Cameroon’s bloody war: Inadequate healthcare leaves women and children on the edge

By Ndi Eugene Ndi

A smile adorns Sonita’s face as she watches her two-year-old son play with his peers. Sonita’s mind races back to when, animated by joy, she hoped the experience of bringing forth her first and only son would be easy. But she says that hope didn’t last long as giving birth to him became one of the most exacting moments of her 27 years on earth.

Sonita got pregnant when she lived in Ekona, a town in the restive English-speaking Southwest region of Cameroon.

“First of all, I could not properly follow up antenatal care because of gunshots here and there,” Sonita says.

While she thought the conflict situation would get better, insecurity instead worsened, forcing her and other Ekona residents including Sonita’s lover and author of her pregnancy to run for their lives. After spending months seeking safety in the jungle, Sonita says she had a fierce bout with malaria. And it was not going to be her last fight for her life.

“That is how labour started,” she says. “I came to town with the younger sister of the man who impregnated me. After three days in labour, I had to be operated upon,” she explains.

The surgery, however, did not end Sonita’s sorry story.

“They did a wrong surgery… After three days, pus started coming out of the spot where they incised me and it was smelling. I was taken to the theatre again, but the pus did not stop flowing out. When I was taken to the theatre for the third time, the doctor said my case was above him,” Sonita tells NewsWatch.

Sonita was transferred to the Buea Regional Hospital, some 14km south of Ekona, by the Ayah Foundation, a humanitarian organisation which has been providing lifesaving healthcare to victims of Cameroon’s drawn-out conflict. The socio-political tensions have exposed women and children to health problems, and then denied them the basic right to healthcare.

Ayah Ayah Abine, Founder and President of Ayah Foundation, says when tests were conducted on Sonita at the hospital, it was diagnosed that she was between life and death as her womb had been infected, but medics saved her life.

“By the grace of God, Sonita is one of the most beautiful success stories we have had since we started healthcare assistance to victims of the crisis,” Abine says.

He regrets that not all of the cases his foundation has handled have been successful like Sonita’s.

“We have those cases in hundreds,” Abine says. “There was another lady we took from the bush to the regional hospital. She underwent surgery and everything was just fine. But subsequently, she suddenly died. That is the most painful loss we have had since we started this,” Abine regrets.

After overcoming such an unforgettable experience, Sonita named her son Victory, “because going through what I went through and coming out alive together with the child shows God has given us victory.” Since she left the hospital, Sonita and her son have been living in Souza, a precinct near the country’s economic capital Douala.

“I had no strength to take care of my child following repeated surgeries. His father too ran into the forest for safety. So, my auntie who is in Souza was helping me to take care of the child. I have been living with her since then…I cannot go back to Ekona because everybody is on the run,” Sonita says.

Intractable bloody conflict

The conflict which started in 2016 as peaceful demonstrations by lawyers and teachers in the Anglophone regions over perceived and real marginalisation by the Francophone-dominated government has killed over 3,000 civilians, soldiers and separatist fighters, according to early 2020 estimates by the United Nations.

The escalating violence and increasingly deteriorating security situation arising from the armed conflict, aggravated by restrictions on movement, have prevented many people, especially women and children, from accessing healthcare. It has been hindering this vulnerable set of people from reaching healthcare facilities and disrupting vital supply chains of essential drugs and equipment. Medical staff too have been compelled to flee, forcing health facilities to shut down.

The government and English-speaking separatists who want to create a separate nation made up of the Northwest and Southwest regions have been trading accusations over the burning of several healthcare facilities in the regions. However, rights groups have largely indicted the government for the burnings.

The government blamed the burning of the Kumba District hospital in the Southwest region on February 11, 2019, on armed separatists, but separatists on their part, accused the military of perpetrating the inferno that left four people dead.

Some 255 (34%) out 7,421 health facilities in the Anglophone regions remain non-functional or only partially functional, according to the United Nations Children’s Fund, UNICEF. Immunisation in general and measles prevention have been significantly disrupted as a result of the conflict and the risk of outbreaks increased.

Existing health centres, authorities say, are increasingly under pressure due to the influx of the injured and severe trauma patients. The healthcare facilities are overwhelmed due to inadequate staff – majority of whom have flown to safer regions.

Healthcare access denied

Again, not all emergency cases in the regions can reach the functional health facilities which are mainly in the urban areas. Armed separatists intermittently block roads and have since declared and enforced all Mondays and some national and international days commemorated in the country as “ghost town” days with no movement.

Doctors Without Borders (MSF) noted on its website that a majority of the 2,500 patients it referred by ambulance between June 2018 and March 2019 were women suffering from obstetric complications, “but also include children under 15 and people suffering injuries and wounds inflicted by violence”.

In the restive areas, women, alongside their children, have fled into forests or bushes where they live in extremely poor conditions in makeshift shelters. Others have been forced to relocate to other cities, where they live on the streets, or with host families in sometimes overcrowded and unsanitary settings.

“The women live in the bushes without even hygienic pads,” Abine says, adding that: “They squeeze tree leaves and insert in their genitals during menstruation. The diseases that follow this method are so terrible for them”.

Untold traumatic experience

In addition, many people have faced traumatic experiences like conscription into armed groups, kidnappings for ransom or for use in rebel camps as cooks, exploitation and sexual abuse, gender-based violence, restriction on freedom of movements and family separation. Women have been the most affected.

