"ALL THIS DISLOCATION AND DESPAIR": The Nobility of V.S. Naipaul

By David Kaiza
Kampala
October 2001

When V.S. Naipaul won the 2001 Nobel Prize for literature, it brought to an end annual speculation which had lasted nearly 30 years over whether the Stockholm announcers would say, "...V.S..."

He was one of the four or so perennial contenders bet on each year, only to be tripped up by a surprise winner.

The celebrated writer of such classics as Miguel Street, A House for Mr. Biswas and A Bend in the River, has made himself into the most controversial interpreters of colonialism, migration and the postcolonial disintegration of the Third World. In a 46-year career, he has built a reputation as the dispenser of crackling but brutal wit. Many of his 26 novels and travel books chart the progress that his characters, all Naipaul really, make from Trinidad to the English countryside.

It begins on Miguel Street (1959) and ends on an ominous note in The Enigma of Arrival (1987), to be resurrected again in A Way in the World (1994), and a Half a Life, (2001) - the last a not too successful novel, though.

His books are perhaps the most brilliant to come out of the Third World in the past 50 years. He wrote with a severity matched by few contemporaries. Hence from the 1970s, he seemed the natural candidate for the Nobel Prize, but spent that time in anxiety, sweeping up lesser prizes along the way.

The Nobel Committee picked out The Engima of Arrival as an outstanding book. Salman Rushdie, a writer Naipaul holds in contempt, once said it was a book devoid of love, while Paul Theroux, a friend of Naipaul's of 30 years till a bitter break up in 1996, called it a "strange, but major" book.

It is this division that has marked the man's career. While both critics and supporters agree on the superiority of his prose, the critics see outright racism where supporters see "incorruptible scrutiny."

Outside his books, he has attacked those he despises with brutal dismissiveness. He considers most writers inferior to himself. Soyinka wrote "nothing," while Charles Dickens "died of self- parody", and E.M Forster's Passage to India was "false."

This is from a man who declared that the novel was dead, only to write Half a Life.

His attitudes to the poor mirror those of Margaret Thatcher, under whose premiership he received a knighthood from the Queen and became Sir Vidia in 1990.

His life and writing start with the narrator of Miguel Street, a young boy who, like Naipaul, hates his birthplace, Trinidad, and finally manages to leave it. Naipaul too, when his chance to escape came in 1950, with a scholarship to Oxford, pounced on it, and never returned. In England, he fashioned himself into upper-class gentleman, lost his accent and married an Englishwoman, Patricia Hale. One of his more famous characters, Ganesh Ramsumair, goes to England and re-invents himself as G. Ramsay Muir in The Mystique Masseur, published in 1957.

The book that secured Naipaul's fame was A House for Mr Biswas. An unassailable masterpiece of staggering proportions, it charts the life and death of Mr Mohun Biswas, whose struggles with poverty represent the fractured lives of people in British colonies.

His early books are acknowledged as his best. They tell of the poverty faced by the Indians who came to the West Indies from Uttar Pradesh, India in the 1880s to work on the sugar plantations. What marks him out is that he writes without sentimentality. The tragic and the comical both come out absolutely deadpan.

Ganesh Ramsumair in The Mystique Masseur, Naipaul's first published novel, embodies the Third World lapsing into fraud and mediocrity. He metamorphoses chameleon-like from a failed teacher, into a turbaned, Sanskrit-chanting, incense-burning faith healer and then into the be-suited diplomat, G. Ramsay Muir, MBE.

This satirical treatment of Ganesh echoes Wole Soyinka's treatment of the beach preacher in the play, The Trials of Brother Jero.

Naipaul's prose style was a radical departure for the time, achieving a severity of structure, which compacted meaning, colour and situation in terse sentences.

Unfortunately, Naipaul turned his caustic genius on the victims of Western hegemony. He dismissed blacks, just as he did lower caste Indians, with blatant brutality. Black people appear in A House for Mr. Biswas as a fat woman swaggering uselessly, as bad workmen (given only first names saucily borrowed from real life black Caribbean novelists George Lamming and Edward Kamau Brathwaite, Trinidadians Samuel Selvon), and as a boy who emerges best in national exams, but spends his time chasing women.

At Makerere in 1966, as a writer-in-residence, he is described in Theroux's Sir Vidia's Shadow accompanying his houseboy to buy fried grasshoppers. He smiles, watching him munch. "Good, eh, Andrew?" he asks the servant. "Delicious, eh? Mazoori (mzuri), eh?"

The best thing to do, he says, making Patricia burst into tears, is to "whip those noisy Africans."

In Nairobi, a big man in a suit comes to see US Ambassador Attwood. Naipaul dismisses him as another black beggar. "Maboya," Sir Vidiadhar Surajprasad Naipaul, a man who effortlessly enunciates labyrinthine Indian words, mispronounces Tom Mboya's name as he does all African words (Makerere is Maka-ray-ray). This was three years before Mboya was killed.

Following the deportation of some Indians from Kenya, he entreats the Indian High Commissioner to have Mombasa shelled. "Punish them," he tells the rattled diplomat. "When Mombasa is in flames, they will think twice about persecuting Indians here."

Fellow Caribbean Nobel Laureate, Derek Walcott, who called him VS Nightfall in a poem, wrote: "The myth of Naipaul as a phenomenon, as a singular, contradictory genius... has long been a farce. It is a myth he chooses to encourage - though he alone knows why.

"There is something alarmingly venal in all this dislocation and despair. Besides, it is not true. There is instead another truth: Naipaul's prejudice. If Naipaul's attitude towards Negroes, with its nasty little sneers... was turned on Jews, for example, how many people would praise him for his frankness?" The beauty of his early books sits uneasily with the charge of misogyny.

Yet even the creator of Miguel Street had to struggle almost all his life. Publishers were not always forthcoming with money. "My grief is that the publishing world, the book writing world is an extraordinarily shoddy, dirty, dingy world," he said in an interview in 1984. "I took writing too seriously. I was wrong. I was punished for it. I was punished by neglect."

He travels to Africa and South America, rubbishes both and is duly awarded the Booker prize in 1971 for In a Free State. The 1979 novel, A Bend in the River, is set in Zaire, echoing the Conradian darkness.

He has thus seemed to parrot Western stereotypes of subject races. In him, Western readers generally find a confirmation, almost comforting, of their record on slavery and segregation - the reclining master labelling his labouring servants lazy.

In his latest creation, Half a Life, an Indian named William Somerset Chandran comes to Africa, to Mozambique, still under Portuguese colonialism, and yearns for racial segregation, anticipating apartheid. Willie, a neglected writer, despises his Brahmin father for deracialising him by marrying his mother, who comes from the lowest of the low dark-skinned Indian castes.

Naipaul's Nobel is controversial, coming after he had attacked Islam for the September 11 attacks. Against the bombardment of Afghanistan, it is hardly surprising that the view in the Islamic world was that his prize was more about Western Christian sentiments than literature.

Still, Naipaul's works remain unassailable. His excesses make him, if anything, more human. He is not a hypocrite. It is easy to pity him when you move from his earliest to his latest books. The boy in Miguel Street ends, 30 years later, in The Enigma, a broken, ageing man. He is essentially as much a victim of colonial dismemberment of society as his characters. The titke for the book comes from a painting by Georgio de Chirico depicting a stranded seafarer.

Yet even the Nobel has received the rough edge of Naipaul's tongue, as when he accused the committee of pissing on literature when Wole Soyinka won it in 1986. "What has he written?" he asked.[O]

A HUNDRED YEARS OF DARKNESS

By David Kaiza
Kampala
November 2002

A hundred years ago, Heart of Darkness, a book that more than any other fixed the image of bestiality that the African continent has had to grapple with, was published.

The author, Joseph Conrad, set the basis that was to inform the cultural repertoire about the continent that the mass media, book publishers and the visual arts lurched onto: nothing good comes from Africa. And if anything does, it is by an Albert Schweitzer, a Lucille Cotti or an Ernest Hemingway.

The book was first serialised in 1899 in the magazine Maga, whose readers lapped up exotic tales of skulls, jungles, mountains, ivory, darkness and natives. Heart of Darkness, whose author Nigerian novelist Chinua Achebe once said was "safely dead," outdid all classics in these special effects.

The image stuck. In books and on TV, Africans squirm in primordial muck and like tropical trees or hippos, are spectacular backgrounds for white heroism - recyclable fodder for writers and film makers: Ernest Hemingway, in his first Kenyan book, Green Hills of Africa, using the words "savage" and "black" interchangeably, and in the films I Dreamt of Africa, Out of Africa, Lucille Cotti, The Gods Must be Crazy (white South African), Africa becomes a therapeutic backdrop for determined white women facing personal trials.

Darkness is a powerful novella that has generated much debate but has also been misread by, among others, Achebe.

Conrad was venerated during his time as a genius who dared look into the depth of darkness. He wrote dozens of other books like Lord Jim, Nostromo, Under Western Eyes. But he has become kitsch; cheapened, sold by the literary bucket-load with journalist after journalist travelling the Congo River, ripping money and fame. To go on the precarious ferries and peer into the rushing water, gaze up at the trees and draw timeworn conclusions explains nothing of the state of the country, but is the literary equivalent of mineral plunder.

Conrad's dense prose was distinct. But it drew mockery from contemporaries. The penchant for chain clanking adjectives leaves you hallucinating. "Inscrutable", "inexplicable", "brooding" and "dark" - quintessentially Conradian words. Even the lightest moment traumatises. Reviewers of the time noted "sombre fate" in his work. Hemingway’s support for him was ironic because Hemingway's tight, airy style was a response to the Victorian techniques that Conrad so epitomised.

His characters are disillusioned; seeking the nefarious glory of a Francis Drake, they became greed and pestilence. They are lost people whose search for meaning leads to self-destruction.

Conrad himself started rather badly. A Pole who later became a British national, he was born Josef Teodor Konrad Nalecz Korseniowski in Ukraine in 1857, a country then still under tsarist Russia. His parents were exiled for anti-Russian activities and died when he was a child. He grew up under his uncle and left for the sea, his life-long passion, at 25. He however spent only eight years sailing, mainly in Asian waters. One of the most important trips he made was on the river Congo, the setting for Darkness.

His famous character, Mr Kurtz, has occupied African analysis since, compared with Idi Amin, Mobutu Sese Seko and Jean-Baptiste Bokassa. Kurtz is destroyed by lust for wealth. He kills, robs, decapitates and turns himself into a god in the Congo, anything to get ivory.

Like most Conrad tales, Darkness opens with a group of seamen waiting for the tide. A sailor says something profound and then starts a narrative. In Darkness, as in Lord Jim, it is Marlow who talks about Kurtz. The plot is simple. Marlow dreamt of the Congo (as young Josef did). He gets himself recruited by the "Company" to go on the river. Along the way, Marlow's ship passes by as the French fire into the continent, scrambling for West Africa. The British are scrambling in East and Southern Africa, with the Germans exterminating the Namibian Herero further south. At the mouth of the Congo, the name Kurtz is whispered, implied, feared, admired. As the book advances, the focus becomes meeting Kurtz. There are hints at evil.

Kurtz is universalised. He is an ivory extractor with the dominance of a Moses, a Christ, an orator, a writer, a Lucifer; kaleidoscopic, inscrutable. He probably does not exist. Like an onion, he fades when the layers are gone. We meet him for a few paragraphs and then he is dead. His burial on the banks of the Congo is poignant.

Scholars have pointed out that a man named Arthur Hordister, thought to be Kurtz's model, was trading in the same haunts at the time Conrad went on the river. But in terms of evil, Kurtz seems closer to Henry Morton Stanley, the flamboyant journalist explorer who lied and murdered and intrigued for Leopold.

Africans take a battering in the novella: meeting a black was "unearthly, and the men were - No, they were not inhuman," says Marlow. "Well, you know, that was the worst of it - this suspicion of their not being inhuman. What thrilled you was just the thought of their humanity."

They have no idea of time because "they still belonged to the beginnings of time." You must read closely to see that the "black shapes... shadows of disease... bundles of acute angles... brother phantom" are actually people, or be it blacks, whose names could have been Kofi, Bongo or Kabila.

The dismissal is complete. As they march into what is thought to be Riba Riba by some scholars, Marlow comments that the bullet-hole in the head of a middle-aged black corpse was "a permanent improvement."

Achebe wrote bitterly of Conrad, that, "Heart of Darkness projects the image of Africa as 'the other world,' the antithesis of Europe and therefore of civilisation, a place where man's vaunted intelligence and refinement are finally mocked by triumphant bestiality."

Conrad scholars have written books refuting the charge of racism, saying that he, like Rudyard Kipling, wrote for their class, to an audience for whom the realities of race were yet to be tempered. Since Darkness, civil liberty and the anti-apartheid movement have changed cross-race and sex language. Political correctness was unknown in 1902. Like all books, Darkness has suffered from changed juries.

Professor of Asian Studies at Queensland University in Australia Carl A. Trocki, who says Conrad was a critic of racism and not a racist, draws the context of Conrad's seafaring days:

"While virtually all Europeans in the pre-war (1914) era associated the tropics with lethargy and decay, there is also something in Conrad that resonates with other anti-imperialist commentaries about Europeans in the tropics. George Orwell's cast of characters in Burmese Days, who inhabited "the Club," were also the type who liked "good deck-chairs, large native crews and the distinction of being white."

At any rate, a writer ought to be judged by the honesty with which he interprets his time, including admission of his own prejudices. He may be mocking his own narrator who says, "The conquest of the earth, which mostly means taking away from those who have a different complexion or slightly flatter noses than ourselves, is not a pretty thing when you look into it too much."

What is true in the novel was true of Belgian Congo, a terrifying unleashing of European civilisation. Hands were chopped off for the crime of not bringing a cupful of rubber. At the same time, the Kaiser’s troops were dousing Herero water holes with cyanide.

As the anti-imperialism din pitched, Conrad wrote in 1903 to the British Consul in Congo, Roger Casement, who was to investigate Leopold's dealing, that, "It is an extraordinary thing that the conscience of Europe which 70 years ago put down the slave trade on humanitarian grounds tolerates the Congo State today. It is as if the moral clock had been put back."

Literature and cinema that humiliate minorities foster a typecast, are themselves symbolic extermination. Excusing Conrad is as difficult as accusing him, for there is a difference between literary insight and biological reflex: Conrad was a fine writer who reported well his observations, but he was still a product of his culture, which set civilising "savages" as its mission. In the novel, Marlow tears out Kurtz's conclusion that Europe should "exterminate all the brutes." But Conrad left it in the novel, where the likes of Hitler and, earlier on, the Kaiser’s advisers must have read it!

Europe's claims to spreading civilisation burnt out at Auschwitz, which in itself was the culmination of a sometimes malevolent artistic tradition (Shakespeare's and T.S. Elliot's attitudes towards Jews and Africans could only logically end in Hitler's final solution.)

The Congo shook Europe's ideas and assumptions about itself. A decade later, the First World War broke and a new reality was born. Thinkers, including British philosopher Bertrand Russell, commented that the war was a direct result of imperialism, a kind of curse for Congo criminals.

One man, E.D. Morel, who fought to bring out the pillage of the Congo, noticed that ships coming from Africa and docking at Antwerp, Belgium, brought ivory and minerals and timber, but left with only guns and soldiers. No trade was going on. Reality was the dried heads on Kurtz's stockade, beheaded for resisting exploitation.

In a hundred years, little has changed for Congo. An inquiry is going on in Uganda over the looting of the country by Ugandan soldiers. Like Kurtz did, today's conquerors have bestowed untold suffering. The Belgians were less suave compared with the British and, to an extent, the French in colonialism. They wanted minerals and in the process, destroyed the country completely. They had no administrative skills of any kind. When the independence movement sent them packing, there were no administrators to take over, a fact that still haunts the country.

