Burkina Faso Gives France 1 Month to Leave

Prajakta Khade walked into a public health center daily for three months in early 2021, without ever receiving medical care. The healthcare worker’s 26 notebooks—containing more than 3,000 pages of community health records—point to why she couldn’t seek treatment for her ailments. She was simply too busy.

In March 2020, India’s health ministry tasked 1 million Accredited Social Health Activists (ASHAs) like Khade with COVID-19 duty in rural areas. This, in a country where 65 percent of its 1.38 billion people live outside cities. Suddenly, ASHAs’ workload increased exponentially. Yet, they remain underpaid and now suffer stress-related chronic ailments.

“If a positive case was found in the area, we had to visit the patient, contact trace, arrange medical facilities, measure their oxygen and temperature levels daily, and ensure they complete quarantine,” Khade explained about the added duties to treat the infectious respiratory disease. But all Khade was given to do her job in the assigned area in India’s Maharashtra state was a single N95 mask and 200 milliliters of sanitizer.

ASHAs, an all-women healthcare cadre, remain the foot soldiers of India’s rural healthcare. One worker is appointed for every 1,000 citizens under India’s 2005 National Rural Health Mission. ASHAs are responsible for more than 70 tasks, including providing first-contact healthcare, counsel regarding birth preparedness, and pre- and post-natal care. Plus, they help the population access public healthcare and ensure universal immunization, among other things.

The World Health Organization announced a pandemic in March 2020. But in many countries, lack of adequate healthcare and no social safety nets amid lockdowns wrecked the lives of ordinary people. In India, for example, an additional 150 million to 199 million people are expected to enter poverty in 2021 and 2022.

Chronic Illnesses Spike

One day about a year ago, while surveying people in her village of Vhannur in India’s Maharashtra state, 40-year-old Khade felt dizzy. But she couldn’t take a break. “At one point, my face was swollen, and I could barely see anything.” It turned out her blood pressure level had surged to 252/180 mmHg (millimeter of Mercury), much higher than the standard limit of 120/80. That is how she got diagnosed with hypertension.

However, a month’s worth of medications didn’t help because she continued to experience stress as her workload increased. Senior officials at the health center had early on issued an order to submit patient records daily by noon.

ASHAs, who aren’t considered full-time workers, receive performance-based incentives paid on the number of tasks completed. “For COVID duty, the government decided our worth as merely 33 Indian Rupees per day (43 U.S. cents),” she said. “We received this amount only for three months in the past two years.”

Moreover, during the peak of COVID-19 cases in 2021, salaries for Maharashtra’s ASHAs were delayed by five months, according to Khade. Netradipa Patil, an ASHA from Maharashtra’s Kolhapur district and leader of a union that represents more than 3,000 ASHAs, confirmed this.

One day last year, Khade’s supervisor asked for a list of hypertension and diabetes patients from her village of about 1,200 people—at 10 o’clock at night.

“How could I survey the entire community in the night?” she asked.

Often, such orders meant skipping lunch and staying hungry for 11 hours at a stretch. ASHAs worked four hours prior to the pandemic. Now, 12-hour days are normal.

When medications didn’t help, Khade consulted two private doctors. “After six months of hassle, the doctor doubled my dose to 50 milligrams.” Khade lost over 10 kilograms (22 pounds) of weight and was placed on medications to address anxiety. Even today, she suffers from fatigue.

“I was never this weak,” she asserted.

Chronic diseases among ASHAs are rising rapidly because of the workload, says Patil. “We protect the entire community, but there’s no one to look after our health.” ASHAs in Maharashtra, she says, average a monthly income of Rs 3,500 to 5,000 ($45 to $66 USD).

This reporter spoke to ASHAs’ senior officials from Maharashtra’s Kagal block. (In India, a cluster of villages form a block and several blocks form a district. Vhannur village is in the Kagal block of Maharashtra’s Kolhapur district.) Senior officials said they are not responsible for ASHAs’ deteriorating mental and physical health, and pointed to the Indian government’s order to submit data. The officials didn’t want to be named. Instead, they relayed that they also are overworked.

“ASHAs do the majority of the health department’s work, and they are massively underpaid for their duty,” said Dr. Jessica Andrews, a medical officer at Kolhapur’s Shiroli Primary Health Center. She has been handling mental health cases. “Without them, the health system will collapse.”

