Author: IRIN

Economic freedom for refugees: The Ugandan model

Refugees from South Sudan wait to board trucks to the Nyumanzi Resettlement Camp in Uganda on January 26 2014. (Pic: AFP)
Refugees from South Sudan wait to board trucks to the Nyumanzi Resettlement Camp in Uganda on January 26 2014. (Pic: AFP)

When a team from Oxford University’s Humanitarian Innovation Project set out to explore what work refugees and asylum seekers in Uganda had managed to find, they were struck by the breadth and scale of businesses they were engaged in – from being café owners to vegetable sellers, to farmers growing maize on a commercial scale, millers, restaurateurs, transporters and traders in fabrics and jewellery.

With the number of the world’s displaced having now passed the 50-million mark and rising, debates are intensifying over how this many people can be supported. Alexander Betts and his team wanted to see whether it was realistic, and politically acceptable, to encourage refugees to be more self-sufficient.

Uganda has a relatively liberal policy towards its 387 000 refugees and asylum-seekers, most of whom have fled conflict in the Democratic Republic of Congo (DRC) and South Sudan. Uganda does not have refugee camps as such, but most live in designated refugee settlements where there are allocated plots of land to farm. They can, however, get permission to live outside these settlements if they think they can support themselves, and Kampala in particular has a sizeable refugee population.

Betts told Irin: “Uganda is a relatively positive case in that it allows the right to work and a significant degree of freedom of movement. That isn’t to say that it’s perfect, but it’s definitely towards the positive end of the spectrum. The reason we chose it is that it shows what’s possible when refugees are given basic economic freedoms.”

His team spoke to more than 1 500 households in Kampala and in two rural settlements – Nakivale in the south, and Kyangwali on the DRC border. The families were registered with the UN Refugee Agency (UNHCR) as refugees, but that did not mean that they all received humanitarian assistance. In Kampala 78% of refugee households receive no assistance at all from UNHCR or any other agency. Even in the refugee settlements, 17% of households receive no assistance, and even where families do get help they are unlikely to be fully dependent on aid, since UNHCR gives food rations for a maximum of five years, unless the refugees are designated as vulnerable.

So what do they do instead? They farm, certainly, in and around the rural settlements. Around half the Congolese, Rwandan and South Sudanese refugees the researchers talked to there had plots of their own, and others worked as farm labourers. Only the Somalis showed little or no interest in farming.

Not just subsistence farming
Ugandan crop buyers come regularly to the settlements, and take truckloads of produce from Kyangwali to the market town of Hoima. The researchers spoke to a trader in Hoima who said he bought around 500 tonnes of maize and beans from the refugee farmers last year, some 60% of his stock. He sold the maize on to other parts of Uganda, but also further afield, to Tanzania and South Sudan.

Now the farmers in Kyangwali are trying to cut out the middlemen and take their crops directly to market, through a co-operative with more than 500 members, including some Ugandan farmers from local villages. Kyangwali Progressive Farmers is registered as a limited company, and has started getting contracts to supply produce directly to manufacturers.

Kagoma weekly market in the Kyangwali refugee settlement in Uganda. (Pic: IRIN/RSC)
Kagoma weekly market in the Kyangwali refugee settlement in Uganda. (Pic: IRIN/RSC)
The research uncovered another substantial trading network with refugees at its centre – in this case Congolese refugees who were doing business in jewellery and printed cloth, known as bitenge. They buy from Ugandan wholesalers in Kampala, and sell, not just in the refugee settlements but also to Ugandan customers in nearby towns. Some also engage in cross-border trade, taking their wares into Kenya and South Sudan.

The picture which emerges is of a very “connected” economy, with refugees using their networks of contacts among fellow refugees and in their countries of origin to do business. But they also trade with their Ugandan neighbours, work in Ugandan enterprises and – when they prosper – create employment both for their countrymen and members of the host community.

