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Health care

Relief operations badly affected by Boko Haram

Since July last year Boko Haram, the Nigerian Islamic terrorist movement, has been carrying out regular attacks in Cameroon. In the far north of the country, particularly where it borders Chad and Nigeria, a psychosis of fear has been rife among the population for some time now. Using Results-Based Financing (RBF), Cordaid and its local partner organization, APROSEN, supports dozens of small healthcare centers and a few hospitals in this area. “The program has been badly affected by this wave of terror,” says André Zra of APROSEN. “We are taking the necessary security measures and we’re doing all we can to keep the health centers going.”

Life is tough enough as it is for the people of the Far North Region (known locally as Extrême-Nord), which is the most densely populated province in Cameroon. There is just one doctor per 34,000 people in this arid and extremely warm region. People have to walk on average half an hour to reach a water point.


One of the burnt down villages in Extrême-Nord province (photo: Caritas Maroua-Mokolo)

Razed to the ground

The violence being meted out by Boko Haram is putting an additional and unprecedentedly heavy burden on the shoulders of the people throughout northern Cameroon. The list of villages that have been razed to the ground by armed Boko Haram fighters, murdering and looting as they go, is long: Baljouwel (where all houses were burned, at a cost of 37 deaths), Zénémé (24 houses burned and 3 deaths), Vouzi, Hodogo, Goldavi; the list goes on.

And it looks like Boko Haram’s surge into Cameroon is gaining momentum. Just last week an army base in the northern city of Waza was attacked by guerillas, probably belonging to Boko Haram.

André Zra works for APROSEN, a procurement organization that runs contracts on behalf of Cordaid with 32 healthcare centers and two hospitals in the region. They monitor the healthcare given to pregnant women, children, HIV/AIDS sufferers and other patients. Every week Zra and his colleagues spend hours driving by car or motorbike to the remotest of areas to visit nurses and village comittees.

“Women and children have fled to camps or to people who are willing to offer them shelter. Men have been killed.”

Zra has been to many of the villages that have been attacked by Boko Haram. “It’s always a gruesome and disconsolate sight. Houses have been burned, the villages are deserted, with survivors forced to leaving everything behind them. Women and children have fled to camps or to people who are willing to offer them shelter. And men have been killed,” he says.

Health centers, schools and markets are closed

He thinks that a quarter of all the healthcare centers and hospitals in the far north no longer function because of the ongoing violence. Schools and markets have been closed too. People are terrified of going there, the roads have been blocked off and employees have either fled or found work elsewhere. Those who have the means have left the danger zone and set themselves up in safer areas.

Influx of refugees

“Since December, there has been an influx of refugee women and children, and many of the children are malnourished,” says Zra, who puts the number of persons currently displaced in the Far North Region at about 32,000 in the refugee camp in Minawao and thousands of others in villages spread over the north. They come from the long border area with Nigeria, where, according to Zra, all the villages have, to a greater or lesser degree, been attacked by Boko Haram. People in the big cities are governed by fear as well. February 11 was the Fête de la Jeunesse, an important national holiday in Cameroon. “At one point, in Kousseri”, Zra explains, “a soldier shot in the air. A mass of people ran screaming in every direction, clearly terrified of possible attacks by extremists.”

“They are everywhere”

Members of this terrorist organization operate in civilian clothes and mingle with ordinary people. This makes it very difficult for the military to decide who is and who isn’t a member of Boko Haram in these Muslim villages. The armed islamists typically strike in groups of between 10 and sometimes up to more than 100 men. Among the fighters children have been signaled. After their murderous looting sprees they withdraw. So far they’ve shown little interest in capturing territory. And while Zra himself has not yet encountered any armed Islamists himself, he knows “they are everywhere”.

Joint strike force

Nigeria itself is doing little to stop Boko Haram, and neighboring countries like Cameroon are unable to control the wave of violence they now face. Heads of state from Cameroon, Niger, Chad and other Central African countries are conferring about the possible creation of a joint strike force to combat Boko Haram.

Impending food crisis

In an emergency plea in early January the diocese of Maroua-Mokolo warned of an impending food crisis in the departments of Mayo-Sava and Mayo Tsanaga. In many villages the harvest has been looted or destroyed and cattle have been slain. During the coming months, with the dry period upon them and as they wait for the next harvest, more than 200,000 people will face starvation, according to the diocese.

“People in the border area are afraid to work their fields,” says Zra. “And farmers who do so are sometimes murdered. Boko Haram guerillas are turning people’s crops to ashes. And those who are fortunate enough to keep their harvest have to share it with refugees who have nothing left. Food reserves here in the north have been depleted.”

“People are afraid to work their fields. Food reserves have been depleted.”

Security measures

While the diocese tries to raise funds to provide food, Zra is doing what he can to keep implementing the healthcare program. “Many roads have been blocked and often we can only get to the healthcare centers with a military escort. Transport by motorbike is prohibited throughout the region because Boko Haram itself makes extensive use of it. Fortunately, healthcare and education workers are given passes that permit them to use motor bikes and, thankfully, so do we because it’s our main mode of transport. If it’s not possible to travel through certain areas, healthcare workers have to make detours to reach us at Maroua. Together with Cordaid, which has lots of experience with RBF healthcare programs in conflict areas in the Central African Republic, we are looking at extra security measures. These include equipping our vehicles with GPS and additional communications equipment.”

Adjusting the health program to the conflict situation

Soon an international RBF training will be held in Douala, Cameroon. Health professionals from the Extrême Nord and East of Cameroon are participating with Cordaid support. “We have set funds aside so that APROSEN can take additional security measures,” says Cordaid’s Fenneke Hulshoff Pol, who is supporting APROSEN from The Hague. “And in Douala, it will be evaluated whether we can adjust the RBF indicators in accordance with the current security situation. We could, for example, see if we can contribute towards the shelter of the victims of the violence, refugees and malnourished children. Or it might be possible to devote extra attention to the care of people with HIV. The violence is making it difficult to keep track of these people and medication is of life-or-death importance to them. Much depends on the resources that we have. But, unfortunately, due to development cooperation cuts, these are decreasing.”

Decreasing health indicators

In addition to trade, education and food production, healthcare provision is also suffering as a result of Boko Haram’s reign of terror, explains Zra. “For the past 18 months the numbers of assisted births, child inoculations and pre- and postnatal consultations had been increasing in the healthcare centers with which we collaborate. But lately they’ve been decreasing. Pregnant women no longer dare to come to the centers, preferring instead the old-fashioned way of giving birth at home, but often in unsafe and unsanitary conditions.”

Spending the night elsewhere

Of the 32 healthcare centers that Cordaid finances, the violence has already forced one of them to close and its eight nurses have been transferred to other centers. And due to security reasons, four centers have been forced to dramatically reduce the healthcare they provide. “Health centres in Tourou, Toufou, Nguétchéwé and Gudjimdélé are now closed during the afternoon and the night, to minimize risks of Boko Haram attacks”, explains Zra. “Health staff spends the night in a more secure city and travels back to work every morning.”

Continue to work, despite the terror

For as long as they can, APROSEN and the medical personnel in the remote villages in the Far North Region of Cameroon will do everything they can to continue their work. This, despite the terror they now have to contend with, but in the hope that the international community will soon ramp up international military and humanitarian support for the victims of Boko Haram.