While accusations against the western media's "negative" portrayals are political, there is truth in the pandering for it. When terrorists attacked Nairobi, pictures of crashed bodies were shown around the globe, a stark difference to the sanitised New York attack. Frenzied suffering is still an African typecast. Progress and innovations on the continent do not fit into the darkness creed.

Achebe's accusation that Conrad made Africans a backdrop for studying the lives of westerners is truer of today's Hollywood. The Kenyans in Out of Africa are no more than furniture. Even in the film about the Canadian doctor, Lucille Cotti, of the same name, who founded Lacor Hospital in Gulu, northern Uganda, the country is a backdrop for the Cottis to fall in love. African traditions are mocked rather than elucidated.

The popularity of safari films is rather depressing. To Walk With Lions casts respected Kenyan actor David Malwa as a servant to Sir Richard Harris. Whether it is in I Dreamed of Africa or No Where in Africa, the black still belongs to the Darkness creed of "inexpressible and incomprehensible mystery."

It is a formula that sells well. Western journalists in Kampala will tell you that Kenya is not a "sexy" news place any more because Kenyans have seen too many whites. The Ugandan countryside still affords the "distinction of being white."

That Kurtz still holds sway is evident in such titles as In the Footsteps of Mr Kurtz, a book about Mobutu's leadership. Then there is Congo Journey. And Nobel laureate V.S. Naipaul wrote A Bend in the River, a 1979 book hacking on the idea that Africa went back to the bush in the absence of lighter skin.[O]

DEATH IN THE AFTERNOON

By David Kaiza
Kampala August 2004

The Red Road to Aromo

Beyond Lira town and past Ngeta, Bar-Lonyo, Ogur and Agweng - names that are now emblematic of LRA attacks - we meet less and less people. The red earth road is potholed every few meters so in an ambush, you are trapped.

"Olum (Luo for guerrilla) passed here last week," the driver points at a spot. The spot is the ordinary clamp of acacia trees now in full bloom. In August, under heavy rains, northern Uganda turns into a green reverie of wild flowers, and hibiscus, flame trees.

We manage the 47 kilometers to Aromo in an hour. The deserted homes and schools, the grass that grows even inside the houses; the silence and the pictures you race out of the car to take, lengthen the drive so it seems like hundreds of kilometers.

Past the skeletal bridge over the trickling River Moroto, it appears:

A sea of grass-thatched huts like a beige coloured mat spread over the countryside, it takes the horizon. As we descend the valley this side of River Moroto, it is lifted up from the other side, so that it is literally thrown into our faces. Sporadic flashes of clothes punctuate the distance; bright pink and blue polyester from children who escaped in their school uniforms; rows of yellow jerry-cans queuing for water; white rows of tall mobile toilets. All these you take in one sweep. Past the river, we enter Camp.

"My children are hungry, so am dodging them."

The gray soil sticks to everything; closely built huts, unwashed human bodies, worn-out single shirts, skirts and trousers won since June 2003, children bloated out by Kwashiakor, aged by marasmas, all of them bearing this gray.

Masses of disoriented people mill, back and forth, like a macabre dance. Children squat to pass watery stools only feet away from weedy tomato piles on sale. Someone walks past, a woman whose age is now indistinct. She is either drunk or hungry, or both, for out in the sun, she starts to sway. Then another scene distracts: a soldier sweating from drink sways forward. He is running away from a teenage girl who is also drunk. She is shouting and gesturing after him. They disappear behind a bank of huts; behind them, mutterings about prostitution.

In the centre of the camp, Agnes' week-old baby is no larger than her two hands; her arms and thighs no wider than a grown-up's thumb. The mother cannot give enough milk and there is no feeding supplement. All of life is this dump courtyard. Agnes' friends gather around and conversation moves to June 2003.

Fires, gunshots and knives creep up in every story. That June, when the LRA went further east than they had ever done, marked the beginning of the worst stage of the war, which started in 1986. When they came, the rebels beheaded the adults they did not need; if in a hurry, just slashed their throats. Children, even babies who slipped off a mother's grip were piled in huts and torched.

500 homes were torched, scores of people killed at the start of months' long orgies, which culminated in, but did not end with the death of over 300 in Bar-Lonyo.

Molly, Agnes' acquaintance, who says she is 21 years, walks in. She has three children. She receives a few cups of maize and beans a month. To grind the maize at one of the several mobile mills, she has to sell some to Ush150 (Us cents 8). It has been going on like that for over a year now.

"We have been brought here to die," Agnes' neighbour who does not get out of her hut says. Molly refuses to sit. She starts to fret. "This government does not want us," the neighbour goes on, the dark interior of her hut and crumbly decomposition of the place, setting an eerie background to her words. You cannot get out of the camps. If you go to dig, the rebels and the army kill you. When people go to burry you, they force them to cook and eat you. Then they line them up and cut their heads off. That is the life we live. We are all going to die. They want us all dead."

Molly keeps switching her daughter from one arm to the other. "They cut Jochi's head up like pork," she says suddenly, of a dead sister. "I cannot eat meat. The picture is in my head."

She cannot count how many relatives and neighbours were killed in June. But she recalls what happened to her sister. "She was running with one child in her arm, the other she was pulling. They tried to grab her and failed and so they took her son. The boy was put in a hut with other children and burnt up. They cut her head like pork. They laid them in a line like this and went with their panga, chop chop, chop, like pork."

That day, Molly dragged her children racing towards River Moroto. She half drowned them in the stream to keep them quiet. Her youngest daughter she muzzled, keeping half-stunned to stop from crying.

In the camp, a warning may come at any time; 4 or 5 o'clock and they are told to go to bed. It is a living story. Two weeks after going to Aromo, on Sunday 5th September, three men, Acede Omara, Tom Lwak and Ayo Ogwang, a camp leader would be arrested by the army over the alleged defection of Ogwang's son. They were each caned 200 strokes. Ogwang never recovered and died. Another week later, 14 people would be abducted and another five heads of cattle stolen.

"We are all going to die," Agnes' neighbour keeps intoning.

Molly was twelve when rebels burnt her school and her father's house. She stopped school and was married off at fourteen. She had her first child at 17. "I keep walking like this the whole day because I have no food in the house," she says. "My children are hungry so am dodging them."

Yesterday, eleven heads of cattle were stolen. The women discuss this. It could be rebels, they say, but they don't trust the army either. To force people into the camps, the army destroyed their homes. They also say that the army stood by and watched when in the late 80s, their cattle were stolen. So they say they don't know who really stole the animals. They think they will not be allowed to reclaim their land. Here in the camps, the only outsiders are humanitarian workers who sneak in and out, dodging rebels to provide the only medical service. Aromo is out of telephone range. Government officials are afraid of the camps. They talk about the visit on March 9th, of Security minister, Betty Akech, a day after 10 people were killed at a near-by camp in Te'Oburu. She told them they were suffering because they refused to vote for president Museveni in 2001. Four days later, on Math 12th, a further 15 killed in Ayami camp.

"The worst time"

Mzee Jeremiah was a cattle trader in the 1960s and 70s, who is today reduced to the huts. He is LC3 chairman of Aromo. His statistic is forward and brutal - 23,000 people live in this camp. 3 people die daily. 20 per cent of children die off from malaria, Kwashiakor, Marasmas, Respiratory Illnesses.

“This is the worst time we have had ever since the war started,” he says. “Alice Lakwena passed here, the Karimojong stole our cattle. But we have never lived like this before. The children dry up and die. You are a father, you cannot do anything.”

The area MP, Charles Gutumoi Angiro condemns camp life, which he says is worse than rebel attacks. "People were forced into the camps. It was a deliberate policy of government to make people die, to starve people, to impoverish people just because the people of northern Uganda are alleged not to support the movement. The army burnt the houses left so that they will have no houses when they go back. People say they want to go away from the camps because they cannot tolerate the conditions."

Mr. Felix Omodi gave up a well-paying 12-year old job to head the PATH Ministries Northern Uganda. On June 16 2003, 22 people were killed Anyangapuc parish, Adekokwok a few kilometers from Bar-Lonyo. 18 were his relatives. As a missionary Christina, Omodi had been running a mobile clinic that traversed eastern Uganda, going up the inaccessible Mt. Elgon areas. The mobile clinic had, before the June escalation, run sanitation drives. But with 50,000 people trapped in Aloi, Aromo and Bata, in Lira district, the ministry, with a grant from USAID, is now concentrating on the camps.

"There was nobody handling these people in the camps. Even government wasn't there because the health staff had abandoned their centres." His observations of camp life are grim, "Prostitution is rife. Even girls as young as 9-years sell themselves. Even housewives sell themselves, husbands agree because they need money and that is the saddest thing."

Estimates say that AIDS prevalence rates in northern Uganda are more than twice the national average. In Lira town, the Uganda Aids Information Centre has just opened an office. Now that the Global Fund has availed money to treat AIDS, the people in the camps will not get the drugs, for to access Antiretroviral treatment, they must have the unheard of balanced and regular diet.

"AIDS is beyond us," Omodi says. "There is nothing we can do. But we treat the symptoms."

The territory is a lawless, unpredictable one. To send a mission out, Omodi has to wait for military intelligence reports on rebel movement before shooting in and out.

25 people were killed in Awiealam

We leave Aromo camp in a scramble. Towards 4 o'clock, a man presses a note at us and says we should read quietly - there are said to be rebel informers in the camps, so sensitive matters are written down. One of the camp lookouts (they operate a security watch separate from the army's) saw rebels cross the road we used, minutes after we photographed Odama Primary School. They abducted a schoolteacher named Tom Otim. The letter warns us not to go back the same road. We strike out through a long curving route that takes us into Apac district before returning to Lira.

Out 77 kilometers from Lira Town, Bata is among the worse-off camps. PATH Ministries is setting out with a five-vehicle convoy to take medicine. The convoy sets off at 10 o'clock. You can't travel before 10 Am and after 4 Pm. It starts with a prayer. Then Bob Higgins, PATH Director, speaks up the morale of the 14 nurses, 2 clinical officers and American volunteers like a team before a difficult match. There will be thousands of people, he says. They will all want treatment. They will not all get it. They might be rowdy, but in order to help, you will have to be tough.

Bata camp, with some 10,000 people, is less congested compared to Aromo. But they are more isolated, the death rates higher - up to 3 people estimated to die daily. Ever since they came here, they have not had medical attention, so disease and hunger hang like shadows on the people's faces.

The clinic is set under a clamp of mango trees; the five vehicles packed to mark the dimensions; hung on the ropes, A 4 paper size signs reading Gynaecology, optics, bone and joint, dysentery, fevers, dermatology, pharmacy.

Toward 1 o'clock, the packaging of drugs starts, and with the flow of patients, it goes on till the tablets have run out. This community has been through the worst. In the late 1980s, all the cattle here were swept off by rustlers for which the impoverishment continues to-date. In the last half of 2003, each parish lost scores of people: 25 people were killed in Awiealam; 25 in Akwang, 15 in Atabu, 28 in Alapata, 20 in Abyenek, 35 in Aderolongo (which we drove past coming to Bata); 28 in Abako.

You got killed if you stayed near a house. You got killed if you strayed from the camp. And yet you had to leave the camps to get food for the family. But even when you stayed in the camps, the rebels came. The rebels lined up people in a courtyard to behead, to save on bullets. They spared you when they needed you to show them directions. You directed them for as long as you were still familiar with the little paths. Soon you were beyond your range. Then they cut your throat and abducted another guide; whose throat was also cut when they were out of range; passing the baton of death to ensure no one pointed which direction they went.

If you were not murdered, then disease got you. It is disease, which PATH is fighting to fold back. Before they came, the death rates in the camps were as high as five people a day. Now it is down to one or two:

Hunger and poor hygiene are the bane of the camps. In the absence of water and soap, fungi have spread through the human population. Pathogens; scorptes scabie, responsible for scabies, cover the children's arms and hands in yellow puss. "It normally affects people because of hygiene," Says PATH's clinical officer, David Alula. "In the presence of water and soap, they are not supposed to be there."

Close human contact and the piling of huts give wing to vectors. Malaria is rampant, the medical assistants know, but documentation is non-existent. Fungus spreads easily, louse too, and as Higgins explains, trigger off secondary and tertiary hazards. "It's primarily a hygiene problem," he says. "In the camps, you are unlikely to have good water. The fungus comes from not being clean. But if it's untreated, then it goes into secondary infection because I have seen this happen."

Solomon Otiti, 2 years

The palm of his hands and soles of his feet are yellow. His body is turning yellow too. For a child of his size, the hemoglobin level in his blood must be over 10 HB; below 5 HB and there is danger. His is 3.4 HB. Alula thinks that he will die in 24 hours if he gets no medical attention.

A week ago, with no clinic to turn to, Otiti's inflamed tonsil was cut off by a traditional healer. He developed a temperature. He could not eat. He started passing black feaces. PATH finds him a beaten, docile pile in his mother's arms. Alula discusses with his colleagues what approach to take; "If we take this child to a government hospital, the procedure alone, of getting blood for transfusion will take until the next day," he says. "He will die." So it's to a private clinic then. Otiti and his mother will join the convoy back to Lira.

He has malaria and given his level of anaemia, they think he might get partially brain damaged for good.

Jasper Odongo, 12 years

Jasper Odongo survived death from snakebite. One night, in the June 2003 drive, his family woke up to shouts and gunshots. He ran after his mother and hid behind a shrub. When the first wave of rebels passed, the family ran again. Jasper felt a sharp jab on his right foot. The next morning at the camp, his family woke to find him bloated out. They tried herbs and washing him with antibiotics, which could not remove the fangs lodged in. His entire body started to rot, his body to yellow. Says Higgins, "The people who knew Jasper know this; there was a time when you could not stand next to him because of the stench."

PATH rescued him and paid for an operation in Kampala. The rotted metarsals that stuck out of his foot were extracted, leaving the foot pinched-in and stumpy.

Death in the afternoon

The lines keep lengthen out. The sun is intense, the colours strike out. People's faces have collapsed in from the one meal a day life. So the lines are yawns and forlorn looks. On the sidelines, PATH has brought music instruments from its orphanage. So the cadence of music drives up a festive mood. The soldiers from the UPDF detach who watched from a distance at the start, now join. They too are in dire need of medical attention. They beg to be treated fast because they have to return to patrol duty. It is past 2 o'clock and there are thousands in the lines. But the truth is clear: They won't all be treated today.

Winnie Apiro, 3 years

This morning, Winnie woke up playful. In the afternoon she got a seizure and went into a coma. Julina Akwero, her mother considered it provident that she collapsed on the very day PATH Ministries came. So she carried Winnie on her back and hurried to the school compound with the rest of the family in tow.

Along the 3 kilometer walk, Winnie, now very hot with fever, let out a jet of diarrhoea on her mother's dress. Julina thought it was sign of recovery and kept running. Then with only 50 meters from the PATH vehicles, a friend noticed that Winnie's head was hanging wrong and stopped Julina. They took the girl down. She was not breathing. They felt her chest. The heart was flat.

At 3 pm, the death of Winnie is announced by a scream from Julina. The body is taken from the mother. People gather around. They close the mouth. They bring the eyelids down. They bind up the face in white cloth. This is happening at the sidelines of the mobile clinic. The hum of human activity shuts out Julina's voice. This is taking place on the sidelines and with the activity, no one notices, so it's a very private tragedy. The family transforms into a death party. Through the fields of cassava, pigeon peas, disused cattle tracks and wild flowers; past grim faced passersby, Julina's voice grows creaky as she cries:

Atero cana kwene
Atero cana kwene,
Atina oto ope otwoye
Atero cana kwene

(Where do I turn with my grief
Where do I turn with my grief
My child died without illness
Where do I turn with my grief)

They cross a small stream that takes them past the final elevation before they get home in Amanabunga parish. Winnie's body is laid under a pillar in a hut. The realization that this really is the end comes hard. The wails rise higher.

