Water Carries Death to Many of Africa’s Suffering Children

In Africa, you can start with water. Actually, you can begin with any of a dozen reasons that this continent has the highest child mortality rate in the world. Water is just one entryway into the vicious, unfair cycle downward.

In one area of rural Mozambique, families rely on the same 20-foot mud puddle to dip out the day’s drinking water, to bathe and to water their livestock. This is not because they are lazy or ignorant but because other approaches to the thin stream that feeds into the puddle are covered with land mines--the result of civil war. Experts are working to clear the mines, and, if they keep at the same pace, they will finish in 400 years.

In Kenya, supersonic jets bring tourists to $500-a-night, gin-and-tonic safaris. But almost half the resident population cannot find safe water to drink no matter how far they walk. Slum residents near the capital, Nairobi, once were allowed to fill their buckets from water traps at a local golf course. But this was found to disrupt golfers and has been disallowed.

In the Niger River valleys of Mali, nature’s fountain of fresh water descends each year in seasonal rains. Crops are nourished--and diseases too. As in other places, rains overfill primitive village garbage dumps and latrines, flooding streets with raw bacterial soup.

Poverty, corruption, war, lousy government, ethnic rivalries, a moist climate favorable to bacteria, overpopulation, malnutrition and, of course, dirty water--all these propel the cycle of disease and suffering that has devastated the children of Africa.

The U.N. Children’s Fund, UNICEF, measures clean water as a standard for health. In a survey of 34 sub-Saharan nations, 27 could not provide more than two-thirds of their populations with clean water. In war-torn Sierra Leone, only 3% of the citizens had it; in Nigeria, the most populous country, the share was 39%, and in Ethiopia, the second-most populous, 25%.

Earlier in this decade, the world made a heroic--if short-lived--effort to help in the lovely, forbidding landscape of Somalia. A $2-billion military campaign provided the shield for humanitarian efforts to save a populace caught in the murderous cross-fire of civil war and famine.

Hunger was only part of the problem. A weakened population is ripe for assault by disease. In Somalia in 1991-92, a measles epidemic killed “thousands upon thousands of children,” according to UNICEF’s representative for Somalia, Pierce Gerety. Diarrhea killed thousands more.

The following year, outside relief agencies inoculated 600,000 children against measles and gave them Vitamin A. Fresh-water wells were dug, food distributed by the ship-full.

But since the U.N. mission ended last spring, Somalia’s slide back has been precipitous. “In 1992, we had a budget [for aid] of $52 million, we were flush with money and had the protection of the world’s soldiers,” Gerety says. “This year, we’ll be lucky to have $10 million.”

As a result, only 70,000 children were inoculated in the first half of 1995. He says relief workers will be lucky to reach 140,000 by year’s end--about 20% of the children born since 1993.

Sure enough, in November another measles epidemic emerged and began killing infants to 2-year-olds. Relief workers say cases numbering in “the hundreds” are being seen. On Nov. 18, Doctors Without Borders launched a new immunization campaign in the vicinity of the capital as best it could between bouts of clan warfare.

Will the outbreak be as bad as last time? “That possibility exists,” says Imanol Berakoepxea, coordinator of Doctors Without Borders in Somalia. “We’re worried about nutritional levels, and we fear they are getting worse. Meanwhile, we’re seeing an upward trend in measles. If combined with an outbreak of cholera . . . it could be an explosive combination.”

Somalia is an extreme case. But all Africa, it sometimes seems, is extreme in its anguish and contradictions.

Just 18 months ago, 2 million exhausted Hutu refugees fled Rwanda in the face of ethnic fighting. Images of their suffering shocked a world that thought itself hardened to misery. In a span of weeks, perhaps 50,000 people died in refugee camps, primarily of cholera and dysentery--diseases where water is both cause and cure. No one knows how many of the dead were children, except to say many thousands.

Cholera normally has a fatality rate of 1 in 10. Here it was much higher. Intense crowding on hard ground where latrines could not easily be dug created a veritable hothouse for disease. Much of the local surface water soon became contaminated.

The world poured out its heart and resources. More than 200 relief organizations hoisted their flags in the region. Military health and medical teams arrived. The largest Red Cross outpost in the world, even today, is in Rwanda. And many agencies recorded astounding public donations from abroad.

Now, after the outside world spent about $750 million on their care and feeding, Rwanda’s exiled refugees are among the best tended anywhere. Access to food and health care is better than for many peaceful, working Africans. Virtually 100% of the refugees have access to clean water.

A happy story? Yes and no.

Surely, many tens of thousands of children and adults who otherwise would have perished are healthy.

But the leaders of these Hutu refugees include hundreds, perhaps thousands, guilty of Rwanda’s 1994 genocide against rival Tutsis. They are said to be strengthening themselves for a new invasion of their homeland.

This has caused much soul-searching among relief agencies. Doctors Without Borders, one of the biggest and fastest-responding agencies in the 1994 cholera outbreak, closed its relief operations in neighboring Zaire two months ago, citing “the moral dilemma” of easing one kind of suffering to encourage another.