A lesson for other countries?
The picture is a generally positive one, but not every country chooses to allow its refugees such economic freedom. Governments worry that if they are making a good living where they are, they will never go home, although Betts points out that when the time does come to leave, it is a lot easier to repatriate someone who has been busy and active and developed their skills, than someone who has spent years surviving on food rations in a refugee camp.

Successful refugees can also generate resentment in local populations. Uganda has remained generally tolerant, unlike neighbouring Kenya, where there has been a backlash against Somali refugees following a series of al-Shabab attacks. Uganda has also suffered terrorist attacks, but says Betts, “for some reason, unlike Kenya, they haven’t been connected to refugees in the same way, perhaps because in Kenya politicians have started to use the refugee issue for political gain”.

So the situation in Uganda does very much depend on its local context. Even so, Betts and his team are convinced that their study has implications for refugee policy elsewhere, particularly for the new crisis in the Middle East. “The traditional response is to create camps,” he told Irin, “but we can’t afford to do this in places like Lebanon. The cost – the human cost in terms of the waste of potential, and the possibility of developing resentment and frustration – is just too high.

“We have to realise what refugees can contribute, and not just warehouse them in camps. We should start by recognising that long-term encampment is not an option, and that when they are allowed, human beings can do a lot for themselves.”

Solar lighting revolution underway in Sierra Leone

In the face of inadequate provision of power by the Sierra Leonean government, companies are stepping in to provide solar electricity systems that ordinary Sierra Leoneans can afford.

Since the 1980s Sierra Leone has been unable to reliably provide electricity to its citizens. Its capital Freetown, once dubbed “the world’s darkest city”, experiences daily power cuts. Outside the major cities the situation is far worse, with just one in 10 Sierra Leoneans having access to the national grid. That figure drops to 3%  in rural areas, according to government and World Bank figures.

For now in much of the country it is only the privileged few who can afford to run costly and breakdown-prone diesel generators. Instead, for light, most people rely on kerosene lamps, candles or cheaply made battery powered plastic lights shipped in from China.

But in recent years the country has embarked on something of a solar revolution – at least for lighting and mobile phone charging. Main roads in the larger towns are now lit by solar streetlights. A Laos-based firm, Sunlabob Renewable Energy, is building 13 off-grid solar plants to supply lighting to universities and other community facilities.

Up to 60 health centres now get their lighting and power some electrical equipment thanks to “solar suitcases” installed by We Care Solar, who aim to reduce maternal mortality – Sierra Leone has the world’s highest maternal mortality ratio – by lighting hospitals and clinics. Meanwhile, in February Mulk Energy won a contract to construct a 6MW solar park in Freetown, which is set to be West Africa’s largest. It aims to provide electricity to hospitals, schools, and to 3 000 households by the end of 2014.

Solar energy still supplies a small fraction of Sierra Leone’s energy needs but the Advanced Science and Innovation Company, involved in setting up the solar park, hopes that in two years time one quarter of the country’s electricity can be supplied through renewable sources.

Indigo pay-as-you-go system
But one particular project has found a way to make solar energy affordable to individual households using a pay-as-you go system. Azuri Technologies (who have partnered with rap musician Akon’s ‘Akon lighting Africa’ project) describes the product, Indigo, as “solar-as-a-service” and says it can cut energy bills by as much as 50%. To avoid the prohibitively high costs of buying the system outright, Indigo customers use scratchcards to buy it over time. They pay an initial US$12 to have the unit installed, and then 10 000 leones ($2.30) weekly for 18 months.

All those spoken to by IRIN said the Indigo lights were saving them a significant amount of money.

“Yes, we have been saving a lot,” said Aminatta, whose shop selling fabrics, a few rough cut diamonds and cigarettes remains open long after dark.

Aminatta uses an Indigo pay-as-you-go solar powered light to run her shop in Tombo village. (Pic: Tommy Trenchard/IRIN)
Aminatta uses an Indigo pay-as-you-go solar powered light to run her shop in Tombo village. (Pic: Tommy Trenchard/IRIN)

She was the first of 300 people in the fishing village of Tombo in western Sierra Leone to invest in the device. In five months her weekly payments will cease and her shop will be lit for free.

