia activity in the Democratic Republic of Congo, civil conflict in Burundi and in east Africa and the long standing conflict Somalia, not forgetting the genocide in Rwanda in the 1990s. All these conflicts have cost the continent over two million lives of children – who would have grown to be productive citizens of the continent.
Conflicts have a tremendous impact on the lives of children. For every child that has succumbed to death in conflict, nearly ten of them have survived with injuries, disability, abduction, orphan hood, childhood violence and forced engagement in conflict. Other children have even suffered sexual abuse by those supposed to protect them as in the case of the UN peace keeping mission in the Central African Republic and the Democratic Republic of Congo.
Conflicts severely disrupt the lives of communities and the functioning of systems established to address socioeconomic gaps. Conflict notwithstanding, sub-Saharan Africa is home to the highest number of child deaths. In 2015, there were three million child deaths on the continent. This is equivalent to five children under 5 years of age dying every minute. Two-thirds of these deaths can be attributed to preventable causes. Preventable illnesses such as pneumonia, diarrhoea, malaria and HIV are still the leading causes of death in infants and young children.
Besides diseases and conflict, other situations increase vulnerabilities. Prominent among these are negative social practices like female genital mutilation and child sacrifice that are still prominent in many parts of the continent.
Child Health – the facts
Despite some countries making notable improvements in child health in recent years, sub-Saharan Africa’s average child mortality rate is still almost twelve times the average of high-income countries such as the Netherlands.
At the time of birth, over 60 percent of the children are born at home or on the road to seek care. This means that six out of ten children are born without a skilled attendant who could intervene in case the mother has excessive bleeding, infection or hypertension, major killers in pregnancy.
Less than 50 percent of children below the age of five in Africa completes immunization, leaving the unimmunized children at risk of diseases, such as polio, where the continent is seeing a resurgence of the condition.
Under-nutrition is associated with more than one third of the global disease burden for children under the age of five. Sub-Saharan Africa has one of the highest prevalence of low birth weight ranging from 7-42 percent. Only 37 percent of children in sub-Saharan Africa are exclusively breastfed for the first 6 months of life, and complementary foods are inadequate and inappropriate. Maternal nutrition increases the risk of death of the mother at birth and may be associated with about 20 percent of maternal deaths. Pneumonia is the single biggest cause of death for children worldwide, accounting for nearly one in seven deaths among young children, with over 950,000 estimated deaths annually. Most of the deaths occur in resource-constrained countries, with 50 percent in sub-Saharan Africa. There were 528,000 deaths from malaria in 2013, and about 78 percent of them are children under the age of 5.
Nearly 70 percent of children who live beyond the age of five years start going to school but quickly drop out because of illness, a lack of resources to continue or to take on socioeconomic responsibilities (child labour). In addition, girls face menstrual health challenges as well as early marriages that keep them out of school.
Over the last 50 years, Amref has worked to address bottlenecks in order to improve child health and child survival in Africa. One of our programmes in Kenya, the Dagoretti Child Protection and Development Centre, seeks to improve the health and living conditions of street children and other vulnerable children by strengthening community-based child protection systems. Over 26,000 children have passed through the centre and been rehabilitated and reunited with their families.
Despite these and other intervention by us and other stakeholders in the health sector, major challenges have continued to plague the progress to achieving lasting gains in child health. Key among these has been; 1) Inadequate numbers of skilled health workers, 2) poor health infrastructure to host the lifesaving interventions such as the cold chain for immunization and for referral systems; 3) weaknesses in sub-national leadership for health especially in new and emerging settlements on the continent and 4) lack of vital equipment and regular stock outs due to weak supply and maintenance systems.
Over and above these, poverty is widespread among communities affecting women and children disproportionately.
Empowerment of African communities
The empowerment of African communities to establish and maintain their own health – in this case that of children, is a sustainable approach to reaching a lasting health change for children in Africa. With empowered and healthy African people, even conflict and its effects can be largely curtailed.
The post MDG era is an opportunity to consolidate the knowledge and gains from regarding child health. The rapid drop in global child deaths in the last 20 years is one of the world’s most spectacular, and most hopeful, success stories. It shows what is possible with the right resources, programs and political will in place. But the story isn’t over yet – we have a long way to go before achieving the Sustainable Development Goals (SDG) targets to reduce the neonatal mortality ratio to at least twelve per 1,000 live births and under-5 mortality ratio to at least 25 per 1,000 live births. With millions of children still at risk of dying of preventable causes, maternal, new-born and child survival must remain at the heart of the post-2015 global development agenda.
Communities can change
Drawing from our experience in transforming communities to change from harmful practices i.e. the work on ‘alternatives rites to passage’, we know that communities can change provided the transformation begins from within the communities themselves. The Masaai community in Kenya designed an alternative to the traditional circumcision. A ritual that still celebrates the transition from girl to womanhood, without the cut. There is dancing, dressing up, the ceremonial arch, the blessings from the elders and the wise lessons from the mothers. And the best thing that was added: the girls participate in three-day long workshops about sex education, self-confidence and human rights. To date, over 10,000 girls went through this ritual.
Expansion of such transformative approaches can significantly improve and establish a supporting environment for the African child to grow and thrive without violence.
Role of the governments
African Governments should create and maintain a safe and conducive environment for children to grow, develop and mature properly during the period of childhood. This means that armed conflict and violence, which take a heavy toll on children‘s lives in many parts of Africa should minimized. Over and above the fact that children suffer from direct consequences of conflict and violence, such as their recruitment in armed groups, physical injuries and even death; they also suffer indirectly as a result of displacement, loss of relatives and from trauma associated with witnessing acts of violence. In addition, the denial of education and an early constructive childhood propagates the successive unproductive generations for many years which in turn affect the continents economic growth.
Whether during armed conflict or peacetime, children have the rights to protection, freedom from violence and exploitation and to a safe and supportive environment. It is imperative that a safe and conducive environment needs to be created and maintained for children to enable them to grow, develop and mature properly during the period of their childhood.
Zaitun is a midwife in Juba Teaching hospital, South Sudan. She will not go to sleep while on night duty and will move around the wards throughout to check on the mothers. She can attend to almost 6 mothers a night. Meaning by the end of the year she will have taken care of more than 2,000 mothers and their children.
John Kavoo, a boy from Dagoretti: “I never thought I could ever get this far. I had given up on life, but today I have dreams. It’s hard to think about my life before. I grew up on the streets, sleeping on the pavement, eating from the rubbish dump. I was addicted to drugs and survived through petty crimes. I wasn’t a troublemaker by choice though. At just ten years old I started working, selling recycled paper to help mum support our family. We lived in a one-roomed hut in a slum in Nairobi. I had never gone to school. Being young and naïve I got involved with a group of boys who introduced me to drugs that helped me escape the reality of my life. Within a month, I was addicted and couldn’t return home – I was too ashamed.
Those years on the street taught me to trust no-one. I became a loner, even though I wasn’t alone – there are 250,000 children on the streets in Kenya and 12,000 in Dagoretti alone. And society hates us all. But one Saturday afternoon, after two years on the street, an Amref social worker, Nicholas Kiema, challenged me and a group of mates to a game of football. We loved football and the offer was too tempting. I liked Kiema and slowly began to trust him. When he suggested that we come to the project for help, I agreed. Slowly, I stopped sniffing glue, and I joined the project’s theatre group which taught me discipline and self-confidence. I eventually went home, and have trained as a mechanic. One day I will run my own garage.”
*Patricia Vermeulen is CEO of Amref Flying Doctors