15,000 tablets of mabendazole

At the school, the mobile clinic winds up towards 4 o'clock. It has not treated half the people who needed attention. They are pushing back a tide of death with only 2 clinical officers. Medical doctors shy away from the north.

15,000 tablets of mabendazole were given out to treat 3,604 cases of intestinal worms. 224 cases of peptic ulcers were attended, 134 treated for Sexually Transmitted Illnesses and 155 women treated for Yeast Infection. 344 elderly have been given medication for aches and pains.

There were 74 fungal infections, 71 cases of malaria. 23 wounds were dressed - all fractions of the needs.[O]

CHAIRMAN MAO

By David Kaiza
Feb 2006

No doubt one of the most outstanding parliamentarians of his time, Gulu Municipality Member of Parliament, Nobert Mao - Museveni and NRM critic, stunned the nation when he declared he was not standing as MP, but would contest the post of Local Council V - district chairman for Gulu Local Government, a considerable demotion. He spoke to David Kaiza about his decision.

DK: What made you decide to run for district chairman?

NM: It is unusual for a very safe seat like mine, but even before my first term, I promised myself and my electorate that I would serve for two terms and run for president. Indeed I ran for president and got 26 percent of the party vote. In a multiparty setting, you have to be disciplined and support the candidate

I had decided not to seek for elected position. But one time, a radio presenter in Gulu opened a talks how and asked whether MP Mao should run for chairman. 98 percent of the callers wanted me to be chairman. They told me the quality of decision-making needed a high calibre leader. There are problems of corruption; challenges of resettlement and challenges of land. They thought someone like me could offer better leadership. I hope my success in Local Government can show that I can be a president. Of course if I fail to run Gulu district well, then I cannot run Uganda.

DK: Is it not a demotion from MP to LCV?

NM: The challenges in Gulu are so much that I wish the Pope could be chairman. Even the Pope would be overwhelmed. In terms of protocol, an MP is more highly placed than a chairman. But I believe that you must go where the problem is. It's about duty.

I am looking at the effect of a 20-year-old war between the (Lords Resistance Army) LRA and the Ugandan government-two uncompromising sides. In Gulu alone, because of this war, we have about half a million displaced people who have been forced into camps for 10 years now. They have no access to water-in fact they are entitled to only one litre of water per day.

The people are malnourished, there are human rights abuses-civilians were raped by the army in Padibe late last year, there were killings recently in Lalogi. Then people have to deal with an informal case of curfew in some camps. Civilians are not allowed to hunt for wild game yet they have no access to food.

We need a leader who can propose new policies to government forcefully. There are many things that Gulu local government can do to handle these challenges. I believe I am a good fundraiser. I will call a donors' conference to raise money to resettle people.

Even with $3,000 per household, this would enable them to buy farming equipment and other basic needs. It is not enough but it would get them started.

DK: What is your assessment of Ugandan politics today?

NM: We have a president who has been exposed as a hypocrite. He can afford to talk peace with the murderous Burundian rebels but cannot do the same with rebels in his own country. He condemns corruption but spends $0.2 million to fly his daughter and daughter in law to deliver in Germany; then he appoints ministers who have been censured by parliament.

He claims to be building a national army but its leadership is from his own ethnic group. The country's economy is floundering. Our capacity to attract investors has declined while Kenya and Tanzania are getting more; unemployment has skyrocketed. The war in the north has been sucking 3 per cent of GDP-we have almost spent $2 billion on it.

And politically, Uganda is now more divided than it has ever been.

DK: Against this background do you think the election will provide an alternative?

NM: This is a test to determine whether Ugandans will ever have confidence in political processes. I doubt the elections will be free and fair. If they are free and fair Ugandans will have the confidence about choosing alternatives.

DK: Is there a possibility that we could become a pariah state once more?

NM: A pariah state means a state decent people do not want to do business with. And I think we are already on the way. Tanzania and Kenya have refused to sign a document for political federation because they think there are uncertainties about Uganda. Donors have cut aid. These are the milestones for pariahdom - if there is such a word. Even our friends, the USA have become weary.

DK: Looking back now, could we have seen things turning out differently?

NM: Conflict is part of political process. That is why if Museveni was a visionary and an architect, he should have built systems.

DK: Is it possible to be a visionary given Uganda's political configuration?

NM: Greed for power is said to be human but no leader in Uganda has ever had what Museveni had. For the first ten years, h was worshipped like a god. Unfortunately, one of his biggest mistakes was to think you could have democracy without parties. The other mistake is this pay-as-go democracy putting every political supporter on a payroll so that public support has collapsed. Politicians are ranked so low; we are ranked alongside pickpockets.

DK: Can this army serve another president?

NM: you have heard Chief of Defence Forces Gen. Aronda Nyakairima. He has been explicitly partisan. And in the last election, Lt. Gen. Katumba Wamala, whom we thought was a disciplined officer, stated that if Kizza Besigye became president he would resign. We have heard Gen. David Tinyefunza threatening a presidential candidate. It is because of this we have concluded that the army is loyal to Museveni rather than Uganda.

DK: What does that mean for politicians like you?

NM: It means that we have a bitter struggle to get there. That struggle involves articulating alternative agenda, explaining the real situation to our friends abroad (who must now be swallowing their words). They touted Museveni as the new breed of African rulers; Africa's beacon of hope.

But we are also bracing ourselves to suffer. Politics is no longer for the faint-hearted.
At the end of the day, nations rise and fall depending on the quality of leadership. Museveni has made some achievements. The level of entrepreneurship has improved. I think his economic policies like allowing for competition - something like making the dollar available to anyone who wanted it - was positive. The first ten years, he was building. The next ten years he was destroying. What was said of Napoleon will be said of Museveni; a man who built and destroyed Uganda in equal measure. He has destroyed our sense of nationhood. He has destroyed our sense of integrity. [O]

THE CONTROL OF ALIENS AND REFUGEES

By David Kaiza
Kampala September 2002

The house stands in a nondescript village outside Kampala, unfinished, bare and crude. The daily food consists of beans and maize flour, but for the two young Sudanese, Manek and Bol (not their real names), this is the home they have known for 13 years.

They were abducted in 1989 at the age of eight and 14, respectively, during a Sudan People's Liberation Army (SPLA) raid on their home in upper Torit in the Bahr el Ghazal region. They have never seen their parents since. At that tender age, they did housework and went to the front as child soldiers. Early this year, they lobbed a grenade into their commander's hut while he slept and escaped to Kampala, where they hoped to get help from the United Nations High Commissioner for Refugees (UNHCR).

Today, they are afraid of both the Sudanese government and the SPLA. They were detained by the Ugandan Chieftaincy of Military Intelligence, who insisted they were Kony fugitives. They were thrown into Kira Road Police station after an SPLA operative started asking after them. They were rescued by a court order secured by the Refugee Law Project.

The RLP legal officer forbade the press from using their names or taking their pictures. They are in hiding. They share the place with about 20 other people - all with similar histories: An Ethiopian nursing a knife wound, a Rwandan escaping conscription and a Congolese whose hut was set on fire in Oruchiinga camp, western Uganda.

For an increasing number of refugees, Uganda is no longer a safe place to live. But it is a predicament that neither the government nor the UNHCR have awoken to. A week before the Lord's Resistance Army overran Achol pii camp in northern Uganda, killing over 80 of its occupants, both the government and UNHCR had assured The EastAfrican that the camps were secure.

Although regional conflicts have grown, Kampala has become a centre of relative calm - for those who can hide. Refugees allege that secret agents follow them to the city, and even though both Rwandan and Ethiopian diplomats deny it, the two countries are said to be hot on the heels of political dissidents. Kampala is taking on the romantic but dangerous character of a spy city reminiscent of the Cold War era.

Human-rights activists say Uganda must change its laws and policies to provide security for refugees, and that UNHCR should review its operations in tune with the changing times. Attempts to get comment from the UNHCR concerning accusations of corruption and abuse of refugees and asylum seekers were fruitless. A report by RLP accuses both the government and UNHCR of running an inefficient system. The ransacking of Achol pii drove the point home that refugees would rather live a precarious existence in Kampala than stay in the camps.

"The government must provide security for refugees and asylum seekers," Emmanuel Bagenda, a lawyer and researcher on refugee affairs at RLP, said before the Achol pii raid. "Uganda is a signatory to the convention on refugees, but our government is abdicating its responsibility."
Christine Aporu, State Minister for Disaster Preparedness, said: "People misunderstand our work. We do not go out shopping for refugees. We cannot know that they have problems unless they come to us."

While the UNHCR has a protection officer and safe houses, the greatest danger to asylum seekers, says Bagenda, is at the time when they are seeking refugee status. The process is riddled with bureaucracy and is handled unprofessionally. Uganda still follows the 1960 Control of Aliens and Refugees Act, a heavy-handed law that treats refugees as a threat.

"We are afraid of both Uganda and Rwanda," says Moses a Rwandan asylum-seeker who wished to identified only by his first name. He says he escaped conscription in his country. "We hear that those who are caught are hanged."

He does not say which part of Rwanda he comes from for fear of identifying himself. He had a year left to join university when he was called for military service. His brothers had already been drafted. He dodged security agents, but came to Uganda when he could not hide any longer.

Uncertain, he went to the Old Kampala police station and spent months living in an old bus with a group of 40 asylum seekers. It was there that Catholic priest Fr Anthony Musala found him. A soft-spoken young man, he has a pair of Adidas shoes dyed black to hide the cracks. His jeans and T-shirt are giving way at the seams, but they are clean and well tucked in.

Fr Musala founded an organisation called Agape - Greek for love - after he stumbled upon the group of asylum seekers. But even the future of his organisation is uncertain. Christian charities have been warned not to help stranded foreigners.

At Agape, the refugees are taught skills such as soap making and tailoring - which some now use to earn income. They live in a lush green village overlooking a wide swamp, a view in sharp contrast to the life inside the home.

For Rwandans like Moses, approaching the UNHCR means exposing themselves. Showing up at InterAid is a risk. There might be no help, and people he knew went there and never returned. The hope for him, advocates say, would be to keep on the road; to Kenya, and back again, then maybe try the US. But after the September 11 terrorist attacks in New York and Washington, few countries will be receptive. The Office of the Prime Minister is also weary of taking any Rwandans for fear of worsening relations with Rwanda.

Amnesty International often receives cases of refugees on the verge of desperation - after exhausting the processes of RLP, InterAid, UNHCR and the Prime Minister's office. After that, they go underground.

"I receive up to 15 cases a week," says Richard Haavisto, an Amnesty researcher on Rwanda and eastern Congo. "One boy came here after his brother was grabbed from the Office of the Prime Minister. I contacted them but they denied it. After that, the boy disappeared."

Ethiopian Yimer (not his real name) says he stopped going to the UNHCR, InterAid and the Office of the Prime Minister after he was trailed in all three places. He reported to the authorities that his life was in danger. But his concern was not addressed. "One night as I was walking, some people followed me," says Yimer. "When I turned to look, they stabbed me and left me for dead. I was rushed to hospital by police." Fortunately, the incident happened close to Mulago Hospital.

Today, he is withdrawn and angry. He does not know who attacked him, but to be safe, he stays one district away from Kampala, where the distinctive Ethiopian features would easily be noticed. He is among the batch of Ethiopians, mostly students, who fled the country last year following the killing of 52 students in Addis Ababa. He is from the Oromo, the most populous ethnic group in Ethiopia, who claim to be marginalised by the ruling Ethiopian People's Revolutionary Party (EPRP) dominated by the Tigre.

Yimer first fled to Nairobi in April 2001, a tough journey made in hiding. Nairobi, he says, was infested with Ethiopian agents, so he crossed over to Kampala. In Uganda, he was thrown into jail, sent to a camp, then got registered as a refugee by the UNHCR. Although he was permitted to stay in Kampala, he was not entirely safe.

Ethiopian diplomats dismiss his case of political persecution. Ethiopians seeking asylum say that they have lost thousands of dollars to bogus asylum officers. Almost all those who lost money say they were going to the US.

"These are economic refugees who want to spoil the good name of Ethiopia," a diplomat in Kampala said. "Those who say they were students started a riot and killed policemen."

The two brothers, Eado and Hussein Wotiya, have failed to get refugee status in Uganda. They lost $4,000 in Kenya last year when they bribed UNHCR officials. The amount of money they used makes it hard for advocacy groups to believe that theirs is a political case.

Kampala has a significant population of Ethiopians, with the divisions back home being replicated in the city.

"Supporters of EPRP and the Oromo Liberation Movement (OLM) don't meet. I can't even go to the orthodox church here," Yimer says. He has asked for protection from both the Office of the Prime Minister and UNHCR and received no response.

"I'm safer with non-Ethiopians," he says. When he asked for resettlement, a UNHCR paper was thrown at him showing that he had six children and a wife - that for a student born in 1971! He has grown suspicious of the UNHCR. "I am fearful for my life. I want to be relocated to any other country. There are too many Ethiopians here. I don't care whether I will be relocated to Rwanda or Congo, as long as I am safe."

The UNHCR warns that there are conmen selling status papers, and that asylum seekers often try to make their case stronger by claiming political persecution. Fr Musala says that among the people he picked off the streets were economic refugees seeking resettlement to third countries, mostly the US and Australia, but he said they only opened up to him because he is a priest. Nevertheless, he says, a good number are fleeing persecution.

The story of Kanda is slightly different. Hailing from Bukavu in eastern Congo, he was a lecturer at a teacher training college. But he was also a human-rights activist working for the Association Pour Pay Progress. Rwandan-backed Banyamulenge rebels stormed the city in November 2001 under the pretext that they were forestalling genocide. Kanda was jailed without food for six days and was released only after his family bribed the guards.

He first went to Kyangwali Camp in western Uganda, until he saw elements of the same Banyamulenge living at the camp as refugees. Today, in Kampala, his daily routine includes visiting the Jesuit Refugee Service, InterAid and the Refugee Law Project. The UNHCR registered him as a refugee but he gets no help from them. He makes the rounds because along the way, an official could part with a thousand shillings. He has spent nights on the streets and sometimes with fellow Congolese.

Today, he lives with the irony that Uganda is both aggressor and refuge for him. He has learnt to speak English, an important factor for any Congolese to survive in Uganda. On the first day we met him at the Jesuit Refugee Services, he was looking for news of food, resettlement, anything that could uplift him. The long queue at the compound breaks up when the lots are drawn. The line forms again, and more people keep joining.

Kanda hikes a ride in an RLP vehicle to InterAid. There, he is told that there is no medicine and that the UNHCR cannot provide him with help unless he returns to the camp. He explains that his hut was set on fire, but he can't prove it and he can't talk too much because his English is broken. They think he is lying. Outside, someone gives him one thousand shillings. Three days later, we meet him and this time, he no longer lives with the Congolese family. The woman's Ugandan husband grew jealous and threw him out. He is looking forward to going back to Congo, but is not sure the warring factions are serious about ending the fighting.

For asylum seekers and refugees, the story is similar. Genuine cases find it hard to get audience because of the large number of bogus asylum seekers. After exhausting the UNHCR, InterAid, RLP and Amnesty International, they go underground, run to another country and re-emerge under a different identity. For Rwandans, the trick is to keep constantly on the road, or what they call "transiting", in the hope of tiring their pursuers.