Mr Benga, also from Tombo, bought two. “Now my children can study here at night,” he told IRIN, pointing to a covered courtyard with a large Indigo LED light dangling against one wall. “I even gave one to my daughter to use in the dormitory at school.”

Alarm as Uganda moves to criminalise deliberate HIV transmission

Activists in Uganda, where HIV prevalence is on the rise, have warned that new legislation criminalising deliberate transmission of the virus will further undermine efforts to stem the Aids epidemic and erode the rights of those living with HIV.

As well as setting out fines and jail terms of up to 10 years for those found guilty of “willful and intentional” transmission, the HIV/AIDS Prevention and Control Bill, passed by Parliament on May 8 and now awaiting presidential assent, also obliges pregnant women and their partners to take HIV tests, and in some circumstances empowers health workers to unilaterally disclose a patient’s positive status to an at-risk partner or household member. It also obliges parents to tell their children of their status.

“Despite years of engagement and labouring to explain the dangers on an HIV-specific criminal law, Parliament has refused to be advised. When experts on HIV research and management attempted to speak, [lawmakers] still failed to heed to the key concerns,” Dorah Kinconco Musinguzi, executive director of Uganda Network on Law, Ethics and HIV/AIDS (UgaNet), told IRIN.

“If we have not managed to test 67% of Ugandans for HIV without a law that punishes transmission, will this number improve when citizens know that more legal burdens are added to testing? The answer is no. Will their behaviour improve because of this fear? No. Will we have helped the HIV situation then? No. We shall have more people transmit HIV in ignorance of their status. Laws do little to change behaviour, instead it takes behaviour underground,” she said.

Over the past five years HIV prevalence in Uganda has risen from 6.4% to 7.3%.

“The evidence from the Ugandan Ministry of Health shows clearly – criminalisation of HIV doesn’t work. It drives people away from services and fuels discrimination and fear,” Asia Russell of the HIV advocacy organisation Health GAP, told IRIN.

(Pic: Mujahid Safodien / IRIN)
(Pic: Mujahid Safodien / IRIN)

Alex Ario, the national co-ordinator of the ministry’s AIDS Control Programme (ACP), said “the Bill may not be that useful in my view. It does not add value to the current efforts. Actually, with dwindling support from donor communities to ACP as it is now, we would rather divert efforts to lobby government of Uganda to put more money for HIV activities rather than legislating against people with HIV.”

“We need to redirect legislative reform, and law enforcement, towards addressing sexual and other forms of violence against women, and discrimination and other human rights violations against people living with HIV and people most at risk of exposure to HIV,” he said.

Russell added that in conjunction with the Anti-Homosexuality Act, which passed into law in February 2014, this new law could lead “a sex worker apprehended for sex work, who is transgender and HIV positive, [to] be sent to prison for life.”

UgaNet’s Musinguzi said: “This [Bill] will hurt the women we have been encouraging to come up to take an HIV test such that they can have HIV-free children. But in this case, they will be forced to disclose their results and should they fear, and not do it in time, that means that they are potential candidates for [prosecution under] the Bill…

“There is high likelihood that justice will not prevail for the HIV-positive [people] found in this situation because of the high levels of stigma and condemnation that we have seen the HIV-positive go through,” she added.

More than 150 000 people are becoming HIV-positive every year; 1.5-million Ugandans are HIV-positive, according to Uganda Aids Commission statistics.

The Bill also flies in the face of the “rights-based” approach to HIV embodied in the regional HIV/AIDS Act passed in April 2012 by the East African Legislative Assembly.

Those in favour… 
Meanwhile, some MPs have been defending the Bill.

“Every piece of legislation is to prevent mischief. The Bill is both [a] legal and moral thing. We want to reduce down HIV deliberate infections,” Medard Lubega Ssegona, opposition shadow minister for justice and constitutional affairs, told IRIN.