‘Not Treated As Humans’

Several ASHAs across India have worked for over a year without a break. One of them is Pushpavati Sutar, 46, diagnosed with hypotension (low blood pressure) and diabetes within seven months of COVID-19 duty in November 2020. Like Khade, she experienced constant spells of dizziness.

“Often, there was fake news of community COVID transmission in my area,” she said.

Every day, senior officials at the health center hounded her to find more details about such instances.

An ASHA for 13 years, she’s never made an error in her surveys and was sure of no community transmission. “After investigating, I found that the accused was COVID negative. Instead, two of his relatives were positive.”

She had to clear such misconceptions almost every day, answer senior officials’ questions, collect records and perform her regular duty. “For several days, I couldn’t sleep,” she remembered.

Further, fearing COVID-19 guidelines and quarantine rules, community members began demanding ASHAs hide COVID-19 cases. “People even accused us of spreading COVID as we would survey the entire village,” Sutar recounted. Moreover, she said senior officials asked ASHAs to visit the families of COVID-19 patients—instead of allowing data collection over the phone—putting them at risk of infection.

“At several places, there have been instances of community violence, where ASHAs were beaten up,” said Patil, who has filed legal complaints on behalf of the assaulted workers and is helping them mentally recover.

Kolhapur’s ASHA union has written to several government authorities, including Maharashtra’s chief minister and Indian Prime Minister Narendra Modi, highlighting the mental toll of COVID-19 duty. Still, none of their letters have garnered a helpful response.

“Forget adequate pay,” said Khade, as she continued surveying, juggling between completing her task and trying to keep her mind at ease. “We are not even treated as humans.”

 

Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.

WASHINGTON, D.C.—It was a meeting of Uncle Tom and Uncle Sam.

At least, that’s how African-led anti-imperialist organization Black Alliance for Peace (BAP) referred to the Biden administration’s U.S.-Africa Leaders Summit during a Dec. 16 press conference.

“Uncle Tom” is a euphemism for a person of African descent whose loyalty appears to be with their European-descended master. “Uncle Sam” is a nickname for the United States.

“Some people think that was somewhat harsh,” said BAP National Organizer Ajamu Baraka, moderating the press conference at the Washington-based Institute for Policy Studies. “We believe it reflects the character of that relationship. African leaders claim that they want to have respect, but it’s difficult to get respect when you allow yourself to be put in a position where you are summoned to the center of empire with a stick and a carrot.”

Day 2: Amid many protesters at the DC Convention Center, where the #Biden administration's "Meeting of Uncle Tom and Uncle Sam" aka #USAfricaLeadersSummit22, is taking place, we raised the call for #USoutofAfrica! Banner painted by BAP CC member repping @aaprp @RafikiMorris. pic.twitter.com/nBY32UcNsi

— Black Alliance for Peace (@Blacks4Peace) December 14, 2022

‘100 Million Electric Vehicles’

Some perceived a major deal that took place at the summit as an example of the subservient relationship many African countries have with the United States. On Dec. 13, a memorandum of understanding was signed between the U.S. government and the governments of Zambia and the Democratic Republic of Congo (DRC) that would employ U.S. agencies’ technical assistance and financing support to mine for copper and cobalt. The goal is to help Zambia and the DRC develop an “electric vehicle value chain,” according to U.S. Secretary of State Antony Blinken. The terms of the deal remain unclear.

He added the DRC possesses 70 percent of the world’s known cobalt reserves, though other sources estimate it at about 50 percent. Meanwhile, Zambia is the world’s seventh-largest copper producer, according to the U.S. International Trade Administration.

After the deal was announced, media outlets reported a Bill Gates-backed startup, KoBold, bought a $150 million stake to use artificial intelligence to search for copper in a Mingomba-based deposit owned by the Lumambe Copper Mine in Zambia.

“Converted to copper contained in electric vehicles, it’s like 100 million electric vehicles,” KoBold President Josh Goldman told the Wall Street Journal.

Blinken touted the deal as a way to combat the global climate crisis. However, the thirst for minerals to produce gadgets and electric cars has been linked to the 2019 coup of Bolivian President Evo Morales and 5.6 million Congolese dying in a war. That led the International Court of Justice to order Uganda to pay $325 million in reparations to the DRC.