"Rwanda hunts for political opponents and people with corruption cases all over the world, but it suspects everybody who runs away from the country," a security official who spoke to The EastAfrican said.

Although Kigali's external security is reportedly vast, employing students, civil servants and moles within Uganda's security forces, Rwandans running to Uganda can easily integrate into society. They speak the local languages and are often familiar with the country.

At the height of the quarrel between Uganda and Rwanda last year, 63 Rwandan nationals were in military detention, suspected by both Kampala and Kigali of espionage. At the intervention of British Minister for Overseas Development Claire Short, access to counsel was granted, but the process was almost brought to a halt when Rwandan secret agents turned up and scared the dissidents. Some of the dissidents had refugee status, which made it illegal for the government to detain them - another factor that Haavisto says gives the government a credibility problem. Uganda admitted that it was "an honest mistake" to let in Rwandan security.

However, Haavisto says that some of those in detention preferred to stay in the cells. "The threat (to kidnap) is so real that their families preferred that they be held in military barracks than be kidnapped and taken back to Rwanda."

Haavisto says that following up Rwandan cases is difficult. Inside the country itself, people are too scared of an often ruthless security service - the Directorate of Military Intelligence - to say anything. It is when they come to Uganda that they talk.

Security personnel - the CID and Interpol - don't want to talk about organisation of espionage and skulduggery, for it is highly political. Because of the secretive nature of these operations, no one can tell the scale with any certainty. "We hear about them," Uganda's CID director said. "But we cannot act unless we have solid evidence."

"Uganda has the ability to protect refugees, but sometimes you find a camp manned by only two people," says Bagenda. "What can they do when a group of rebels come?"

Rwanda's Charge D'Affaires in Kampala, Alois Gapira, says it is a lie that Rwanda sends out hit squads. But he says that the security of his country, both inside and outside its borders, is of concern.

Rwanda's history when it comes to dealing with political opposition has struck fear in the hearts of its opponents. The assassination of former interior minister Seth Sendashonga in May 1998 in Nairobi is a case in point.

People have been kidnapped or killed for corruption, but it is the high-ranking enemies of the government that have the most to fear," said a non-governmental researcher on Rwanda who declined to give his name.

He also said some cases involved people out to exploit the tension between the two countries. There are people running from personal vendetta. When a group of Butare University students protesting against learning French came to Uganda, the government offered them sanctuary. Kigali called them spoilt brats.

Haavisto says that it is difficult to say how far Kigali's reach is. But as a country living in trauma, its government has operated with few illusions. The most important example was the forcible removal of refugees from Kivu, a precursor to the 1996 invasion of the then Zaire. Kigali had informers at the camps, who came in handy after France and Belgium tried to use an international force as a pretext to shore up the Interahamwe. Kigali acted within hours and forestalled the international force. The world saw on CNN a stream of half a million refugees returning home.
Security sources say that it is impossible to offer protection for refugees against hit squads, chiefly because the squads are designed for secrecy. They look ordinary, and most often masquerade as legitimate business.

The fear of refugees is not just out of paranoia. Ugandan refugees in Tanzania overthrew Amin in 1979 - and the 1990 Rwanda invasion by Uganda-based refugees still remains the classical case. Uganda has given its neighbours cause to fear. Rebels fighting against Kigali, Khartoum and Kinshasa are welcome in Kampala. In the past, Khartoum bombed northern Uganda, until Uganda acquired MiG pursuit planes. Kampala has been a conduit for the SPLA to get supplies.

"Our people grow food in Kiryandongo (Masindi district) to send back home," says SPLM cadre Gordon Chan Manyiel who stays in Kampala. As with the majority of Sudanese in the city, he has no refugee status. The Arabisation policy that the post-independence government in Khartoum pursued has occupied him ever since he was a 16-year-old boy in 1969. Each time the war became heavy, he ran to Kampala, only to return home for battle. He first came to Kampala in 1971 after taking part in the 1969 uprising against President Ibrahim Abud's government.

He returned to Sudan in 1979, joining the civil service. He is back again after he was jailed for supplying arms to the SPLA - something he was actually doing - but says the case was dismissed for lack of proof. He lives on money sent to him by relatives in the US. "I have no fear of saying all this, because ours is a just cause," he says.

This attitude makes all refugees suspect in the eyes of their governments. It is the knowledge of this that Uganda's neighbours keep watch over their exile populations. Southern Sudanese have created worldwide networks, in which SPLA sympathisers in the US, Australia and Europe send money back home. Nairobi is a conduit, but increasingly, the SPLA have found more receptivity in Kampala, which has never denied its support for the SPLA.

"We have the most to fear from our neighbouring countries," says Gapira. "But those living far can come regularly to the region, can send money and help."

The killing of Seth Sendashonga, a one-time interior minister in Kagame's government in May 1998, observers say, was designed to both eliminate him and send a warning to opponents. There were no attempts at secrecy. At an earlier attempt on his life, a Rwandan diplomat was caught red-handed with a gun at the scene. He was released on claims of diplomatic immunity. When Sendashonga was later killed, those said to have participated in his murder died one by one.

The government and the UNHCR are accused of indifference to the plight of refugees. Advocates say that complaints are not investigated. Scores of refugees have complained about camp commandants extorting money and threatening to kill them, but no action is taken. The RLP says it has received four rape cases from Kyangwali camp, a matter confirmed by other humanitarian organisations.

A shocked human-rights activist said: "We contacted UNHCR about refugee complaints that the camp commandant's relative was Interahamwe. They said, oh that guy is bad, but they did nothing about it."

As a result, there are estimated to be more asylum seekers outside the books than those registered. By June, there were 4,016 Congolese and 3,263 Rwandans on the UNHCR register.

"To be frank, what we are doing is illegal," says Fr Musala. "But I ask, is it legal for someone to sleep in the streets? My response is one of a Christian. We are just ministering to people, putting the gospel into action. If that goes against the law of the land, perhaps the law needs to be in dialogue with the gospel."

He hopes that the changes in the law will separate innocent refugees from dissidents. They are hoping that it will decriminalise helping asylum seekers. But the reverse is likely to happened, Amnesty warns. "Refugees move with a kind of freedom not found even in Western countries," says Haavisto. "In certain respects, the new law is even worse than the old one."

On the third meeting with Kanda, he says he has contacted some people who want to learn French. But he will have to wait until September to earn the money. He sometimes sleeps at the Old Kampala police barracks. He finds it ironical that rebel leaders are staying in posh hotels in Kampala whereas he cannot get help, even from charities. "When I go to a Catholic parish, they say the government told them not to take care of us. Uganda invades my country, and now it doesn't want me to get help. Does UNHCR want us to go to the camps to die?" [O]

THE PLATEAUS OF SOUTH ITURI

By David Kaiza
Kampala August 2004

At the mention of Congolese rebel leader Laurent Nkunda, Bernadette convulses, starts to cry, and stops narrating the events leading to the murder of her family.

Bernadette's village in Rutshuru was attacked on April 17, 2000. Her mother, father, siblings, nephews and nieces killed. After five months in hiding, she fled to Uganda with her children. One night in September 2000, men came and took her husband away.

In October 2003, her daughter was attacked in a suburb of Kampala while she was away. Even in Kampala, the activities of the Congolese Rally for Democracy, RCD, make it hard for her to feel safe.

Zachary Lomo, the director of the Refugee Law Project (RLP) of the Faculty of Law at Makerere University, says that with the ongoing ICC investigations into the massacre of some 3.5 million people in Congo that started in June, the refugees who witnessed the killings are targets of perpetrators trying to hide the evidence. But he says that neither the Uganda government nor the UN High Commissioner for Refugees may be able to protect refugees who have information the courts might need.

For the refugees, it's a concourse of failure and frustration against what they see as official neglect.
RCD combatants one day in 2002 arrested Agathe, princess of the Fulero kingdom, which for over a century hosted Rwandans fleeing ethnic killings back home. In Bukavu central prison, she was beaten and raped - losing a tooth and acquiring permanent rope scars on her arms - before buying her way out with a watch. She was pursued to her mother's home in Bunagana, from where she again fled to her uncle's in Goma. But in the end, Congo ceased to be an option.

In Kampala, she was granted refugee status with her mother and children. But the events were too much for her aged mother who died of hypertension. On July 2, 2003 people speaking "Rwandan-accented French," tried to break into a house she was renting in a Kampala suburb. She shouted and the neighbours intervened. The UNHCR could not act without a police letter.

"I went to Queen's Way Police Station to report," Agathe says. "When I told them that I was a refugee they asked me for Ush10, 000 ($5.7). I told them I did not have money so they told me that since I was a woman, I should remove my clothes."

Agathe abandoned redress and shifted to another part of Kampala.

Evelyn, a widowed-mother of five, fled to Uganda in 2000 following the death of her husband. It was felt she was too "Ugandan" and "Rwandan" and must pay for the invasion of Congo.

Technically, she is not a refugee because she has not been granted status. She gave up the usual channels when an official demanded sex before status. Now she is pursuing legal action.

She used to do self-help training for girls in Congo, but has failed to sustain her Kitenge business because Kampala City Council officials depleted her capital by asking for bribes every time they visited. Jonathan had to drop out of school when the time to run came. In Kampala, he tried to look for a scholarship and having got papers from the Clinton Foundation, went looking for a recommendation letter from the UNHCR.

Instead, the papers were flung in his face. Outside of the system, authorities elsewhere did not help. He paid Ush120, 000 ($70), for rent in Wandegeya. The landlord rented the house to a third party, before he even occupied it. To report to police, he needed a letter from the Local Council - who demanded Ush10, 000 ($5.7). The police wanted Ush5, 000 ($2.8). He gave up and tried looking for a job. Except...

"...when you apply for a job, you don't say that you are a refugee, because they will underpay you," he says.

Researchers, civil-rights activists say that the refugee system, operating on the 1964 Control of Alien Refugees Act, is not only outdated, but operates with a high level of impunity; breaking international conventions while failing to protect otherwise bona fide refugees. However, the large number of bogus claimants, UNHCR and the OPM say, makes it hard to identify genuine cases.

Nevertheless, the RLP has documented at least 10 cases in which refugees thrown out of the UNHCR and the OPM as "liars", have been attacked in the streets by would be kidnappers. This includes the case of two men who ran out of Bukavu, speaking of an imminent attack, a few weeks before Laurent Nkunda commandeered Bukavu.

History and the politics, researchers say, points to a trajectory, which might end in an even more serious genocide in the Great Lakes region.

The Kivu where Agathe comes from is the epicentre, and even more central is her own family to the crisis. The Fulero Kingdom, which lies in the Itombwe plateau east of Lake Kivu was since the 1830s, a receptor of the Rwandan ethnic fall-outs. The waves of refugees in the 19th to the 20th century settled in various areas of south and north Kivu and became known as "Banyamulenge" and "Banyavyura."

They were never accepted as Congolese, even though scholars say that they were in the Congo earlier than 1885 when the Congo Free State was created. But the fear of ill intentions against Rwandan refugees, which along with hatred of the Kasaiians of Katanga (the meltdown for which Patrice Lumumba was killed) and continues to tear up Congo, started with Mobutu's regime.

With Mobutu came Barthelemy Bisengimana, a Rwandan immigrant who rose to become the dictator's chief of staff from 1969 to 1977. A man responsible for public policy co-ordination in Zaire, he used his clout to win citizenship for the "Banyamulenge" and the "Banyavyura" in a 1972 Mobutu decree, and to help Rwandan immigrants, now citizens, to grab large tracts of land and plantations in the east, especially in Masisi, northern Kivu, where "authentic" Congolese were displaced. It is this act scholars say, which sparked off the on-going catastrophe in Congo.

When the "land grab" threatened political reversals for Mobutu in 1981, the 1972 decree was revoked. Tens of thousands lost citizenship.

But it was not enough to stop the resentment. The killings, in a gory replay of the killing of the Kasai people in 1964, started in 1990. But this time, it was of "Rwandans." It was ignited by the return to Rwanda of the 1959 refugees, but spearheaded by the "Ugandan" Rwandans, the Rwanda Patriotic Front and Army (RPF/A). The "Congolese" Rwandans started to leave to aid them.

By the time the RPF took power in 1994, tens of thousands had already perished. But again, a fresh stream of refugees from Rwanda, the fifth wave since 1830, started. Its implications were grim, for murder on a scale larger than happened in Rwanda in 1994 would come within only two years. To start with, the fall of Habyarimana left Mobutu vulnerable. In Kigali was a hostile regime, supported in Kampala, composed of people who resented him for the 1981 citizenship withdrawal, but also the instigation of killings from 1990 to 1994. Some in the RPF ranks had fled from not only Mobutu's killers, but also from the local Kivu people who had wanted their land back.

That Kigali would control eastern Congo was a foregone conclusion. That it would want a favourable government in Kinshasa was a geopolitical imperative. But Laurent Kabila did not deliver the protection and territorial gift in the east, so Kigali and Kampala turned against him. The emergence of the Rally for Congolese Democracy was seen as a cover for this venture.

That the local Congolese would face the wrath of a people they resented was inevitable. But the international community did not see it in these terms. Under the protective cover of the US, and heavy guilt, and given the hold of fascination that the April 1994 genocide exercised, it was accepted that the RPA pursue the Interahamwe into Congo. What the international community knew little of – or did not wish to talk about, was the sedimentation of the conflict; the bedrock of sharp ethnic affinities; the murderous hatreds of a region whose refugees speak of "racial differences", of a "Bantu-Nilotic" divide to explain the Hutu-Tutsi impermeability, which they have inherited. For the international community, reality was the linguistic summations of US Secretary of State, Madeleine Albright whose epithets "great lakes region" and the "new breed of African rulers" papered over a region dangerously on the skids.

In practice, pursuit of the Interahamwe was the exacting of ethnic traumas that predated colonialism. The Fulero, the Lubero, Uvira, Hunde - inhabitants of the Kivu who called their guests usurpers - were the primary targets of the dichotomous war that engulfed Zaire in 1996, but which was understood only as an uprising against Mobutu.

Under the cover of Kabila's inexorable march to Kinshasa, an estimated 3.2 to 3.5 million were killed: tens of thousands in Masisi; 350,000 of the 1.7 million strong Banyabwisho; up to 300,000 in Tingitingi; Tingitingi the most notorious of the massacres, with very strong evidence showing Kigali's hand, while Washington tried to cover it up by interfering with investigations.

Researchers say that Kampala and Kigali's precipitate interference in Congo may have sealed the fate of the very people whom they told the world they were going into the Congo to protect. With direct military intervention now hard, the wrath of the "authentic" Congolese turning against those sharing ethnic affinities with Ugandans and Rwandans; who speak the dialects close to Kinyarwanda, Lufumbira, Lukiga, like Bernadette and her family, the prospect that the killings will stop and the region stabilise, looks dim.

Bernadette's husband was killed because the "authentic" Congolese were unhappy about his marriage to a Nyamulenge, a "Rwandan" in their opinion.

On July 21, a motion was brought before the Congolese parliament that revived the dread topic - citizenship. While the "Banyamulenge" want their "tribe" declared Congolese, opponents in parliament say it is a ploy that would mean anybody from Burundi and Rwanda can move in and out as Congolese claiming to be Nyamulenge because of the physical features. Instead, the offer of individual application for citizenship, which would have drawn a line between Congo, Rwanda and Burundi, has not been accepted. The question now is what will happen should the parliament reject "Nyamulenge" as Congolese.