“The Bill will encourage more people to go and test for their good. It will compel two consenting adults to test before they engage to each other because of the sanctions of false disclosure,” he said, adding: “The deliberate infections have caused a lot of burden [on] our economy. The government spends a lot of money on treating and taking care of people who have [been] deliberately infected by people with bad hearts. This is going to stop.”

Olivia Kwagala Kabaale, a legislator from the ruling National Resistance Movement party, said: “The mandatory disclosure will help to protect those who take care of the HIV sick people. Some of these people don’t want to disclosure their status yet they pose a risk of transmission of the virus to others.”

Laws in Burundi, Kenya and Tanzania also criminalise deliberate HIV transmission, leaving Rwanda the only member of the East African Community not to do so.

The new Bill also establishes the legal framework for an HIV Trust Fund to finance local-level programmes using money generated by levies on bank transactions and savings interest, air tickets, beer, soft drinks and cigarettes, as well taxes on goods and services traded within Uganda.

“The Bill is creating [an] HIV trust fund which is going to help the government raise local funds to support the HIV programme. It’s a right time for us now as a country to mobilize our own resources to fight the epidemic. We have been depending on donor support for our HIV fight,” said Kabaale.

Growing up in war – the DRC’s child soldiers

When he was seven Dikembe Muamba* became a soldier on the orders of his uncle, a chief in the Democratic Republic of Congo’s (DRC) North Kivu Province.

“I stole my first gun, when I was 10. It was a flintlock. By the time I became a captain at 14, I had many guns. I led 50 people, both children and adults. There were about 30 children in the unit. The youngest was 10,” Muamba, now 17, told IRIN.

When IRIN met him at one of the “half-way houses” for former child soldiers in the town of Kiwanja in Rutshuru Territory, Muamba was enjoying his first month of “comfort” in a basic brick and mortar house after a decade of bush living.

“I am still angry with my uncle. Those 10 years feel like a waste of a life,” he said. “It was very difficult. There was no school. I had only completed two years of schooling [before being forced into child soldiering].”

The “half-way house” – which provides counselling, parental tracing services and tutoring in preparation for a return to school – is run by mother-of-nine Afiya Rehema*. Her own children are aged 7-19 and in the past nine years she has cared for more than 50 former child soldiers.

This boy was 11-years-old when he became a child soldier with an armed group. (Pic: IRIN / Guy Oliver)
This boy was 11-years-old when he became a child soldier with an armed group.   (Pic: IRIN / Guy Oliver)

“At the moment there are children from Mai-Mai Nyatura, FDLR [Democratic Forces for the Liberation of Rwanda] and Pareco [Alliance of Resistant Congolese Patriots] staying here. When they arrive some can be disrespectful, but they soon become like other children. There has never been any violence towards me,” she said. “Only one ever stole, and then left.”

“I do get some financial support [from local NGO Union pour la paix et la promotion des droits de l’enfant au Congo (Updeco)]. But I do this as a parent. Maybe one of my kids will be taken by an army. And if that happens I hope another parent will be there to look after my child [if he/she escapes from an armed group].”

Muamba spent his first few years as his uncle’s bodyguard before being enlisted into Pareco, which emerged in 2007 from a variety of diverse North Kivu communities, including Hunde, Hutu, Nande, Nyanga, and Tembo.

With a barely discernable pencil moustache indicating the onset of adulthood, he knows exactly how many battles he has fought and replies without hesitation: “It was 45, but I don’t know how many people I killed… The youngest was a girl about six. She was shooting at me.”

Muamba was wounded twice during his decade as a child soldier.

“The first battle I fought in was against the FDLR [an anti-Rwandan armed group that had an informal alliance with Pareco]. I fought against ADF-Nalu [Allied Democratic Forces – an Islamist armed group opposed to the neighbouring Ugandan government] in Beni, and M23 [23 March Movement, an alleged Rwandan proxy armed group].”

In the end, it was his rank and a chance meeting with members of a local child activist NGO that allowed him to walk away from soldiering.