As Toward Freedom reported in August:

“Non-governmental organization Global Witness reported in April that 90 percent of minerals coming out of one DRC mining area were shown to have come from mines that did not meet security and human-rights standards. Companies relying on minerals from such mines include U.S.-based Apple, Intel and Tesla.”

‘Uncle Tom Part and Parcel of U.S. Plunder of Africa’

To counter the U.S.-Africa Leaders Summit, various organizations pulled together events to raise public awareness. The African Peoples’ Forum held Dec. 11 in Washington, D.C., attracted a couple of hundred African-descended people for three panel discussions, two of which Toward Freedom published here and here. The Global Pan-African Congress held a “people’s intervention” on Dec. 10, while BAP organized a week of actions Dec. 12-16.

“The U.S.-Africa Leaders Summit was clearly set up to obscure the real U.S. role in Africa and give legitimacy to the continuing U.S. plunder of African resources, exploitation of African people and military domination of the African continent,” said BAP Mid-Atlantic member Khari Gzifa, as he read aloud an organizational statement at the Dec. 16 press conference.

BAP Coordinating Committee member Margaret Kimberley defended the use of terms like “Uncle Tom” and “Uncle Sam.”

“Do not rejoice just because African leaders gather in Washington,” she said. “The U.S. cannot cover up its many crimes […] the overthrow and murder of [first Congolese Prime Minister] Patrice Lumumba, coups against [first African-born Ghanian Prime Minister] Kwame Nkrumah, the destruction of Libya, the murder of its president. You cannot cover all of that up with a few days of receptions and photo opportunities.”

Samir Amin analysis of neo-colonialism with Frantz Fanon Critique of the National Bourgeoisie is so useful to understanding economic constraints on African nations today. pic.twitter.com/nIzvr8wqFU

— K.Diallo ☭ (@nyeusi_waasi) December 17, 2022

Rafiki Morris, who represents the All-African People’s Revolutionary Party on BAP’s Coordinating Committee, said the summit wasn’t simply a meeting, but an indication of a partnership.

“Uncle Tom isn’t colluding with U.S. imperialism,” Morris said. “Uncle Tom is part and parcel of the U.S. plunder of Africa.”

Morris added no amount of attempting to appeal to U.S. Congressional Black Caucus members’ or African leaders’ conscience could work to transform their actions or, as he said, bring them over to “our side of the fence.”

“We now realize Uncle Tom helped build the fence.”

Julie Varughese is editor of Toward Freedom.

SFAX, Tunisia—Until the first week of December, mountains of garbage littered the center of the coastal city of Sfax. For more than two months, locals put up with thousands of tons of rotten household trash and hazardous medical waste left uncollected in public areas.

The crisis began after Sfax governorate authorities closed in late September the governorate’s main controlled landfill, El Gonna, in the town of Agareb, some 22 kilometers (13.6 miles) from the city of Sfax, due to opposition from the local population. (Tunisia is divided into provinces called governorates. Sfax governorate contains a city by the same name.)

The people of Agareb rejected the Ministry of Environment reopening the controversial dumping site. Residents said it was full and being used to dump toxic chemical waste, causing the spread of several diseases. Reported health complications include respiratory and skin disorders, sight problems, and infertility.

Some private waste-management companies are known to illegally dispose of toxic material—such as medical refuse and industrial waste from factories—in the landfill to avoid expensive treatment processes.

Protests Turn Deadly

Opened in 2008 as a near-term fix to ease the burden on the Sfax governorate, the dump at Agareb was originally supposed to close after five years.

“We had a problem of trust with the government, which has still not implemented the solutions that they had announced,” said Sami Bahri, a Agareb-based environmental activist, during a webinar Paris-based think tank Arab Reform Initiative organized in December.

Weeks of protests against the trash crisis and the reopening of the landfill last month escalated on November 8 when security forces’ tear gas killed a protester. The next day, angry demonstrators burned a local national guard station. “We are choking on all this garbage!” was one of the main slogans of the day’s rallies.

The closure of the El Gonna site, which had already been overloaded since September, led to the accumulation of garbage and industrial waste on the streets of Sfax city. Local municipal services had stopped trash collection, citing a lack of alternatives for waste disposal.

“We are in a situation where seeing garbage in the open air becomes something ordinary,” said Hafez Hentati, coordinator of Collectif de l’environnement et du développement de Sfax (Environmental and Development Collective of Sfax) in the city of Sfax, speaking in an exclusive interview with Toward Freedom. “It’s dangerous for all economic and social activity, besides being a human health issue.”