Expulsion would be a certainty, observers say, but it may put the Congo clock back to 1964. The desperate but ineffectual action by Nkunda against Bukavu seemed to be aimed at forestalling this. But Kinshasa, more righteous now in the world's eyes than it was under Mobutu and Kabila Sr, has started girding its eastern flanks. The fear in Rwanda and Uganda is of a retaliatory attack - a conflagration when it comes - should Congo continue to gain firm footing.

To these, the refugees have no answers. Instead, talk is rife amongst them of a conspiracy in Kigali and Kampala to erect a "Tutsi-Hima emporium" over their land; "La Republique Ituri"; the restoration of Chwezi hegemony, which debuted in the interlacustrine region in the 14th century.

They know the killers personally. Some say they were schoolmates with Nkunda; that they know of his movements between Kigali, Kampala, Bukavu and Goma.

Kivu is within quick striking distance of the RPA, a territory outside Kinshasa's orbit. Their forces frequently deploy on speedboats on Lake Kivu, crossing to land at the lakeside town of Kalehe in Kivu – equidistant in the 100 km stretch between Goma and Bukavu - the route that Nkunda used when he fled Bukavu with his forces.

There are already several leads on the ringleaders of the massacres; well-known commanders responsible for thousands of deaths apiece.

Patrice, once a university student in Bukavu, now stranded in Kampala says: "We went to school; we had some level of education. We fear that if they know that we are here, they will follow us. Sometimes they use their women to track us. There are secret agents who have refugee status."
Kanda, whom The EastAfrican first met two years ago, says he gave up computer classes after total strangers referred to him by name. He says he has been followed on the streets.

He was working for a civil rights organisation campaigning against the war. When he walks out, he does not use the same route back. The Congolese refugees, under the Association of French Speaking Refugees, ASSOREF, are campaigning for better treatment. Although belonging to ASSOREF is invitation for hostility, even rejection by the OPM and the UNHCR, some of their complaints of impunity may be getting through, for the UNHCR headquarters in Geneva has requested for direct contact with refugees.

The 80,000 Rwandan refugees living around Rwanda's borders are seen as a political threat by Kigali. The greater majority is repatriated, some kidnapped. The range of tactics used to kidnap and dispose of opponents are use of phoney business contacts; infiltration of security organs including the police - of which an incident in Kisenyi where a refugee was rescued by an irate crowd, revealed that the police had been bribed by kidnappers.

Fears that poisoning is now being applied are rife but hard to prove, although the death of one refugee remains suspect.

The departure of former Rwandan ambassador to Kampala, Sagahutu Murash, is said to be connected to the busting of one such ring by security forces in Uganda.

"Kigali realises what can happen amongst refugees," Amnesty International Researcher for Central Africa Robert Richard Haavisto says, "which is why they don't want refugees sitting around their borders."

RLP says that the tactics of refugee-hunters are subtle. They use the ethnic affinities to blend in with the respective immigration departments. "People choose nationality as far as it is convenient," Emmanuel Bagenda, the advocacy officer of the RLP says. "Lack of controls is what makes it easy for people to switch sides."

To pass as a bona fide citizen, an agent working need only buy a graduated tax ticket. Says Bagenda: "In Mbarara, they told us the only national ID they had was the graduated tax ticket. You have many people who go to the district offices and buy a tax ticket. The authorities are always short of money and don't ask too many questions."

Gunning down refugees, researchers say, tends to be restricted, although it has been used to effect in, Nairobi, the killing of former Rwanda Internal Affairs minister, Seth Sendashonga, in 1998; the murder of two children and near fatal shooting of their mother - a relative of Habyarimana in Parklands Nairobi in April, 2002.

Amnesty International says it receives desperate e-mails from Rwandan refugees in the supposedly safe Western countries saying their lives are in danger. Lomo says that the tactics of Kigali are ruthless, subtle and professional.

In this milieu, researchers say guilt is not the only reason for execution. Ethnicity itself is a crime; children guilty by parental association. Said a researcher, "The regime sees them as a threat that should be dealt with. He who kills Brutus but does not kill the sons of Brutus will be a target."

Amidst the changed threats to refugee security, there are accusations that the system is asleep, redolent with corruption - bribery for papers, for resettlement, and even sale of resettlement to non-refugees seeking greener pastures. Documentation shows a higher proportion of sexual violence in the settlements. Accusations of rape against camp commandants have gone uninvestigated. Murder, arson and loss of property in the camps get incomplete attention.

Bagenda says that these refugees are victims of a system, which no longer matches modern challenges: "The system deals only with generalised refugee problems and not individual cases of persecution. If persecutors can come freely and pursue a refugee, then this ceases to be a country of refuge. The police treat assaults on refugees as ordinary cases of assault, and do not consider the very complex political background behind it."

"The majority of the refugees that come to us are alleging insecurity," Stephen Gonah, UNHCR senior protection officer, said. "Some of them are true; some of them are not true."

State Minister for Disaster Preparedness, Christine Aporu Amongin, says that the greater majority of refugees are safe. She denies accusations that officials in her ministry mistreat refugees or that they demand for sex and money.

"We have never heard about that," she said. "It is shocking for people to make such accusations. If there was any threat to the lives of refugees, we would have heard about it."

"There are people who are out to do damage to our country or to individuals," Carlos Twesigomwe, the Commissioner for Disaster Preparedness in the OPM said. "We have Amnesty International writing reports that are so damaging. But we are on record as the best hosts for refugees in the region."

Both the minister and the commissioner say that the process of granting status is done by a technical committee, which eliminates chances of graft. But the RLP says that status can also be granted prima facie - by authorised individuals - which would then circumvent the Refugee Eligibility Committee.

The police spokesman, Asuman Mugenyi says that all threats against refugees are duly investigated. But he says that there are instances in which refugees have tried to bribe police to get documents that would help them get easy resettlement.

The expulsion of former UNHCR representative to Kampala, Saidi Sayou, over the forcible removal of refugees from Kiryandongo, Bagenda says, may have dispirited both the OPM and the UNHCR, who now "go through the motions" of looking after refugees; sticking fast to the rules - in the case of Agathe's mother, Inter-Aid, supposed to dispense assistance, doing nothing even when Agathe reported her mother's hypertension and acting in the extreme to take her to Mulago Hospital where she died within three days.

Her daughter too is reporting similar symptoms, but she cannot get medical attention because the rules say that refugees can only receive assistance in the camps. Hakim, a Somali-Ethiopian refugee, says he is the victim of a system that does not function well. At Nakivale settlement camp, he was suspected by both Ethiopians and Somalians, sceptical of his ethnic and religious dualities (Christian-Ethiopian mother and Somalian-Muslim father). He says that he was beaten and nearly drowned, was hospitalised in Mbarara hospital and relocated to Kampala.

He says he has been stabbed twice, on the chin and in the groin - by Ethiopians and Somalians who accuse him of spying for either country. He was jailed at one time but was released on police bond. His entire family was butchered in 1992 when Somalia went up in smoke. He once was candidate for resettlement to the US, but thinks his resettlement may have passed to someone else. As an urban refugee, he is prone to police raids for "aliens."

In this light, Haavisto fears that up to 40,000 refugees could be forced back to Rwanda at the behest of a jittery Kigali, but ultimately, against the 1951 United Nations Convention on Refugees and with the full awareness, by the UNHCR that it is against regulations. In Kigali itself, security agents, without the commission’s intervention, frequently snatch asylum seekers off the UNHCR gates.

The RLP says several parts of this convention are frequently broken. Lomo says that several cases are not properly handled on allegations that the refugees are liars. "While it is true some may lie, it is equally true that some are aliases." But he says that Article 31 of the '51 convention provides for that, on the understanding that refugees may need to conceal their identity to protect their lives.
"Contracting state parties shall not penalise refugees and asylum seekers who use methods and means that may otherwise be unlawful. This includes use of forged documents and aliases as long as they report it. Surprisingly UNHCR field staff has this in their work manual but don't refer to it."

The RLP says that the government should consider the political dimensions of the refugee’s background. Lomo fears that a too precipitate investigation of war crimes in eastern Congo may make victims of refugees.

"We would be happy if a prosecutor was careful," Lomo says of the International Criminal Court. "They are dying for limelight, and that is wrong. The terrain on the ground is not safe. They have to take time and ensure that the work is properly done."

But he fears the worst: "The anger, the frustration among sections of Congolese who feel they are victims may lead to genocide. While the Banyamulenge believe they are the victims, the other tribes feel they are the real victims. About three million Congolese have been killed and what has the international community done? These people feel they were invaded by Uganda and Rwanda but the international community did nothing to condemn it." [O]

DEGREES OF DEATH

By David Kaiza
Kampala

SOME 180 years before they intervened to quell the civil war in Sierra Leone, the British had to stabilize the place after hundreds of troops died and they were forced to change governors four times in seven months.

In 1826, a frightening disease caused by a "peculiar state of the atmosphere", killed 905 of the 1,567 troops garrisoned in the Gold Coast: West Africa, land of gold and slaves; rich pickings; also of death – the "White man's grave".

In the middle of the 19th century, with little known about Africa, that state of the atmosphere that rendered energetic people feckless could only confirm that this continent was cursed – a "Dark Continent".

The Italian language had a better description for that atmosphere; “male aria” (bad air), they called it. And so described, something that had nothing to do with the air came to be known in our times. Or did it not have anything to do with the air?

Malaria has since marked Africa and the 6000 km-wide belt of the tropics came to be known as the cauldron of virulent diseases that slip out of the forests to strike men down in their prime. As with malaria, so with Aids and Ebola. And the count is not complete...

What malaria does is immense in its tragedy. In Kenya, researchers say farmers lose 12 per cent of annual income to the disease. It costs an average family $36 treating the disease a year in Africa. Failure to afford treatment means that 3000 people (as statistics say) die everyday on the continent.

Amongst health experts, this disease is far worse than HIV/AIDS. It is a standing civil war in which communities are facing an enemy that never lets up.

When the British intervened in West Africa, the answer was to open up a school of tropical diseases. For all the ancient sea-faring nations of Europe, prosperity meant first erecting a firewall against the mosquito and the seriousness with which this problem was dealt with is illustrated by the fact that no rich country is without a communicable disease research centre. Right in the middle of the Amazon forest is the Instituto do Medicina Tropicao, Brazils firewall that keeps it economy the largest in South America.

But where the institutes are most needed, here in the Kampala suburb of Kinawataka, century since colonial powers opened "schools of tropical medicine", the advance in medical science did little to help Brenda Onzima when she fell sick at school. Dosed up on a written-off drug by a nurse suspecting malaria, her blood test still showed B++ when the last Chloroquine tablet was swallowed. I found her at Geoffrey Lulua's clinic, St. Joseph's in Kinawataka, a festering slum in Kampala, tubes going into her nostrils and arms.

In this slum, scores go to St Joseph's with the same condition as Brenda. Around the clinic, hundreds of slum dwellers lead a life of destitution: Uncollected garbage, overgrown bushes, mothers constantly cleaning feaces after squatting children, sewage on the doorstep, water sources and food daily contaminated. The germs show in the bowels when they go St. Joseph's.

It is perfect post card of much of Sub Saharan Africa (SSA in WHO-Speak) a region with some 600 million people standing as the worst place in the world; the last refuge of diseases that have been largely eliminated elsewhere. Statistics show that it is not the place to be if one wants to live beyond the age of 60. A 40 per cent certainty of premature death hangs over Africans under 60.

It definitely is not the place to be born. The above figures pale in contrast to the fact that more than half of all deaths (53%) in Africa is among children under five years old; a terrifying concourse of horror and desolation in a continent stunted, crazed and impoverished by disease; the economies under siege from it, the demographics deformed by premature deaths.

Like other poor parts of the world, these deaths are from communicable diseases associated with poverty, ignorance and poor nutrition. In contrast, deaths in the group of rich countries classified as Established Market Economies (EME) come from the non-communicable diseases like Parkinson's, Dementia, cancers and heart conditions.

A look at the global map of disease reveals something else: the intensity of disease increases the closer you come to the equator, for even in Africa itself, the penumbra of disease radiates away from the center of the continent. This delineation, curiously, also applies to money – with wealth as health - staying away from the points between the tropics of Cancer and Capricorn.

Dr. Ben Biryahwaho of the Uganda Virus Research Institute explains that Africa and those parts of the earth found in the 6000 km belt of earth between 23° north and south of the equator find themselves in the climate conducive not only to lions and elephants but unfortunately, to streptococci and Staphylococcus (bacterium) as well. Says h, "Disease agents, where they existed in temperate countries, naturally, the weather becomes adverse to them so that there is no sustained transmission. At one level the difference between the tropics and other areas is that the natural conditions that favour these diseases is remarkably different."

Average temperatures over much of equatorial Africa are between 22 °C to 32 °C complemented by high rainfalls and humidity of about 250 cm and 88 per cent respectively.

In comparison, beyond 23° to 45°, 50° to 70° north and south of the equator, climate gets hostile to life. There is little precipitation and rainfall. The climates fall into the sub-humid or semi-arid climate type. Temperatures range from 41 °C (74 °F) highs, plummeting to lows of -25 °C and more.

According to Dr. Biryahwaho, disease-carrying vectors need temperatures above 10 °C to remain constant in order to breed well. A clutch of infectious diseases is now stuck between tropics Cancer and Capricorn. Known in turn as "neglected," "orphaned" and "tropical cluster", they include Elephantiasis, Sleeping Sickness, leprosy, Kala Azar, Chagas disease and River blindness.

Some 1.0 billion people across the tropical belt are said to be infected with them and don't expect any cure. Dr. Peter Mugyenyi, director of the Joint Clinical Research Center in Kampala says that the list of neglected diseases ought to include the entire coterie of communicable diseases.

Disease in SSA acquires a vicious edge. To put it into perspective, a year after SARS broke out, announcements were made that work on a vaccine was in advanced stages. In contrast, it is decades since Ebola broke out but little is still known about it.

A lot of explanations have been forwarded to explain why Africa cannot move beyond disease. The arguments have ranged from politically sensitive ones surrounding imperialism as emerged in the refusal of northern Nigerian states to accept the polio vaccine, to corruption in government. Geography too features strongly.

Dr. Mugyenyi says that a cure for Aids and Ebola would have been found had they affected the rich western countries. Drugs for malaria, he says are still available because globalization forces everyone to travel and Westerners are constantly picking up malaria (which is an environmental disease unlike Aids).

Figures for global expenditure show that Africa does not have the capacity to attract profit minded drug research and manufacturing. The 2003 World Health Report indicates that the monies Africa puts in health make health delivery unprofitable. The health expenditure index shows that African countries spend below 8 per cent of their Gross Domestic Product on the health sector. Europe, the USA and Japan, all spend above that on health, with the USA, the richest state, also spending the most at 13.9 per cent. In East Africa, Kenya spent 7.8 per cent, leaving Uganda and Tanzania behind with only 5.9 and 4.4 per cent respectively. European governments foot more than three-quarters of medical bills compared to Africa where individuals pay more than three-quarters themselves.

Africa does not pay the top dollar.

Any disease, Dr. Mugyenyi says, qualifies to be "neglected" by virtue of coming to Africa. "Malaria is a killer," he says, "but if it was a disease from which you could make money, drugs would be flying all over".

Hence, Africans are forced to do with dated drugs not well known for safety. Melarsopol, still prescribed in Uganda, a 1948 drug for Sleeping Sickness, is said to be so toxic it kills 5 per cent of the patients.

A WHO formula for calculating the impact of death, known as Years of Life Lost (YLL), shows that globally, 900 million years of life are lost each year to premature death, 83 per cent of it in developing countries. But of the five regions of the developing world, Latin America and Caribbean, China, India the Middle East Crescent, SSA carries a disproportionately high burden. It has only 10 per cent of world population but contributes 25 per cent of its annual death figures.

