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Saudi and Iranian competition in the Horn of Africa
Robert Mason

This chapter draws attention to a series of developments which have impacted on the policy of Saudi Arabia and Iran in the Horn of Africa, including: bilateral tensions; the policies of regional and international rivals or adversaries; the logistical requirements of the Yemen conflict; the drop in the international oil price; the economic impact of COVID-19 and sanctions. Employing a case study approach, the chapter identifies the leading dynamics at play in each Horn of Africa state, how these have evolved, and what role non-state actors such as Hezbollah and intergovernmental organisations such as the Intergovernmental Authority on Development and the Red Sea Forum play in obstructing or extending cooperation. The chapter concludes with a note on proximity and the Red Sea serving as a potential fulcrum for an interregional security complex.

in The Gulf States and the Horn of Africa
Qatar–Gulf crisis and the Horn of Africa
Abdinor Dahir

In June 2017 Saudi Arabia, the United Arab Emirates, Bahrain, and Egypt broke diplomatic ties with Qatar and imposed a blockade. Following the crisis, a fierce competition to win allies has ensued among many parties across the world, including in the Horn of Africa. While Djibouti and Eritrea supported the blockading countries, Sudan and Somalia adopted a neutral position, with Ethiopia and Kenya expressing concern. This chapter examines how the Qatar–Gulf crisis has put the Horn, especially Somalia, in a precarious situation. First, it provides a brief overview of Qatar’s diplomatic activism in the Horn, with particular reference to Somalia, Sudan, Eritrea, and Djibouti. Second, it provides insights into the competition for influence in Somalia during the Qatar–Gulf spat. In this part, the chapter also outlines Somalia’s neutral stance and its repercussions. Third, it explores the implications of the Gulf spat on overall regional security and stability. It concludes with how the stand-off could scale back the strategic interests of the Arab Gulf states in the Horn, such as the security of the Bab el-Mandeb, anti-piracy, and counterterrorism operations, the counter-Iran/Houthi efforts, as well as food security. The study aims to contribute fresh ideas to the current discussions on foreign engagements in the Horn in general and Gulf states in particular.

in The Gulf States and the Horn of Africa
Mohammed Sharfi

The chapter examines the Sudanese government’s predicament from the ongoing GCC squabble. It discusses the underlying political and economic forces that shape relations between Sudan and major countries in the Quartet and Qatar. It explores issues of divergence in the GCC ongoing diplomatic dispute and the significance of Qatari support for president Al-Beshir Islamist regime. In this context; the paper looks into the bleak outlook of the Sudanese economy following the separation of Southern Sudan in 2011. It debates the internal and external factors that feed into the National Salvation Revolution (NSR); and the post NSR transitional government foreign policies towards the Gulf crisis. The chapter contends Sudanese foreign policy is profoundly influenced by challenging internal and external factors related to the Gulf dispute. Neutrality in regional issues is a traditional stance in Sudan foreign policy in the past; which is an ideal direction taking into accounts its geopolitical context. The current GCC crisis sheds light on the internal political crisis; the absence of consensus in policy making; and the ability of external actors to influence change exploiting political and economic weakness. The paper discusses the intriguing personal relations between policymakers in the Gulf and Sudan which also play a central role in the Sudanese military involvement in Yemen Conflict.

in The Gulf States and the Horn of Africa
Through the Gulf and into the Horn of Africa
Marwa Maziad

Following the Arab uprisings, the Turkey–Qatar alliance pursued Islamist foreign policy into the Horn of Africa in order to challenge the strategic interests of other regional rivals, namely Egypt with its own African roots and strategic depth into the Nile Valley; Israel with its investments and presence in Ethiopia; the United Arab Emirates with its economic and military training projects in Eritrea; and both Saudi Arabia and Iran with their rivaling attempts to pierce into the same East African region. In fact, Turkey and Qatar made their presence known in the Horn region, triggering, in turn, responses from all the other regional powers. Eventually, however, regime change in Sudan from Islamist to more pro-Egypt/UAE, and Sudan’s normalization deal with Israel, translated into a major set-back for the Turkey–Qatar pan-Islamist doctrine in the Horn. Three-and-a-half years after the Arab Quartet (Egypt, UAE, Saudi Arabia and Bahrain) boycott of Qatar – primarily due to its pan-Islamist expansionist alliance with Turkey – both Turkey and Qatar cut their losses, recalibrated, withdrew much of their visible support for Islamists, and sought normalization with their rivals. This chapter traces developments that marked the rise and fall of the Turkey–Qatar alliance’s pan-Islamism into the Horn and elsewhere.

in The Gulf States and the Horn of Africa
Lessons Learned from an Intervention by Médecins Sans Frontières
Maria Ximena Di Lollo, Elena Estrada Cocina, Francisco De Bartolome Gisbert, Raquel González Juarez, and Ana Garcia Mingo

When the COVID-19 pandemic struck in early 2020, it rapidly became apparent that older individuals were at greater risk of serious illness and death. The risk was even greater for residents in care homes, who live in close proximity and may be suffering other comorbidities. Such facilities also saw a high turnover of staff and visitors, meaning an increased risk of transmission. Data has suggested that care home residents may account for up to a half of all COVID-related deaths in Spain.