The militant, who’s been campaigning on environmental issues for nearly 40 years, estimated above 44,000 tons of rubbish were discharged into the environment without any treatment for more than 70 days after the main landfill shut down.

“Sfax’s garbage issues have been ongoing since long ago,” said Aida Kchaou, a painter and active member of civil society in Sfax, in an interview with Toward Freedom. She alluded to years of government neglect. “People are used to dumping trash carelessly as if they want to punish the state somehow.”

The artist cannot remain indifferent to how environmental conditions have degraded in her region. In 2015, she performed an act of protest on Chaffar Beach, 26 kilometers (or 16 miles) south of the city of Sfax, by wearing plastic garbage bags and picking litter to raise awareness of the decaying state of the seashore because of long-time chemical industries in Sfax governorate.

Kchaou has paid more than one visit to Agareb, meeting residents and local activists, and taking part in small actions in the vicinity of uncontrolled hazardous landfills, very close to residential areas. Recently, she staged an action by standing in the middle of a dump near Agareb, holding her paintbrush as if she was going to cover all of the rubbish with paint. She ended by planting an olive tree. “I live my environment: I see there’s something wrong and I react,” the painter said.

Monem Kallel, professor at the National School of Engineering of Sfax and an environmental expert, pointed out the waste crisis is essentially connected with the method of burying waste in open dumps, which Tunisia has adopted for about 24 years.

“It’s an old policy—one of the worst approaches to waste management—that leaves the fate of the litter unknown and makes people think the state will take care of it,” the expert observed while speaking to Toward Freedom. “Meanwhile, the country’s dumps are getting filled up, and people are growing fed up with the accumulation of unremoved garbage.” He stressed an urgent solution to waste dumping, such as immediately hauling it away, must be accompanied by the longer-term sustainable process of sorting, treatment and recycling.

Striking Against Structural Stench

In the face of growing waste mismanagement, posing serious health and environmental risks, civil society groups in Sfax governorate announced they would hold a general regional strike on December 10. They also successfully filed a legal complaint against the parties responsible for the ecological catastrophe, namely the environment ministry, the National Waste Management Agency (Agence Nationale de Gestion des Déchets, or ANGED for short) and the region’s municipalities.

With the local and national government coming under pressure—just a few days before the anticipated strike—the prime minister’s cabinet decided to resume on December 8 the clearance and dumping of household waste in a temporary collection point located near the port. This plan depended on the rubbish heaps being transported within five months to a new landfill to be created on the road to a town in Sfax governorate’s countryside called Menzel Chaker, about 62 kilometers (about 38 miles) from the city of Sfax. The cabinet also resolved to develop a regional plan for recycling and waste recovery within three to five years.

For Hentati, postponing the general strike was a mistake because pressure that should have served to obtain guarantees from authorities dissipated. The government quickly came up with a package of urgent measures to solve the crisis to avert the labor action. Though, he said, “It did not make any real commitment.” He added residents in the city of Sfax have been left in a disarray, as they are cautiously watching the government’s decisions.

The environmental activist made clear the issue is fundamentally a structural one. 

“Today, the garbage crisis in Sfax shows the limits of the long-applied waste treatment system, which only bypasses the problem without resolving it,” Hentati said.

Increasing numbers of local people are demanding the government introduce waste disposal policies that will protect their right to a safe environment because they refuse to allow their neighborhoods to be turned into landfills.

Poor responsibility sharing between the state and regional and local institutions have resulted in a deadlock in the handling of the ongoing crisis: The central government expects municipal councils to provide much of the waste management, while municipalities call on the state to find sustainable solutions.

Trust In the Dumps

Given their proximity to citizens, local governments are the first bodies held responsible for failing to effectively deal with waste treatment. Yet, it should be noted Tunisia’s elected local councils, which have been operating since 2018, “face severe budgetary and human capital constraints,” as Lana Salman, researcher in urban governance and international development, wrote in a research paper published in April. “[It] is a highly lucrative sector where opacity and corruption are not only endemic, but also institutionalized,” she penned.

While municipalities are responsible for hauling garbage to temporary transfer centers with the ANGED’s assistance, the agency is in charge of transporting waste to the final destination at sanitary landfills and managing such landfills.