Five out of eight deaths from communicable diseases are in SSA, compared to one in eight in China. This morbid disparity conceals a significant incongruity:

Man for man, Asia contributes more numbers to premature deaths than does Africa. 45 million of the 120 cases of elephantiasis are Indian; 32 million African; five in eight leprosy cases are Indian. But cast this against the sheer number of Chinese and Indians and it is clear that disease digs deeper into Africa's economy where the majority of deaths are between people 15 to 59 years old.

The United Nations Development Program said in a 2002 report that in Uganda, 63 per cent of productive land in Rakai district, the epicenter of the Ugandan HIV epidemic, was no longer tilled because of Aids deaths.

Studies that have tried to link this to the economy say that GDP and man-hours are stolen by disease. In Kenya, various studies carried out in the late '90s show that an average school pupil misses out 20 of 186 days of school with malaria. Malaria was also estimated to lead to a productivity loss of 2 to 6 per cent of the Kenyan GDP, 14 per cent of working days and cost an average family $36 treating severe cases.

For Kenyan farmers, malaria ate up some 12 per cent of annual income. This is because the Kenyan government pays only 22.4 per cent of the health bill, compared to Uganda which contributes 55.9 per cent, even less than the frugal USA government that gives only 44.4 per cent to cover its citizen's health bill.

In a 2000 report projecting disease impact, the US National Intelligence Councils says that: "The economic costs of infectious diseases - especially HIV/AIDS and malaria - are already significant, and their increasingly heavy toll on productivity, profitability, and foreign investment will be reflected in growing GDP losses, as well, that could reduce GDP by as much as 20 percent or more by 2010 in some Sub-Saharan African countries."

The inter-play between disease and ability to compete internationally is a sensitive subject. Analyses explain that prolonged illnesses coupled with poor nutrition affects intelligence. Various studies show that school children that suffered frequently from malaria were also anaemic: impaired learning ability; lower IQs; inability to perform complex motor neural functions (do maths). So is there a connection between disease and intelligence? It is not a question to which a straight answer is given.

Experts say that had malaria and other communicable diseases been eliminated, Africa would show a higher degree of economic performance. But they say Africa was not “allowed” to eradicate, only keep in a loose control, these diseases. It is a highly controversial subject, and those who say it, do so on point of anonymity. Uganda’s long drawn out disagreement over DDT and the fracture it caused is perhaps the first time that the country tried to think of disease eradication rather than control. And yet, there are doubts as to whether DDT can do the job.

"I think we maybe doomed to disease," Dr. Dawson Mbulamberi, the assistant commissioner in charge of vector control in the Ugandan Ministry of Health says. "We are too poor to afford some of the measures to protect us. Societies that developed started developing the moment they eradicated infectious diseases. In Japan, they argued that it was not disease control, which led to development, but eradication.

"The problem of disease perpetuates ignorance and this worsens poverty levels. If we eliminated these diseases, our level of development would go up. For example, Bilharzia affects school performance. The intestinal worms compete for the nutrients the body needs. How can they perform well in class? In the case of an adult, he will not be able to work and those are man hours lost."

And yet evidence shows that things will worsen. Global warming is now taking malaria to new areas that previously did not have it. Points in Uganda, above 1700 meters which have temperatures that drop to 10 degrees and low, are seeing rising temperatures and severe cases of malaria.

In the late 60s, it became clear that African states fresh from colonialism would not cope with disease, prompting the WHO to set up the Tropical Disease Research division in 1974. Back then, concerns that infectious diseases were putting lives at risk was high. Yet cast against the reality of Aids, that concern now seems small.

The US National Intelligence Council estimates that by 2010, nearly 42 million children in 27 countries will lose one or both parents to AIDS and that 19 of these countries will be in SSA.

A second front is the city, which for decades had been shielded by infrastructure. Large-scale migration and corruption, have led to a breakdown of order in urban areas and evidence shows that the mosquito, Anopheles Palciparum is adapting to city life, like its relative the Anopheles Stephenus, which now lives in Indian cities.

But perhaps, the worst and the most insidious danger Africa faces is the genetic laboratory. "The poor countries are the most susceptible to bio-terror because they do not have the capacity to identify these," says Dr. Brad Kay, Coordinator Laboratory Capacity Development for the WHO in Lyon, France. "Its an insidious war that shows up as epidemics in the hospitals. How do you distinguish between a natural illness and one done deliberately?"

The failure to invest in scientific research capacity, scientists warn, means that Africa cannot tell if a disease, like the Nodding Disease afflicting children in southern Sudan or any of the now rampant infectious ones are natural or were deliberately introduced.

But researchers also say that geography is not necessarily a barrier, pointing out that public action has changed other regions. "Typically, the governments in the industrialized countries are particularly responsive to welfare issues of the population," says Dr. Biryahwaho. "In contrast, countries in the tropics quite often are susceptible to political upheavals, undemocratic governance, deficient rule of law, factors that hinder positive Human Development. Israel, Italy, until recently, had malaria but they don't have malaria now. Israel has not changed its geography."

Dr. Diego Buriot, the director of the WHO Department of Communicable Disease Surveillance and Response in Lyon France said that, "The tropics mean nothing. If you are a rich country like Singapore, it's nothing. If you are living in Uganda with no water supply, it will be worse."

He dismisses the geography theory as a "congenitally brain-damaged perception by colonialists", pointing out that not too long ago, Singapore had the entire litany of tropical diseases, but that the fast lane policies of former Prime Minister Lee Kwan Yew swept into the state, first world health conditions, right on the equator.

In this regard, African politicians are yet to grasp the situation. Kampala City Council health inspectors I spoke to said that poor drainage systems, broken sewers, poor food hygiene and unplanned development are the way Kampala's politicians make money. A health inspector speaking on anonymity said: "I blame the politicians. When you want to enforce the law, to remove illegal structures from the city, or to close a school where sanitation is terrible, they say, these are my voters. Sometimes, they wait for a person to break the laws and then go and get bribes from them. So you sit and watch things getting worse." [O]

DEATHS IN NORTHERN UGANDA

By David Kaiza

Kampala August 2005

The World Health Organisation has made an urgent call on Uganda to decongest the camps in the war-ravaged north as reports say the country is failing to curtail the run-away death rates.

The special representative of the WHO director general, Dr. David Nabarro said that the government needed to free up space around the camps to offer relief to the Internally Displaced Persons, who live in close quarters without sanitation.

Dr. Nabarro was speaking following the release of partial results of a survey carried out in the north to assess the rate at which people in the camps were dying. The results revealed that northern Uganda faces one of the highest death rates in the world, with 1.2 people out of every 10, 000 people dying everyday.

Dr. Nabarro is the head of the WHO Health Action in Crisis group. He was on a familiarisation tour of the war ravaged Gulu district last week. He also said that despite efforts to confront the four leading causes of death in the camps - malaria, HIV/AIDS, violence and dysentery - the only way to tackle the problem was for the government to bring the war to an end.

He said: "The results suggests that there are an extra 1000 deaths each week as a result of the circumstances under which they live. That is a high rate for the insurgency that has gone on for two decades. The answer is that the insurgency should come to an end. Too many people are dying."

The survey, which was carried out in Gulu, Kitgum and Pader between January and July this year, was the first of its kind to specifically find out what the levels of mortality were and what the leading causes were. As several organisations have pointed out in the past, malaria emerged at the top of the list, followed by HIV/AIDS.

The results so far released by the government indicate that malaria accounts for 25 per cent of all mortalities. HIV/AIDS came in second with 13.5 per cent while violence accounted for 9.4 per cent.

Mortality rates in northern Uganda have been of concern ever since the camps were created. At first called protected villages, they started to arise in the mid-1990s and started to become more numerous as the conflicted escalated. Starting in June 2003, when the conflict spread through to
Parts of eastern Uganda, the camps spread, and with it, disease, hunger and deaths.

To date, the only information available on mortality has been disparate surveys carried out by various organisations.

However, there have been controversies over the accuracy of mortality figures in the camps. In November 2004, the medical charity organisation, Medicine Sans Frontiere reported death rates among children in Lira district camps as standing at 5.4 out of 10,000, while another higher figure of 10.5/10,000 in one of the camps in the same period.

The government has been at pains to defend its policies in northern Uganda, which is facing a two-decade long war. The double-barrelled approach which government insisted on taking to end the war - waging war against the rebels while at the same time extending peace overtures, brought a much anticipated peace talks floundering in December 2004.

But the Ministry of Health has defended its current report, with the acting Director General, Dr. Sam Okware saying that it had been checked for quality assurance.

The estimated 1.4 million IDPs in the camps do not have access to clean drinking water - with individuals said to make do with a little over 5 litters a day - while food is constantly scarce. However, The World Food Program country representative, Ken Davies said that nutrition is not a big contributor to mortality.

He said that the sanitation and nutrition problems of the camps could only be alleviated when the camps were decongested.

"It is the decongestion which is responsible," Davies said. However, he added that the problem of food shortages were bound to continue into 2006 because the people remained in the camps past the August planting seasons.

The Minister for Disaster Preparedness, Christine Amongin Aporu said that government would decongest the camps, but she said there was no time frame for it to be carried out.
"The camps are being decongested by the security situation," she said. "Decongestion has started in the safer areas." [O]

FOOD AND NORTHERN UGANDA

By David Kaiza
Kampala Feb 2005

At 3 PM in the compound of the Christian Counseling Fellowship Centre at Pader district headquarters, two black saucepans sit on top of badly smoking fires, which when the wind turns, blow into the shed where the teenage mothers have escaped from the sun with their children.

The silence of the 20 young adults belies the depth of trauma behind them: All the mothers without exception got pregnant from rape. Safe for a while from bullets and machetes, they sit watching their children withering away from hunger.

They are largely refugees from the fall out of the Ugandan army's Operation Iron Fist - the operation launched in 2003 to militarily end the northern war. When Iron Fist instead escalated the war, the government replied by emptying huge swathes of the northern Uganda districts of Gulu, Pader, Kitgum, Lira, Soroti and Apac of people. Agriculture was restricted as a measure to deny the rebels food.

Now more than the war ever did, hunger and disease are inflicting on the region some of the highest death rates seen in the world in modern times. The operation has boomeranged on the children.

Observers say that more children below the age of five die of disease and hunger in numbers larger than active war managed to kill in its two decades. The World Food Program (WFP) is overstretched trying to feed 1.6 million camp interns.

Agriculture not only provided nourishment, but was for most, the only source of family income. Now, food is so scarce it has become a currency; a weapon of war; an inducement for children to go to school, even work is paid for in pulses and cereals.

"Food is absolutely everything," Mr. Ken Davies the WFP country director in Uganda says. "It is a desperate situation. What we are doing there is saving lives."

Inside the concentrated camps, malnutrition quickly graduates into disease as children lose the strength to fight off infectious diseases. WFP alone stands between them and mass starvation. The food is delivered in convoys that stretch more than a kilometer:

From Lira to Pajule, the convoy wafts along the dusty Kitgum road in a grim drive through a region that has been pushed to the point of desperation and beyond; past rusted remains of vehicles burnt at ambushes; for hours it meets only a handful of people; solitary figures crossing the road ahead are suspicious. For that the convoys are well prepared. The trucks used are the toughest. The blunt-faced 8-wheel-drive M.A.N SX German military trucks used by the WFP to transport food are built to perform like tanks and should need arise, can cut through 2 meter-deep rivers, ram through trees and withstand 8 kilogram mine blasts. Here, they hammer the dirt road apart, sending up dust clouds that can be seen for kilometers away.

When we enter Pajule, some three hours later, it is immediately clear why the convoys are needed. The children drawn to the roadside are clad in unwashed clothing held by strips of thread. Their stomachs are distended, the hair turning a wispy gold, the pasty eyes a magnet for flies. Inside the camp, the realities are jolting: The digging of graves goes on all the time. Those still alive, live amidst the smell of human waste mixed to black sludge with uncollected rubbish. Immediately, you notice that this is a glass prison, for beyond the huts, the world is cleaner, greener, airier place you are not allowed to go to.

Alice Acam talks with intense urgency. She needs more food, more money and transportation and communication and expertise than she will get. As program coordinator of the Christian Counseling Centre, her work is to rehabilitate the children who have escaped from the fighting. But it is often futile. "Hunger is killing children," she says.

She says that 10 to 14 year-olds ought to eat at least 20 kilograms of meat, poultry and fish a year, no less than 10 kilograms of vegetables and fruits with a daily intake of 400 grams of carbohydrates.

A feature you see of the camps is naked children apathetically stubbing forefingers into bowls of corn soy blended porridge. The typical meal is maize meal and beans, millet and sorghum, millet, sweet potatoes and cassava or beans and vegetables seasoned in groundnut paste.

Pader is one of the poorest districts in Uganda. Virtually no economic activity takes place. The entire human population lives in camps. Whatever agriculture there is, is restricted to strips of land hugging the roads and are only a handful of meters long. The cattle were stolen at gunpoint in the late 1980s, when the war started. Now, during an entire year, a child is lucky to get even 3 kilograms of meat.

Right in the heartland of Acholi, the district has seen the worst of the fighting. Its children have been forcibly drafted into both sides of the fighting. Education is frequently interrupted. It is a wasteland; the finely crafted St Josephine Bakhita church on the road to Pader town is disappearing under grass and tree. The road itself is bare earth pressed in by bush. When the town comes, it is a pile of bricks in a dust storm. People's faces are drawn in and blank - the harried looks of those who don't know what the soldiers are going to do to them.

15-year old Jennifer Akello now at Acam's centre, went to harvest sorghum in December 2003 in Pagwere when she was abducted and forced to carry loads to Ogom, a few days walk from the Sudan border. In the bush, her role was food-gathering, for the rebel ranks are now transformed to forage the hundreds of square kilometers for food - tubes of cassava, ears of millet, sorghum, potatoes, edible and inedible leaves - anything to stay standing.

The first time she was sent to look for food, Akello dug at the ground with her nails to get at shrunken cassava tubes. The next time they sent her without escort, she escaped. Now 15, she is just in primary five, six years behind her compatriots in southern and western Uganda.

What happens in the bush if you return without food?

"Oii," she lets out a dry, humorless laugh. "If you find food once you are lucky. The next time you might not find it. Two children who came back without food were cut up with a panga."

When they chance upon a rice field, the rebels jerk up the rice-ears. They boil that so the husks flake off and they chew the half cooked rice. When they stop to cook meat, chicken or edible rats, the boiling meat is tied with a rope to the waist of a captive so that when firing starts and they run, the food is not lost.

The commanders, so called "tutors", eat first. The rank-and-file waits. Something might be left. Most often, nothing is left. In the bush, life tends to be one meal a week and crazed by hunger, the rank-and-file stuff grass and leaves into their mouths. This can kill.

The escaped children who turn up at the counseling centre are mostly severely malnourished.

"They complain of stomach aches, headaches," says Acam. "They all have dysentery. Most of them pass blood and water in their stools with no solid waste."

Their faces are pimply, the hair matted, eyes bloodshot and infected. The babies, born to malnourished mothers lose their eyesights. As I talk to 22-year old Pasca Atimayo, who is seated in the compound of Pajule Catholic Mission, amidst the portions of maize and beans which she has just received from WFP, she pauses in mid-sentence. But it is not to recollect something. She is out of breath, not strong enough to support so much speech.

The food she has been given is meant for a month, but she says it won't last that long. She looks after 5-orphaned children and has 2 of her own. Her grandparents share her hut as well.