“As a captain, I was free to go where ever I wanted. By chance in Lubero, I met people from Updeco. They told me they could give me demobilisation papers and then I could leave Pareco forever,” he said.

A girl sergeant’s testimony
Eshe Makemba* (17) rose to the rank of sergeant in the FDLR, but enjoyed no such freedom of movement. Being “discriminated” against for being a Congolese national by the FDLR’s Rwandan officers prompted her desertion, she says. “I could not speak out as they told me Congolese were no good.”

After seven years as a soldier for the armed group she ran for two days through the forest evading a search party, which she says would have executed her had she been caught.

She was 10 when she and four other girls were kidnapped near Kisharo, in Rutshuru Territory, by the FDLR. She was the youngest of the captives and the only one to survive a river crossing shortly after her abduction. She then did three months of military training.

“I stole and killed people for nothing… killing people was my way of saving my life,” she told IRIN. She was involved in operations against Ntabo Ntaberi Sheka’s Ndumba Defence of Congo (NDC) and M23. At other times she was raiding farms and homesteads.

Four months after her escape and dressed in her only set of clothes, the former child soldier said she did not think about her time with the FDLR, but acknowledged that the gun she carried gave her access to “material [plundered goods]”.

“I felt OK after the battle. I enjoyed the battle because I knew that afterwards there would be clothes, money and food,” Makemba said.

“One day I was with a group [of FDLR soldiers] that raped a woman. But I did nothing. I did not fear being raped as I had a gun and I could defend myself. But I could not do anything to stop the rape [of the woman],”she said.

Call for effective prosecutions
An October 2013 report by the UN Stabilisation Mission in the DRC (Monusco) entitled Child Recruitment by Armed Groups in DRC From January 2012 to August 2013, said in the past five years about 10 000 children had been separated from armed groups, but in the period under review nearly a 1 000 more were recruited and the use of children by more than 25 armed groups remained “systemic”.

Three armed groups, the FDLR, Nyatura and M23 accounted for about half of the child recruitment in the review period.

The International Criminal Court’s 2012 conviction of Union des Patriotes Congolais (UPC) militia leader Thomas Lubanga for conscripting child soldiers in northeastern DRC’s Ituri region between 2002 and 2003 “is important, because it sends a strong signal that those who recruit and use children will be held accountable,” Richard Clarke, director of London-based NGO Child Soldiers International, told IRIN.

“But it needs to be complemented with effective investigations and prosecutions at the national level in order to address impunity for these crimes,” he said.

Clarke said other strategies to prevent the practice included “clear military orders” prohibiting recruitment of children; “strengthening recruitment procedures through the development of age verification methods; training members of the armed forces on child rights and child protection principles; establishing child protection structures inside the military [and] allowing child protection agencies to visit military sites to verify that no children have been unlawfully enlisted.”

Patrice Munga*, a civil society activist based in Tongo, in Rutshuru Territory, told IRIN the FDLR recently began recruiting “really young [under 15] children”.

He said the FDLR were not forcing the children into its ranks, but conducting “sensitisation” at schools in the village “telling them the FDLR is good”, and about 20 volunteered for the armed group between November and December 2013.

He said the boys returned after a few weeks to Tongo with AK-47 assault rifles. He saw one of the child soldiers “showing other children [in the village] how to use his gun and an FARDC soldier walked by them and said ‘So you are a soldier too.'”

Zeka Kabongo* (13) has the body size of a seven-year-old. During the interview he constantly brushes the wooden arm of a chair, his legs curled beneath him.

Abducted with three other boys at noon in Lubero by four gunmen he spent two years as a bodyguard to Kise, the secretary to General Kakule Sikula Lafontaine’s Union des Patriotes Congolais pour la Paix (UPCP).

Kabongo said Lafontaine “told us we were fighting for our part of the country, which the government was refusing to give us”.

He says he “only killed one person” during his time with the armed group and that was during a raid on a homestead by five of the UPCP’s children in search of food.