As morbidity and mortality for COVID-19 was increasing in March 2020, MSF offered support to Spanish care homes during the first wave of infections. Our intervention included different axes: advocacy, knowledge sharing, training and implementation of measures for a reduction in transmission and for infection prevention and control (IPC).

The situation for care home residents was dire, with many people dying alone, away from loved ones and without access to palliative care. Staff were overwhelmed and ill-equipped to deal with the scale and complexity of this tragedy.

Although technical interventions to reduce transmission were crucial, it became clear that other people-centred activities that supported residents, their families and staff, were of equal importance, including facilitating contact between families, providing emotional support and offering adequate pain management and palliative care.

Residents in care homes have the same rights as everyone else. In the event of future crises, the most vulnerable should not be neglected.

Journal of Humanitarian Affairs
A Realistic Ambition?
Pierre Mendiharat, Elba Rahmouni, and Léon Salumu

Despite a concerted international effort in recent decades that has yielded significant progress in the fight against HIV/AIDS, the disease continues to kill large numbers of people. Although there is still no definitive cure or vaccine, UNAIDS has set an ambitious goal of ending the epidemic by 2030, specifically via its 90-90-90 (‘treatment cascade’) strategy – namely that 90 per cent of those with HIV will know their status, 90 per cent of those who know their status will be on antiretroviral therapy and 90 per cent of those on antiretroviral therapy will have an undetectable viral load. These bold assumptions were put to the test in a five-year pilot project launched in June 2014 by MSF and Kenya’s Ministry of Health in Ndhiwa district, where an initial NHIPS 1 study by Epicentre (MSF’s epidemiology centre) in 2012 revealed some of the world’s highest HIV incidence and prevalence, and a poor treatment cascade. Six years later, a new Epicentre study, NHIPS 2, showed that the 90-90-90 target had been more than met. What explains this ‘success’? And given the still-high incidence, is it truly a success? MSF Deputy Director of Operations Pierre Mendiharat and physician Léon Salumu, Head of MSF France Kenya programmes, discuss the political, scientific and operational challenges of the Ndhiwa project in an interview conducted by Elba Rahmouni.

Journal of Humanitarian Affairs
Open Access (free)
The Politics of Infectious Disease
Duncan McLean and Michaël Neuman
Journal of Humanitarian Affairs
Open Access (free)
Lachlan McIver, Maria Guevara, and Gabriel Alcoba

The COVID-19 pandemic has exposed multiple fault lines in the performances of health services at every level – from community to national to global – in ensuring universal, equitable access to preventive and curative care. Tragically, this has been to the detriment of those who have suffered and died not only from COVID-19, but also from the myriad other ailments affecting people around the world. Of those, we wish to highlight here some key categories of diseases that have caused a greater burden of illness and deaths as a consequence of the policies and political decisions made in relation to the COVID-19 pandemic. In our view, these should be considered epidemics or, more accurately, syndemics – the clustering and interactions of two or more diseases or health conditions and socio-environmental factors – of neglect.

Journal of Humanitarian Affairs
Positioning, Politics and Pertinence
Natalie Roberts

This article explores the actions of Médecins Sans Frontières during the 2018–20 Ebola outbreak in Nord Kivu, in the Democratic Republic of Congo. Based on the experiences of practitioners involved in the response, including the author, and on the public positioning of MSF during the first year of the epidemic, it argues that although the actions of response actors were usually well intentioned, they could rarely be described as lifesaving, may have exacerbated disease transmission as much as limited it and had the perverse effect of fuelling corruption and violence. The article documents and analyses contradictions in MSF’s moral and technical positioning, and the complicated relationship between the organisation and the international and Congolese institutions leading the response. It argues that the medical and social failure of the response was the result of an initial belief in a strategy designed at a time when the only realistically attainable outcome was to relieve suffering, and of the later inability of the organisation to convince the authorities in charge of the response to adjust their approach. It suggests that for future success new protocols must be elaborated and agreed based on a better social and political comprehension and a better understanding of the tools now available.

Journal of Humanitarian Affairs
How Can Humanitarian Analysis, Early Warning and Response Be Improved?
Aditya Sarkar, Benjamin J. Spatz, Alex de Waal, Christopher Newton, and Daniel Maxwell

In 2017, the UN raised the alarm on famines in North-east Nigeria, Somalia, South Sudan and Yemen. Starvation has been used as a weapon of war in Syria, and the Democratic Republic of the Congo currently has among the largest numbers of severely food-insecure people of any country assessed by the Integrated Food Security Phase Classification (IPC) system. Each of these sites of mass starvation or famine can be understood as a ‘political marketplace’. They are characterised by the dominance of transactional politics over public institutions, and elite politics is conducted for factional or personal political advantage, on the basis of monetised patronage. This paper examines the relationship between these systems of transactional politics and famine and other forms of mass starvation, and outlines the implications of the political marketplace framework for humanitarian action. It argues that both transactional politics and mass starvation emerge from particular political-economic configurations characterised by economic precarity and mismanagement, violent forms of peripheral governance and war economies. Applying the political marketplace framework can help improve humanitarian information and early warning systems, as well as programme decision-making, while helping humanitarians think more carefully about the constant trade-offs they are forced to make.

Journal of Humanitarian Affairs