35-year old David Kidega has six children. He has to supplement the food given him by the WFP earning some Ush 500 on the days there is an odd job to do. Kidega and Atimayo can't afford medical treatment. Someone told them that when children have a fever, you dig out the root of papaws and boil; boil eucalyptus leaves when they have a cough. The group that gathers around Kidega for the interview is wracked by cough, wheezing breaths for the children, the stained eyes of adults, bony chests that stick out of tattered cloth.

Kaijuka describes malnutrition as a gradual process that builds up from mild, moderate to severe depending on the degree of food deprivation or disease severity.

Doreen Angom's 9-month son, Cosmos Opio whom she escaped from the LRA pregnant with, and who cannot get his mother's milk nor have proper baby food, is facing severe malnutrition. Constantly crying, he is too weak to eat and has to be force-fed.

Even with its budget always stretched, the WFP says it meets only 74 per cent of the people's food needs. According to Davies, the people in the camps are capable of meeting 26 per cent of their calorie needs.

Kaijuka says that the internationally agreed upon energy intake in emergency situations is 2100 kilocalories per day, although this may change depending on climatic regions. However, the WFP uses this to calculate the food basket to the camps. But Davies says "Too many children are still malnourished."

The food given by the WFP is also for most interns, a potential commodity of trade.

Without clean water and a good sanitary environment, Kaijuka adds, the effects of hunger are worsened. "What is happening in northern Uganda is that a lot of children have not been eating properly over a long period of time. The nutrition problem is exacerbated by poor living conditions due to congestion and poor hygiene and health care practices."

The Irish charity organisation the GOAL Project reported that private livestock ownership is dried up. The hundreds of thousands of animals once found here are down to double and single-digit figures. At the beginning of 2003, GOAL counted 109 chickens in Kalongo (a few kilometers from Pajule); 80 goats, 14 cattle, 7 milking cows and 1 duck. A year later, there were 15 chickens, 10 goats, 4 heads of cattle, 0 milking cows and 1 duck.

Four months previous to the June 2003 debacle, 60 per cent of the population reported relying on sale of their food crops as a source of income, a figure that fell drastically to 8.7 per cent towards the end of 2003. Harvest and sale of firewood was a fallback for most, but not for those trapped in camps like Pajule.

In the end, the camp interns are forced to sell the food they get from the WFP to buy a tin-full of charcoal. Some of the maize itself will be brewed into alcohol as mothers look for money to purchase soap and medicine.

Less, then, of the 2100 kilocalories gets eaten.

Kaijuka says that Uganda has acute malnutrition rates of 5 per cent and below - which are tolerable. In the north, the figures shoot to as high as 18 per cent. But 31.6 per cent has been recorded in Anaka; a lower one of 4.7 per cent, in Kalongo.

In Pajule trading centre, milk and meat are scarce. The half-liter Ultra Heated Treated Milk from Kampala milk plants cost me Ush1, 500 (85 US cents) and had gone sour when I bought it. A tray of eggs is Ush6, 000 ($3.4); putting both at five and two times the national average respectively.

In time, the children dry up and cease moving and hence emergency medical intervention is nutritional. Medicine Sans Frontier has entire wards for emergency feeding. In Pajule, the WFP supports the Pajule Therapeutic Feeding Centre. There, 43-year old Sylvia Alwoc sits nursing her 1-year old granddaughter and orphan, Winnie Akano. Winnie is incredibly emaciated, her upper arms no larger than her grandmother's thumb; her skin of a person at least twenty years her grandmother's senior.

The children carry a complexity of afflictions; Kwashiakor, anemia, marasmas and oedema - illnesses that come from not eating well. In that state, they are easy prey to malaria, tuberculosis, dysentery, diarrhea, measles and acute respiratory illness. 80 per cent lack iron.

The health status started worsening with the creation of camps in the mid 1990s. Infant mortality rates increased from 81 to 88 deaths per 1,000 live births between 1995 and 2000. Children aged 3 to 11 months, are weaned on practically nothing and it is they that are the most malnourished.

Surveys in Gulu and Kitgum show that 12.2 per cent of children suffered from oedema, the swelling of the body of children suffering from Kwashiakor.

Besides the unnaturally swollen children, are the unnaturally emaciated; the Median Upper Arm Circumference (MUAC), is a measurement which gauges malnourished children at risk of death. With an upper arm measuring 110 millimeters and below, the child is hours from probable death:

"The children are simply dying," says Dr. Jens Wenkel, volunteer physician for the MSF supplementary feeding centre in Lira. "That is all."

The death figures vary, but all are beyond what the World Health Organisation (WHO) describes as a crisis, which is one death a day out of every 10,000 people. In March 2004, GOAL recorded 2.1/10,000 in Pader. 2/10,000 deaths are considered by the WHO as an "out of control" emergency. And yet worse has been recorded: The US organisation, Action Against Hunger (AAH) recorded death figures of 5.67/10,000 in 21 camps in Gulu in May 2003.

But the worst perhaps, is a figure of 10.5/10,000 by MSF reported in November 2004 in one of the camps in Lira district.

And so the worst image that sticks of northern Uganda is the tent wards. There, the children are skeletal ruins on whom you see the skulls clearly outlined; the sockets around their eyes; the jutting cheek bones over the collapsed cheeks; below that, the neck - birdlike - sticking from the sinking pit of the collar bones. Lower, you can count their ribs. Lower still, you see the pelvic bones awkwardly pushing at the wasted skin. To see how knees ball out is to cease thinking of them as humans:

In the beds, the children are unmoving bundles sinking into the sheets; the heads dramatically larger than the torsos; tubes feed into the noses and skins. They don't move their unnaturally white eyes and they are too weak to cry. You are forced to whip your face away.

"When you go to dig a grave, you find a body already in the ground," Kidega says. "You stop digging and burry a dead body on top of a dead body. People die everyday and you learn not to cry."

Kidega lived in a place called Ora-Otwilo, six kilometers away from the camp. Today he says that his house is constantly suffering from malaria, stomachaches and dysentery. He says attempting to go out to look for food is risky because "when you are caught by the army, they cane you up to 100 strokes; make you sleep in the cold till morning. We are living like prisoners here, to die off one by one. We can work for ourselves and feed our children if they allow us to go home."

The WFP cannot give the interns everything they need. The organisation spends a lot of its money transporting food, which costs $489 for each metric tonne of food aid. Between January and September 2004 alone, it brought 19,000 metric tons to Pader, which came to $10 million.

The monthly average food distribution of food is 12,200 metric tonnes; 146,319 metric tonnes to the camps for the whole of 2004. 2004 was the most difficult year given the scale of displacement; it was the year also when donor support was unprecedented - contributing, with the lead of the USA and the UK, US$ 92 million.

90 per cent of the interns are unable to provide enough for themselves.

The WFP is asking for 452,508 metric tonnes of food for the next three years, in a program that foresees the war coming to an end and people resettled back home. It is slated to cost $263 million. Of this, food alone will cost $118 million.

The war costs the Acholi region alone $100 million a year in lost productivity. The land available to the interns lies in a radius of 2km around each camp. The WFP estimates that what is available to each family is only 0.2 ha - of land borrowed or rented. The maximum grain production, it is estimated is only enough to fulfill 3 months need for a family of seven.

Northern leaders say that the southern dominated government does not care how much the children of the region - seen as a political rival territory - suffer.

"The children in the northern part of Uganda you cannot compare to the rest of the country," says Soroti Women's MP Alice Alasu. "The understanding of a 16-year old in the camps compares to a 6-year old elsewhere. We have asked government to pay fees, to pay for food, for security. But even the little that is given by donors is cut down or not given at all. There is need to understand that this is a country for everyone."

The MPs from the Acholi sub-region make the charge that behind encampment is a sinister plot to commandeer land from the population. MP Nobert Mao was part of a program by Divinity Union, drawn by Lt Gen Salim Saleh to combine food production and security within the camp confines. But he grew suspicious. "If it was meant to feed the people, why did he insist on getting land titles first? We hear now about commercial farmers from Zimbabwe coming to inspect the land. People close to government are going to the camps saying the camps will be turned into urban areas.

"There is fear amongst the people about their land but over the years, people have been dying and there are places where there is no adult left. Since 1996 when the displacement started even the landscape has changed."

The UPDF makes the charge that even within the camp itself, there are interns who still smuggle the little food given by the WFP to the LRA. The interns deny this and accuse the army of sometimes dressing up as rebels and to try and find out who gives food to the LRA. (This particular story was confirmed by an army office in Pajule).

Davies says that in the long term, the people should start to produce their own food. He manages the situation by making sure that he has two-months' stockpile at a time, and is constantly lobbying for support.

The social break down from this food crisis has been extensive.

"There is a great deal of psychological damage," Davies says. "There is breakdown of family with men feeling unable to provide for their family; there is alcoholism; some men have deserted their families - people leaving to go to Kampala, to Masindi looking for casual labour. We haven't always had a problem on this scale. I have brought people to the north from Rome who have traveled elsewhere and I have heard them say this is the worst human suffering they have ever seen.

"It is a uniquely savage conflict."[O]

KEEPING A LID ON THE PARASITE IN BRAZIL

By David Kaiza
Kampala, Nov 2003

The pinprick of the needle on the finger is more telling than the bite of a mosquito; quick and expected, it breaks the skin on the finger tip with a sharp jarring pain, unlike the quiet attack of the female anopheles; thepatient's body jerks in shock, the blood is drawn in a thin glass tube, or spread on a glass slide:

As a Ugandan studying the malaria control program in Brazil, this was not quite what I expected. But some twenty or so minutes later, the verdict was undeniably clear under the microscope. The ruptured red blood cell stained purple by the iodine drop and wedged firmly inside it, the classic magnified yellow image of the malaria parasite confirmed that I was infected.

The wedge was in only one cell so far. But in time, the other cells, still intact and round, would be invaded too. With more and more of them destroyed, the malaria parasites would thin down my blood into mere fluid - colourless plasma without much use. Because the red blood cells carry oxygen, this plasma would lose the capacity to transport that essential gas to the organs of the body needing them. In time, essential body organs could be damaged. With free reign, the parasites replicate, clinging on to the walls of the blood vessels while they mutate, clogging them up, in an act scientists refer to as sequestration. It disrupts the flow of blood, like a sewerage system with too much solid waste. A number of things begin to happen: My eyes would become pale and dull, bloodless because the blood, emptied of red blood cells, has lost colour. The kidneys, because they have more work filtering the blood clogged with unwanted haemoglobin waste, shut down from sheer stress. And the lungs, because they have got the largest, most intricate network of tiny blood vessels, which vessels have been clogged up by those clinging parasites, would fill with fluid as blood, trying to find an easier route, bursts the vessels. Like a river overflowing its banks, the blood floods the surrounding tissue with destructive consequences. Without oxygen and under attack from sequestered parasites, the brain shuts down. The kidneys could be damaged for good, the lungs ruined: Death.

3000 people, for whom effective treatment is unavailable to halt the parasites in their trucks, are said to end

up at the last point on a daily basis - 9 out of 10 of them in Africa. I was lucky that the first signs of malaria - unease and a flat taste in the mouth found me at the Institute for Tropical Medicine in Manaus, capital of the state of Amazonas in northern Brazil - a region of overactive climate where humidity is high, the vegetation dense and wet - very conducive breeding grounds for mosquitoes.

My malaria as the tests showed did not come from the Amazonas. I had carried it for weeks unknowing, in what doctors term "asymptomatic" malaria. It means that while a person is carrying malaria parasites, the condition does not progress to illness. It is an unquantifiable condition in many people in Africa, where a large number are immune to the disease and carry on normally. A change in climate, or diet or an increase in stress is said to lower that immunity and then the parasites, as in my case, jump to attack the body.

This is precisely what happened to me two days before I was due to arrive in Brazil. In Switzerland, unlike much of the world, medical facilitation is excellent. I did not have to line up in a hospital ward. I called a doctor from the hotel room, who arrived promptly at the appointed time. Back home in Uganda, where the doctor to patient ratio is 1:18,000, finding a doctor within the radius of ten kilometers would have been a task. Add to that the possibility that the requisite drugs might be unavailable even after a doctor has been found. There is the added possibility that the parasites will be resistant to the drug.

That was four days before Manaus. The malarone that was prescribed to me in Geneva and the 200 Swiss Francs I paid in consultation fee, plus the 67 Swiss Francs it later cost me to purchase the malarone came to nothing. No sooner had I taken the last three tablets of the malarone than I was sick again. I did not know it back in Switzerland, but in Brazil, the doctors told me that they had stopped prescribing malarone for along time because patients were still ill at the end of the treatment. The same was true of chloroquine, and as in Eastern Africa, of the alternative that governments jumped to after abandoning chloroquine; Sulphadoxine Pyremethamine, or SP or Fancidar as it is commonly known.

Having malaria brought me closer to my subject than is good for any objective study. But the irony was also fortuitous for it gave me first hand experience of how the Brazilian system worked. Hence for me as for 47 year old Lucimar Andrade da Silva, mother of a two week old daughter, and for her husband, Allyson Lima da Silva who went for treatment at the Institute for Tropical Medicine in Manaus, the system reacted rather fast: With my blood sample taken, my name was entered on the central malaria data system which the entire Brazilian government would read. I was given a further dose of mefloquine.

The system that treated me in Brazil goes back to 1999/2000, the time during which traditional approaches to fighting malaria were changed. It was part of a wider change in view, internationally, in which governments came to the realisation that health problems were much wider than availability of drugs and health facilities. Political will and backing was seen at the time as essential in solving health challenges in society. In this vein, former Brazilian president, Fernando Cardoso convened a meeting with the state governors of Brazil, at which commitments were made to combat malaria administratively, as medically.

Observers in Brazil say that this commitment has largely paid off. Within two years of setting up a system to combat the disease, the number of infections in the country had dropped down from 600,000 to 370,000.

HISTORY: From Eradication to Control

Malaria is the disease of the poor. The wealthier coastal metropolis of Sao Paulo and Rio de Janeiro, no longer have malaria except for imported cases. In stead, it is the dramatically poorer northern states particularly Amazonas that still report cases of malaria on a large scale. As incomes go up, so the chances of catching malaria go down. According to Dr. Walter Ferreira, director of the Instituto de Medicina Tropical at the University of Sao Paulo, industrialisation went to a large extent in ridding Southern Brazil of the menace.

"As a consequence of development, the ecology changed," he says. "We have no forest anymore. The vector found it hard to grow."

A century ago, malaria ravaged Brazil. The 1902 Pan American meeting which pointed out the dangers of malaria did not kick into action until the 1930s and 1940s when eradication measures were first taken on a wide scale in Brazil. Dichlorodiphenyltrichloroethane, DDT, was used widely as a spray. An interesting case of governmental action in eliminating the mosquito was in the north eastern states of Brazil. But it was not the Brazil government. In stead, what was a piece of the war effort of the USA government, proved a lasting gift to the poor of north eastern Brazil. It was World War II. The USA was using this part of Brazil as a hopping ground to send troops through West Africa to the war theatre in North Africa but the region was mosquito infested. The realisation that malaria was a danger to the war effort led to a wide scale spraying using an insecticide known as Green Paris. The troops stayed only briefly, but the impact is still felt today.

This period was the peak of the malaria epidemic, with up to 6 million cases reported. The intensity of the eradication drive did not relax and in 1960, a national eradication was adopted. Much of Brazil was left malaria free. These efforts were not applied in the Amazonas region, still too distant from the economically dynamic south.

Although Brazil is largely considered malaria free, scientists say that the level of support to research could make the claims questionable. The eradication, they say worked relatively well because sufficient funds were made available on time. Today, the complaint is that the more charismatic HIV/Aids is taking a greater priority. Scientists say there is danger that urban malaria could be growing unknown, because the diagnostic tools to test for the parasite, malariae are unavailable.