“We entered the home and asked the wife where her husband was. But the wife would not say. So we got together and decided to kill her [with knives]. When we got back to the group we told Lafontaine what we had done. He told us we ‘had done a good thing’.”

*Not their real names

Senegal on the frontline of the battle with Big Tobacco

Djité Sekou (32) smokes as he passes his nights guarding one of the many high-rise apartment buildings in Dakar, Senegal. It has been eight years since his first cigarette – a Monte Carlo from Morocco – and when money is available he goes through 20 to 30 per day. It is an addiction that can cost him up to a quarter of his monthly income.

Like most smokers in Senegal, he rarely buys a full packet, preferring to purchase cigarettes individually – a sales strategy tobacco companies employ to ensure that even those with limited means are able to afford their daily nicotine.

“If my pocket is heavy, I buy the full packet,” explained Sekou. “If my pocket is empty, I buy four Excellence [cigarettes] at 100 [CFA] francs [US$0.20].”

Sekou is one of a growing number of smokers across Africa. While reliable, up-to-date figures are unavailable, the 2007 Global Youth Tobacco Survey estimated that up to 20% of Senegalese boys and 10% of girls aged 13 to 15 used tobacco products – a number believed to be much higher today.

Oumar Ndao, Senegal’s focal point for tobacco control at the Ministry of Health, says, “This is due to extremely weak legislation that, apart from prohibiting television advertising, demands no restrictions.”

Tih Ntiabang, Africa co-ordinator of the civil society Framework Convention Alliance, based in Yaounde, Cameroon, says advertising focuses “on two groups of people – the youth and women. For the youth, they portray smoking as cool. For women, if you smoke you are emancipated.”

In Senegal, there are almost no restrictions on smoking in public places, and warning labels on packets are small.

The exception is the holy city of Touba, where smoking has been banned for religious reasons since 1980 (15 years before the US State of California enacted its ban on smoking in enclosed workplaces).

Yet with Senegal’s Parliament due to vote on new anti-smoking legislation, the rest of the country may soon follow suit.

If passed, the law would ban all tobacco advertising, restrict smoking in public places, and demand health warnings that cover 30 percent of all cigarette packaging.

Ndao believes that, even if the law could be strengthened further, this would be a “major step forward” and “endow Senegal with one of the strongest [such] laws in the region.”

(Pic: Flickr/Gaffri)
(Pic: Flickr/Gaffri)

Weak tobacco control continent-wide
With the largest proportion of young non-smokers and the weakest tobacco controls of any other continent, according to the World Health Organisation (WHO), Africa is a lucrative market for cigarette marketers.

Just five African countries have comprehensively banned smoking in public places, according to WHO, while nine – Chad, Eritrea, Ghana, Guinea, Kenya, Madagascar, Mauritius, Niger and Togo – ban all tobacco advertising. Only four African countries – Madagascar, Mauritius, Niger and the Seychelles – meet WHO recommendations for health warnings on packaging.

“In a number of places, there is no legislation at all,” said Ntiabang. “What is really driving this is the tobacco industry strategy to recruit new smokers.”

Yet even where laws do exist, enforcement is a major problem. Senegal’s Ministry of Health has banned smoking in all health centres, but according to the government’s own report to WHO, this has had “no practical impact in reality”.

WHO estimates that, globally, tobacco kills six million people per year, a figure that, without action, could rise to eight million by 2030, with 80% of deaths occurring in low- and middle-income countries.

Taking on the tobacco industry
Many health advocates believe the tide is turning, however, with Kenya, Mauritius, Seychelles and South Africa all having introduced tighter tobacco control laws in recent years. Ntiabang believes these are symptoms of “a changing trend” – but one under threat by the tobacco industry.

The 2013 WHO global report on tobacco use accuses the industry of trying to influence public health policy, exaggerating its economic importance, manipulating public opinion, fabricating support from “front groups”, undermining proven science and intimidating governments with litigation.

“Tobacco industry interference is the number one problem we have in Africa, especially in countries that are in the process of elaborating legislation,” Ntiabang adds. “The tobacco industry interferes in every single stage of this process.”