Kallel specified greater efforts are needed to raise environmental awareness among the concerned institutions as well as among people, and that an adequate budget should be allocated to make possible feasible solutions. “Rather than shifting the responsibility from one to another, if everyone is involved responsibly through the whole waste management chain, the crisis will be overcome,” he said, underscoring the important role citizens can play in contributing to environmental protection.

The specialist maintained that trust in state institutions needs to be restored, after years of unfulfilled promises. “If the state engages by taking serious gradual steps, the average citizen will be confident that a real solution to this crisis will come,” Kallel said. “Else, it will persist.”

Kchaou similarly referred to lack of public trust as a critical matter, blaming the country’s successive governments for appointing incompetent people to ministerial posts over the past decade. She contended people will hardly act in respect of environmental protection as long as they see the relevant government structures—local, regional and national—not providing waste treatment.

Long-standing dysfunctional governance and corruption within Tunisia’s state administration underlie the garbage emergency in the Sfax province. More than half of the country’s landfill sites have reached their maximum capacity, threatening the environment and human health.

The state neglect mirrors the lack of national strategy to develop recycling capacity to deal with solid waste in Tunisia. The Ministry of the Environment has opposed the closure of dumps as no alternatives exist. In October, the new environment minister, Leila Chikhaoui, said while visiting the city of Sfax that no immediate solutions were available in the governorate.

Raouia Amira, head of the sanitation, health and environmental committee in the municipality of Sfax, pointed to the country’s solid waste management strategy being discontinued in 2016. “We need a national strategy,” Amira told Toward Freedom. “To that end, the state needs to put in place a communication campaign and spare no expense.”

She thinks incineration is the most realistic approach to treating household waste in the Sfax governorate. Tunisia has long suffered waste management problems, with an estimated 2.5 million tonnes of rubbish produced annually, 63% of which is organic, and most of it buried in landfills without being processed, recycled or incinerated.

Sustainable Solutions

The thorny matter is aggravated by lack of investment in sustainable solutions and endemic corruption within the sector in the North African country.

In a press conference in 2014, lawyer Faouzia Bacha Amdouni presented findings of an independent audit revealing “colossal funds” intended for environmental projects were channeled through the Ministry of Environment and its agencies, ending up in the hands of the government of Prime Minister Zine El Abidine Ben Ali (1987-2011) and its allies. The advocate declared several figures within the agencies were working to conceal their involvement in corruption as well as their plan not to design new strategies. “The department of the environment itself was created in 2005, not to develop policies and innovative projects for waste treatment or sanitation stations, but to receive resources from international donors and invest them in personal projects benefiting the clans in power and their relatives,” she said at the press conference. Some of those international donors reportedly include the European Investment Bank, the Italian Agency for Development Cooperation, the World Bank and the French Development Agency. 

In July 2020, then-Prime Minister Elyes Fakhfakh resigned following allegations of corrupt links to the waste industry. In December 2020, the environment minister was dismissed and arrested along with 23 other officials—including members of the ANGED, or National Waste Management Agency—for being linked to a scandal involving the illegal transfer from Naples, Italy, to the Tunisian port of Sousse of more than 200 shipping containers packed full of decaying household and medical waste disguised as post-industrial plastic waste. The Italian and Tunisian companies embroiled had signed a contract worth €5 million ($5.76 million) to dispose of 120,000 tons of Italian waste in Tunisian landfills.

An investigation published by Inkyfada last March revealed a vast network of corruption involving Italian waste.

The critical environmental situation in Sfax governorate poses a clear social challenge for President Kais Saied, who promised to close the El Gonna landfill during his 2019 presidential campaign. This came in a region that strongly supported his July 25 power seizure, in what his critics have called a coup.

The mobilizations against the re-opening of the toxic dump and the wider trash crisis in Sfax demonstrates Tunisian citizens’ yearning for a clean and sustainable environment. This, as they escalate their calls on the government to stop imposing short-sighted decisions without popular consent and demand it find alternatives to landfill sites.

“The extent of the garbage crisis we’ve experienced in Sfax has been of some use,” the artist Kchaou remarked. “If that didn’t happen, no one would be taking the issue seriously.”

Alessandra Bajec is a freelance journalist specializing in West Asia and North Africa. Between 2010 and 2011, she lived in Palestine. She was based in Cairo from 2013 to 2017, and since 2018 has been based in Tunis.