On the whole, Dr. Jarbas Barbosa, secretary for surveillance in the Ministry of Health, says that the eradication succeeded largely because up to the 1970s, scientists and public officials believed "they could do anything."

Dr. Walter Ferreira points out that the successes in the south led to relaxation and says that "the decrease was because we had a lot of money directed into control and now we don't have a lot of money."

The destruction of the ecosystem, which altered the breeding grounds of the rather sensitive female anopheles mosquito, are today largely unacceptable, for according to Dr. Ferreira, industry, apart from cutting down forests, also led to a systematic re-ordering of the landscape. The chemical compounds deposited into the air and the land destroyed the mosquito. These measures cannot today receive popular support anywhere in the world. Hence, the language on malaria has changed from eradication to control.

However, there are questions of income levels, which show that malaria is also an income-insensitive illness. Even in the northern city of Manaus, a burgeoning urban are right in the middle of the Amazon, malaria is no longer reported within the city, but in the peripheries where the poor are mostly to be found.

GOVERNANCE: Renewal and Commitment

Following the meeting in Brasilia between President Cardoso and state governors, the Brazilian government set targets, which are reviewed every two years. The first, in 1999, was to cut down the number of cases by 50 per cent by 2001. It achieved a reduction of 45 per cent. A further, more modest target was set to cut it down by another 30 per cent by 2003. The Statistics are pending.

The commitments presented a major shift in government policy against the disease: A lot is already known about the mosquito, the disease and the manner in which to fight it. But it often fails in many places because of loose governance. The decision to commit government hence shifted the disease from its elemental position as a bio-medical problem expected to be dealt with by slides and tablets, by focusing on the governance structure to ensure that slides and tablets are used correctly. It became a quantity to be watched through a structure fitted with backward and forward, review and evaluation linkages.

"It was the first time a program against a disease was led by a president," says Dr. Barbosa. "It was a challenge but it was an opportunity too because we were at the beginning of a decentralisation process so malaria was a good opportunity to build coordination."

The coordination set out a clear structure within the government of Brazil, a structure which drew up responsibilities right down to the grass roots, setting out what was expected of each level.

GOVERNANCE: Roles and Responsibilities

As an apex body, the Federal government coordinates the entire health system of the country. In the malaria control program, its task is to issue technical guidelines, which guidelines are often adapted to suit the locality in which they are to be implemented. This role involves disbursement of funds, purchases and supply of drugs and other forms of requisite logistics.

A step lower, the State government has to ensure that all spraying is done - in Ultra Low Volumes, with particles that stay in the air for days. The State has to meet a number of administrative requirements to quality for funds - all of which are geared towards ensuring that the State has the capacity to not only receive the funds, but to carry out the role for which the money is intended. It must have in place; infrastructure, personnel, a program to use the funds, a local health council and a specific bank account.

Once these basic requirements are satisfied, the amount of money disbursed will be tied to goals. The number of homes to be sprayed is taken into account together with the number of people treated and the number of slides taken within the period of the last fund release. The annual budget for malaria is $30 million or R$100 million.

At the Municipal level, control is the major task. The municipalities run posts in the risk areas, where a task as specific as taking tallies of mosquitoes is done. The posts also act as coordination centres to educate and inform the public about safety measures and the breeding habits of the mosquito.

In this vertical structure, a system of backward and forward linkage creates, and focuses vigilance on the progress of the control program. The thoroughness of the program is such that the details about every patient from age, address, diagnosis and treatment, are instantly available to all officials within the entire structure, from the medical personnel taking the blood sample at the Manaus hospital, to the Health Minister in Brasilia: All cases of malaria are entered into a database available on the Internet, by the medical personnel taking diagnosis at health centres in the endemic areas.

The instantaneous availability of information therefore creates a system that is easy to monitor and evaluate. But decentralisation created flexibility - the amount of time that it took between observation and turn-around in decision making was shortened. Before that, response to the illness itself was much slower. Brazil is a large country, which a centralised system could not effectively cover.

SOCIETY AND SCIENCE: Causes and the Search for solutions

Dr. Pedro Tauil, Assistant Professor in the Faculty of Medicine, University of Brasilia and health advisor to the Federal Senate says that reducing the time between the first appearance of symptoms, diagnosis and treatment was necessary as a basic control measure. Speed is essential: It takes only a short while for the parasites to reproduce within the human body, meaning that a window period is available in every case to stop mosquitoes from transmitting malaria from one person to another. Says Tauil: "If you treated the person on time, you reduce the risk of infecting another person."

For this to be possible, diagnostic tools had to be readily available. As part of the renewed campaign, the number of diagnostic posts was increased from 3,000 to 30,000.

Brazil is a gigantic country which when stretched out would cover the landmass of Africa from South Africa to Uganda. But it is a country with large inequalities between the rich and the poor. No where is this inequality more acute than in land distribution. The landless see the Amazonas as a region with plenty of land, and this is where human settlement is expanding:

On most afternoons, the air over the Amazon is thickly humid and hot. The rows of houses lying unprotected under the sweltering heat of the tropical sun; the construction basic and done hurriedly, is Nova Cidade. It is the new city which is expanding the city limits of Manaus. This is a raw and recent invasion of the great forest by man. The long and wide gullies, the raw, rotting smell of destroyed plants, uncovered forest undergrowth mixing in with the smell of construction material and the intoxicating smell of tar heated by the sun are tell tale signs that this place is new. Uncovered after thousands of years, the top soil lies loose on the unsealed roads and on the six by six or so feet of courtyards in front of each house. The sun dries these up and when it rains, the beige colour sticks to everything. The road might be bitumised. But the tar is hurriedly done, the foundation of the road is thin and unstable and under the high temperatures, the surface of the road melts, flows, is lumpy and potholed immediately. Vehicles heave and tug about like boats on rough water as they drive along. When it rains, the water gathers in pools or in anything that is upturned - a pothole, a tin, eggshell or polythene bag. Life is hard here and with small income, appearances of a nice neighbourhood are a distant luxury. These settlements are based on the improved slums in South Africa, and like in South Africa, the inhabitants are acutely aware of their poverty, their depravity in one of the world's largest economies. Here, the connection between poverty and malaria are dramatised:

"The malaria in the Americas is different from that in Africa," says Dr. Carlos Protaes Loiola Catao, Manager of the National Malaria Program, Fundacao Nacional de Saude. "Our malaria is largely from movement to endemic areas with poor infrastructure and poor health sector."

The da Silvas are caught up in the same impermanence. They at one time hunted in the forests for a living. Then they fished. They upgraded from that to aquaculture - right on the banks of the Rio Negro, one of the two principal rivers of South America that joins up with the Amazon River 12 kilometers on the outskirts of Manaus. It is a spectacular site known in Portuguese as Encontras dos Aguas, the black of the Rio Negro meeting the brown of the Amazon. But those who make a life there also risk losing it to mosquitoes. Fishing stands along side punning for gold as high risk behaviour in Brazil. Both involve working in mosquito infested waters. Gold punning diverts water from the flowing rivers and creates stagnant pools. Aquaculture involves building ponds which breed both mosquito and fish.

Those who report to the hospital fit the same bill as da Silva. "They have no land to build a house and have to invade the forest," says Dr. Luiz Ferreira, pathologist at the Institute of Tropical Medicine in Manaus. "When they begin to cut the trees, the pools of water become a lake. When it becomes a lake, it's a good place for the mosquito to put their eggs."

Combate A Malaria E Dengue, Base De Operacoes is at the very edge of the Amazon, as it is at the very edge of the malaria program itself. Some hundreds of meters away, starts the density of wood and creeper that is the great forest. Situated in Nova Cidade, a few kilometers outside Manaus, it is one of the outposts maintaining a daily vigilance against the mosquito. All around the post are the rows of new houses built where there used to be forest.

Anastacia Venaucio is one of the young men and women in this Manaus outpost. Her bright yellow T-Shirt, like that of her colleagues, reads, "Forca Total Contra A Malaria". The small red makeshift house they operate in is the outpost that monitors the malaria and dengue risk in the expanding settlement of Nova Cidade. It is here that the national malaria control program makes contact with the targeted population. It is here that it must make its impact felt to be successful.

"We visit houses and ask for permission to go inside to search for mosquitoes," says Venaucio. "We look around the house for possible breeding sites. It maybe very small like a bottle or eggshells, plastic bags, flowerpots. There are some plants which have breeding spots."

Teams are dispatched from the post to the community to map out the areas according to the density of mosquitoes. In the evenings, the girls use their own bodies as bait to trap mosquitoes. They are then tallied. The information is used to draw a map, which then indicates the spots that need the most attention, a variant of what is referred to as stratification.

When they visit the people on the edges of the forest and rivers, they take them through the life cycles of the mosquitoes, explaining that the "warms" wriggling in stagnant pools of water will graduate into mosquitoes.

"We show them the evolution of the mosquito because the people don't always associate the larvae with the mosquito," says Venaucio.

Once the messages have been given out, an evaluation is carried out, to find out if the prevention messages have reached the target. Venaucio says that following each intensive campaign period, there are fewer larvae around homes. The number of people falling sick too goes down. "We feel victorious," she says. "In such a time we have solved so much."

Nova Cidade started its life as a rough settlement, which in the absence of government, was growing without plan - a sure risk factor for any infectious disease to gain grip. With the coming into force of the new malaria drive, government has now taken over. The new houses are built to offer protection against mosquitoes; fitting windows with netting and making sure water drainage is well managed. Here as elsewhere, the risk of malaria and dengue fever are considered before a major project is unrolled, as part of what Dr. Barbosa refers to as "malaria safe development."

In the states that have brought malaria under control, care is taken to avoid infection, for as Dr. Silvia Santi, researcher at the Superindencia de Controle de Endemias (SUCEN) in Sao Paulo points out, mosquitoes do not naturally have malaria parasites, but will act as the vector when one individual carrying the parasites in a population is bitten by the female anopheles, which then goes to bite a healthy person and introduces the parasites into their blood system. An example of where this happened is Madagascar, thousands of kilometers away on the other side of the Atlantic Ocean and the African continent. The Island country had at one time managed to eradicate malaria. Although they had mosquitoes, the bites of the female anopheles were harmless. Later, immigrants carrying the parasites reintroduced the disease into the island. The mosquitoes were once more biting into infected bloodstreams.

There is realisation therefore that even after successful treatment, a constant vigilance has to be mounted. A concept referred to as stratification was once tried out in a pilot project, although it has not been implemented en masse. Under this concept, areas are zoned out according to the degree of risk. Once a successful control measure has been carried out in zone A, all the people moving in from zone B or C, must be tested first for the parasites. If positive, they have to receive treatment as a requisite measure, more like most countries require a yellow fever certificate alongside a passport before admission. This showed that malaria could be effectively contained. But it also tended to work with smaller geographical areas.

The following categorisation is considered in drawing up the strata of endemicity: Where more than 50 people out of 1000 have malaria, the region is marked as high risk. 10 to 49 out of 1000 is medium risk and 0 to 10 is low risk.

Aspects of stratification - useful for concentrating resources were they are most needed - are actively pursued in Sera Pelada, a predominantly agricultural are in northern Brazil. "All the people who go to the area must have negative blood and if they are positive, they must receive treatment," says Dr. Santi.

So is it possible to arrive at a situation where the disease has been completely eliminated in a country so that mosquito bites are reduced to a harmless irritant?

"If everybody is treated at the same time, you can eliminate the disease," says the Director of the University Hospital in Sao Paulo, Dr. Marcus Boulos. "But this depends on other variables."

Variables such as the habits of the mosquito, the strength of a particular strain of parasite, the size of the area under control and the habits of the people. The mosquitoes that spread malaria in Brazil bite between 5 and 7 o'clock in the evening and then from 5 to 7 in the morning. In Africa, the female anopheles feeds from 10 in the evening to 4 in the morning. In Brazil, sleeping under the net is not necessary. Risky behaviours that lay people open to the mosquito at these hours have to be identified. In this way, Forca Total Contra A Malaria therefore prints out leaflets that tell the people to:

* Avoid taking baths past five o'clock in the evening,
* Wear trousers and long sleeved shirts,
* Use repellants,
* Protect windows with netting, and
* Not to wash clothes near streams.

To keep a tight lid on the disease, it is also necessary to keep constant watch on the use of drugs to ensure compliance with treatment regiments. Drugs must be taken at the right time in the right dosage: "Sometimes, when people are not well informed, they take drugs and then stop the dosage when they feel a little better.

They keep them for the next time they fall ill," says Dr. Santi.

Sometimes, the type of houses that people construct and live in will determine whether mosquitoes invade or whether the control measure will be effective: Says Dr. Tauil; "In an urban area, you may apply environmental methods. You reduce the breeding sites. You clean the drainage. When the houses have walls you may apply insecticides. But in some areas, houses are made of poles and canvas."

It is in the pole and canvas environment that Lucimar da Silva made her living. But as a result of the education campaign from Forca Total A Malaria, she is choosing a different location to make her home now - Boa Vista, less risky compared to Igarape do Ehita.

Other variables will also depend on whether a population makes the link between planned settlement, the larvae, the mosquito and lost productivity. Malaria must be treated as a strange and dangerous phenomenon to be fought adequately.

"In Sera Pelada," explains Dr. Boulos, "economic interests were linked to malaria. Farmers realised the connection between illness and decreased productivity."

As a consequence, the pressure to increase surveillance mounted, armed with this solid evidence. Today, lay people are trained to man some of the diagnosis posts. Miners and farm workers are to be found mounted atop microscopes. As Dr. Catao explains, it would be a good thing to have technicians everywhere where there is a danger, but there are not that many to go around. That has not stopped the program either.

With these ideas and responses, the drive started in 1999 showed some results. At the start, the number of states in the Amazonas classified as high risk were 39; medium risk, 12 and low risk, 11. By 2001, high risk states were down to 10, medium risk gone to 27 and low risk, 25. This year, he expects the number of states coloured bright red - to classify high risk - to have fallen even further, but the statistics are not yet ready.

Overall, since 1999, the number of high-risk municipalities in Brazil has fallen from 200 to 98.

The drive to avail treatment free of charge was driven by the pragmatism that malaria was a disease of the poor, affecting those, who like da Silva, scavenge for a living at the margins of society. "The private sector in Brazil don't have interest in the treatment of malaria because the remuneration is low. Malaria is not a disease for the middle class but for the poor who don't have money. But the public sector has a duty to treat these people," explains Dr. Catao.

FRONTIERS: Unanswered questions

Under the decentralization process, the Federal government cannot hire people on a permanent basis, so it has to keep recruiting and retraining people to work on the malaria and dengue program. It is a wasteful process that has seen the Amazonas region employ 35,000 people so far.

Although Dr. Barbosa says that elimination of malaria is not feasible with the available information, researchers say that there is less money now being put into research. There is fear that with elimination in the southern states, there is no more immunity amongst the population, with the fear that urban malaria could easily jump in. already, one case of malaria infection, malarae, which jumped from monkey to man, was found, but only after the patient died.

The Tropical Institute says that it needs more resources to research and develop new diagnostic tools but that they receive hardly any support. Dr. Walter Ferreira and Dr. Marcus Boulos in Sao Paulo, and Dr. Franklin Simoes in Manaus, say that resources must be put into research to ensure that Brazil does not see a resurgence after this current drive runs out of steam.

"We are a pearl in the middle of the jungle who would like to shine. Most of the budget for the WHO goes to Africa but we would also like some money here. [O]

Peoplehouse is a blog started after much prevarication. The choise of the name Peoplehouse is somewhat lofty. But that should not detract too much; say too much of looking up and not enough of looking sideways.