The violence has exacerbated psycho-social distress, according to Dr Belinga Mireille Ndje Ndje, Clinical Psychologist and Senior Lecturer at the University of Yaounde I.

“It is well known that these scourges compromise the future of children. If they do not benefit from serious psychological care, we may find ourselves later with deviant adults,” Dr Ndje says.

UNICEF says over 5,000 children have been registered as separated or unaccompanied since 2018. As schools and entire villages are being burnt, civil society activists say girls who cannot attend school are prone to early pregnancies, difficult deliveries and the risk of obstetric fistula and need care.

“People who have suffered the atrocities of the crisis, whether physically or psychologically, need to be taken care of. Many will have problems but will not manifest them right away. Even resilient people deserve support,” Dr Ndje adds.

She advised that stakeholders should create psychological listening cells in areas in crisis and even in other regions, “especially those hosting the displaced.”

The Ministry of Women’s Empowerment and the Family (MINPROFF) in Yaounde was yet to respond to whether such centres have been established or are being envisaged.

No end in sight

Protracted violence in the English-speaking regions has uprooted more than half a million people from their homes, while over 70,000 others have fled to neighbouring Nigeria, according to the International Crisis Group and Human Rights Watch.

Peace talks dubbed Major National Dialogue, organised in late 2019 in Yaounde, granted a ‘Special Status’ to the English-speaking regions but there are no indications this move will work in favour of  an end to hostilities. Since then, the bloodshed has continued unabated.

Hopes for peace were again rekindled when government representatives and some frontline leaders of the armed separatists from the Anglophone regions, who are in prison, met in the capital last July. But the pre-talks ended in futility.

Some Cameroonians welcomed the New Year 2021 with wishes that the crisis should end, but a grisly start to 2021 could be signalling the conflict’s bloodiest year yet. Violence has surged in the two English-speaking regions, leading to the killing of at least 25 people, including women and children, in the first ten days of the year.

In one of the incidents on Sunday January 10, the army raided the village of Mautu in Muyuka sub division of the Southwest region, killing at least 10 civilians, amongst them women and children. The army, however, denied involvement in the killings, saying troops were on a preventive raid on the position of terrorist groups who opened fire at the sight of military vehicles.

During the exchange, “some terrorists were neutralised,” military spokesperson, Colonel Cyrille Serge Atonfack Guemo, said in a statement.

The UN, UK, US and Canada amongst others condemned the rise in violence and killings since the beginning of the year. The US embassy in Yaounde said “the innocent lives cut short were robbed of the opportunity to serve their families and communities,” while the British High Commission in Yaounde said there “must be an urgent and impartial investigation, and the perpetrators must be brought to justice”.

Colonel Atonfack said “a scrupulous investigation has been ordered to uncover every detail” of Sunday January 10 killings.

Exposed to hardship, then ignored

Good health, which is a prerequisite for every human to enjoy other rights such as the right to work and dignity, is presented in the constitution of Cameroon as an “inalienable right,” yet experts say the government seems not to be taking concrete measures in that light to the thousands of most vulnerable women and children affected by the crisis.

Ndansi Elvis, an expert in Health Economic Policy and Management, says the government has demonstrated a “high level of neglect” towards the health of the people of the Anglophone regions.

A 2018 government emergency response plan identified healthcare as one of the key priorities for the regions, but the government has not made good on its promises. The plan acknowledges that health needs are high as the displaced population – especially children under five, and pregnant or lactating women – had no access to basic health services.

But Yaounde authorities have been distributing foodstuff, mattresses and blankets to some affected persons with no medical supplies and little or no efforts to ensure health services remain functional and health workers stay safe.

Ndansi, who is an Obama Scholar at the Columbia University in New York, says the government is good at identifying problems and drawing up fancy programmes to resolve them but very poor and unable to implement any of them.

“Why should you give homeless people mattresses?” Ndansi rhetorically questions. He suggests that the first thing will be to provide them with shelter since most of their homes have been burnt down.

“For how long will the food sustain them,” he questions further, saying: “I think the approach government is using is far from being realistic and sustainable”.

The government’s near neglect of the healthcare of citizens affected by the armed conflict in the two English-speaking regions of the country, Ndansi says, is in contrast to goal number three of the seventeen UN-adopted Sustainable Development Goals (SDGs) which the country adheres to and claims to be implementing.

“None of the Sustainable Development Goals can be achieved where there is an armed conflict. The government of Cameroon has failed to resolve the arm conflict in the Anglophone regions for over four years today. That is a clear demonstration that the government does not bother about these sustainable goals such as access to healthcare, zero poverty, education for all, and even environmental protection,” he said.

Some Cameroonians think the responsibility to end the conflict in the two regions — which has further compounded pre-existing vulnerabilities for the mostly agrarian population of the regions — lies in the hands of the sovereign government that has the responsibility to protect citizens, provide healthcare and call for a negotiated settlement.

Should the government continue to neglect the health needs of the population in the two regions, Ndansi says, it could breed fresh unrest like it has been the case recently with haemodialysis patients in Bamenda who protested against the breakdown in machines. The neglect, he says, could also reverse the gains the country has made in terms of immunisation.  Also, a sickly population will undermine Cameroon’s prospects of becoming an upper-middle income economy by 2035.

This publication has been written as part of the CHARM 2020 Media Fellowship and CHARM-Africa’s ongoing work to protect and expand the space for civil society organisations and human rights defenders, as well as nurture and enhance the effectiveness of independent media and journalism in the region.