Carter Center leaders from Sudan, Ethiopia, and Niger discuss how armed conflict affects their ability to deliver health interventions. They came together in Atlanta this spring for a series of meetings about their health programs.
In Niger, Carter Center staff are training government workers who are allowed to enter conflict areas to provide health interventions, such as eye surgery for people with advanced trachoma.
After war broke out in Sudan in April 2023, medications used by the Center to prevent or treat diseases were looted.
Helping countries control or eliminate diseases is no easy feat — helping them do so when they’re in the midst of armed conflict is exponentially more challenging.
And yet that’s the reality on the ground in many places where Carter Center health programs operate, including Sudan, Ethiopia, Mali, Nigeria, Niger, and Chad.
When health experts and country office staff met in Atlanta in April for their annual review of each health program’s progress, we sat down with the heads of three country offices to talk about the challenges of implementing health projects in times of conflict. Here are excerpts from that conversation.
Boukari Gambo, Country Representative, Niger
Gambo: We work in three areas, and one of those areas is on the border with Chad and Nigeria, where Boko Haram is active. We have refugees coming in from Nigeria and also from Chad. To access certain villages, we have to have a military escort. And sometimes we have no access at all because there is conflict underway between government soldiers and Boko Haram guys. Another area, Maradi, has issues with bandits.
In addition to all of this, we had a coup last July. They chased out the French troops, and recently they asked the American troops to go. There is a lot of tension in the country.
Dr. Sara Lavinia Brair, Senior Country Representative, Sudan
Brair: Our situation in Sudan is complete war. We went through all the phases, probably, that Niger is going through. We had protests and a coup, a transitional government. We had more protests, we had a military coup, and now we have war.
During the protests and smaller conflicts, we had disruptions of the medical supply chain. Now we have complete collapse. All of our drugs were looted. Most of our staff had to evacuate. There are also issues with the social and economic systems and a high inflation rate. We are experiencing pandemics and food insecurity, with millions in danger of starvation.
Dr. Zerihun Tadesse, Senior Country Representative, Ethiopia
Tadesse: I think we have a lot of commonalities in Ethiopia. In some areas, we have interethnic conflict that comes and goes. Nobody knows when it will come, but the good thing is, in a few days or a week, it goes back to business. That is the case in Gambella, where we have the Guinea worm program. I feel very comfortable and safe working there.
That is not the case in Amhara, where we have our trachoma program. We have had a conflict — really a civil war — there for almost three years.
When the war broke out, everything had to stop. This is after a decade-and-a-half of investment to eliminate trachoma as a public health problem. Amhara is Ground Zero for trachoma. If we fail to eliminate trachoma in Amhara, we fail Ethiopia. We fail Africa. We fail the whole world.
Brair: I can give you two. One of them was the evacuation of an expatriate who was in Khartoum when the war broke out. He was in a hotel in an area that became very unsafe. And we lost all communication with him when the hotel Wi-Fi went down.
I was constantly in touch with our Atlanta team on the best routes for our staff to take as they relocated, I was evacuating my own family to Cairo, and I also was working with Atlanta to figure out how to evacuate the Khartoum expat. After two weeks, we got him back safely to his kids in Kenya. But I don’t think I slept for those two weeks and neither did Yohannes Dawd or Craig Withers from the Atlanta staff.
The second success is that the program is up and running again. In May, we will conduct our first mass drug administration since the war began.
Gambo: One bright spot is our collaboration with government services. Currently, government workers in Niger can go to the tough and hostile places where we cannot go. But we support them with training so they can do surgeries and give them funds to carry out the work. For me, that’s something important to show.
Tadesse: Last year, we lost one of our staff — a security guard who was traveling back from vacation to his duty station when he was attacked by people from another ethnic group. That was a very tragic moment for us.
But after a couple of days, we returned to work because we are all committed to the program. In the back of our minds, we know that anything could happen to us at any time. But we cannot stop the work.
Brair: I appreciate the good security guidelines that are in place to protect staff. And I think the second thing that makes the Center special is the empathy it has shown to staff. Many smaller organizations knew that areas would be inaccessible for a long time and laid off staff, but the Center didn’t do that and committed to carrying out activities where possible. The Carter Center was among the few organizations that reimbursed staff evacuation costs.
Gambo: I like the Carter Center’s focus. I am only working on trachoma. I have worked for other organizations, and I had to work on education, health, shelter. We were doing too much. If you are doing everything, you are doing nothing.
Tadesse: We at The Carter Center feel very proud of alleviating the suffering of people at the grassroots in real time, regardless of the situation — peace, conflict, and the like. That is the reason why we have been not only surviving but also thriving during the last four decades.
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