A WHO official IRIN interviewed agreed: “Every single country in Africa where there is proposed legislation, you find them there.”

According to Article 5.3 of the WHO’s Framework Convention on Tobacco Control, tobacco companies are not supposed to be involved in shaping health policy. But the official said many countries have been swayed by “information given by the industry claiming that they are critical to the economy, and yet the reality is they are just profiteers and are not contributing that much to the economy”.

Senegal has been no exception, says Ndao: “The industry managed to infiltrate the process with strong lobbying of decision-makers.”

In Senegal, industry officials lobbied to soften the total ban on advertising to allow communications at the point of sale, but the government has not ceded. They also pressed to ensure health warnings need not be in picture form, said Ndao, which has been more successful. But the [Senegalese] authorities are trying to resist industry pressure and are “aligned strongly with the WHO Convention” he told IRIN.

A spokesperson for Philip Morris, which controls over 40% of the tobacco market in Senegal and owns a cigarette factory in Dakar, confirmed that the company has “”proactively and transparently” been communicating its opinions to government, “like any other industry”.

While the company “welcomes the proposal for the implementation of a tobacco-control law in Senegal”, it continues to seek amendments to “a few elements” including “the lack of a transition period, the ban on trade incentives for wholesalers and retailers, and the total ban on advertising”.

To Ndao, the incentive is clear: “The industry is losing major markets in Europe and North America, and is seeking refuge in Africa, which explains their strong presence in Senegal.”

Health impact
Ahmadou Dem, surgical oncologist at Joliot Curie Cancer Institute at the Dantec hospital in Dakar, is already seeing the consequences of smoking. He has noted an increase in cancers of the lung, larynx, pharynx, bladder and pancreas.

If nothing is done, the future could be more worrying still, he said. “It will be a catastrophe for our country’s health and economy, because our human and financial resources are limited and cancer care is costly.”

Dem adds that while facilities to treat cancer do exist – offering surgery, radiation therapy and chemo therapy – they remain “largely inaccessible for the majority of patients, who are poor”.

Any efforts to reduce smoking rates in Senegal must include an “ongoing anti-smoking campaign at schools, in businesses, and in the media,” he told IRIN.

Weakening the law
Ndao recognises that, despite the huge public health improvements the law will bring, there is a lot more work to do.

Unless amended by members of the National Assembly, smoking areas will still be permitted in restaurants, bars and hotels, and pictures warnings – considered essential in a country where half of the adult population is illiterate – will be voluntary. Ndao believes parliamentarians will strengthen these areas of the law before it passes.

And the law will not undertake what is commonly regarded as the most effective way of reducing smoking – raising the price of cigarettes. Such a measure has to be dealt with separately through the tax system.

At just $0.80 a packet for an economy brand, and $1.20 for a premium brand, cigarette prices in Senegal are almost 10 times cheaper than in the UK and among the cheapest in the world.

Senegal has chosen not to follow the Economic Community Of West African States guidelines allowing countries to tax cigarettes up to 150% , instead abiding by the West Africa Economic and Monetary Union rules limiting taxes to just 45%.

According to WHO, a 10% price increase for tobacco products reduces consumption by 8% in low- and middle-income countries.

Two years ago, Phillip Morris created a national scandal in Senegal by reducing the price of its Marlboros by one-third. Black market cigarettes from neighbouring countries such as Gambia and Guinea-Bissau also push prices down.

Sekou believes that both a stronger law and higher taxes are “necessary”, especially for smokers like himself. “Senegal has the right to do it. Everyone wants to quit. The more they smoke, the less they eat,” he said.

“For me, someone who struggles to get 1 000 CFA [$2.00] per day, if the price went up – and my wife is next to me, my son is next to me – I wouldn’t do it,” he continued. “Even today paying $1.20 [for a packet] is a problem.

“As of today, I have decided to quit. I got myself into it, and I’ll get myself out of it too.”