Famsa regional conference on war aids african child 2004

War, AIDS & the African Child PROCEEDINGS OF THE FAMSA REGIONAL CONFERENCE OCTOBER-2004

- From the Administrator, FAMSA Headquarters I am particularly glad to bring to you the FAMSA 2004 Conference Report. The conference theme was ―War, AIDS and the African Child‖, it held at the College of Medicine, University of Ibadan on October 26 - 29, 2004. The theme of the conference was chosen after a critical look at the state of the African Child, and the impact that this can have on the future of African healthcare. On consideration, the following became evident; 1. Independently and in concert, HIV/AIDS & Conflicts in Africa pose a clear and present danger to the development efforts on the continent.

2. The HIV/AIDS and conflict situation will impact on the practice of healthcare by the time students currently in medical schools in Africa begin to practice.

3. There is a body of knowledge available on how to deal with this clear and present danger.

As African Youth, FAMSA and African medical students are stakeholders and we must contribute our quota to the developmental effort. It then followed that we needed to bring these issues to the public perspective and to educate colleagues and youth across Africa on the factors responsible for the situation, and to look into ways of solving them. The appropriateness of the theme was reinforced by the UNICEF State of the World‘s Children Report 2004 which showed that armed conflicts and HIV/AIDS are the greatest threats to child welfare. The conference was also to afford us the opportunity to decide who could be partners with us and seek to engage them. To a large degree, in the face of challenges, we achieved our objectives.

Activities at the conference The conference consisted of 4 parts; (1) Seminar presentations and symposia at which thematic papers were presented and discussed.

(2) visit to the Oru-Ijebu Refugee Camp, which afforded participants a first hand appreciation of the realities facing refuges in Africa. We also made some donations to the camp clinic and for general welfare.

(3) A drama presentation based on the theme of the conference.

(4) FAMSA business meetings.

Participation and challenges Youths from 13 African countries (Zimbabwe, Cameroon, Sudan, Nigeria, Ethiopia, Tanzania, South Africa, DR Congo, Ivory Coast, Niger, Togo, and Burundi) registered for the conference. Only Sudan, Ghana and Nigeria were present at the conference, other countries sent in contribution by e-mail. Reasons for not being able to be present at the conference ranged from the security instability in Ivory Coast, clash with academic schedules, flight scheduling problems and late availability of travel assistance. Slow or no response from governmental agencies was also a critical constraint, particularly with the Nigerian government. The most important constraint was funding. This meant that medical students could not get flight tickets and choice of speakers was restricted to the host country. It is our hope that this will be surmounted in future events.

Outcome.

At the conclusion of the meeting, the following outcomes were achieved; 1. Based on information reviewed, and resolutions of the FAMSA 24th General Assembly, a communiqué was issued addressing the issues raised. A copy of these document is included in this report.

2. Preliminary discussions were begun with the Commission of the African Union, with a view to becoming a part of its process and activities.

3. The 25th General Assembly was scheduled to hold after consultations with colleagues at the Nairobi University, Kenya.

4. The FAMSA Youth Agenda was reviewed and set to be presented at the General Assembly after work by a task group.

Finally, We appreciate the financial support of the Commission of the African Union and the Abuja office of the UN Fund for Population Activities. A full list of donors/partners is included in this report.

FEDERATION OF AFRICAN MEDICAL STUDENTS‟ ASSOCIATIONS. COMMUNIQUÉ OF THE FAMSA IBADAN 2004 REGIONAL CONFERENCE. THEME:

WAR, AIDS AND THE AFRICAN CHILD. OCTOBER 2004.

PART I Introduction: The FAMSA Ibadan 2004 Regional Conference was hosted by the FAMSA Permanent Headquarters, College of Medicine University of Ibadan, Ibadan Nigeria from the 26th to the 29th of October 2004. The major venue for the event was the College of Medicine Auditorium at the University College Hospital Ibadan.

Medical Students from Northern and Southern Sudan, Rwanda, Ethiopia, Ghana, Nigeria, and other African Countries, a representative of the African Union, experts from NGOs, Opinion Leaders, representatives of Governments, representatives of media agencies and the general public participated in the conference proceedings which consisted of the following: CONFERENCE SESSIONS: 1.

Expert papers were presented on Leadership and African conflicts Conflicts and Wars in Africa – what Hope for a sustainable peace?

Wars and the African Child Paediatric AIDS Wars and Spread of HIV/AIDS in Africa AIDS Advocacy 2.

Student presentations on The role of Medical Students‘ Associations [MSAs] in deepening the emerging African renaissance The impact of conflict on health 3.

A visit to the Oru refugee camp in Ogun state Nigeria.

4.

FAMSA Business meetings.

5.

A press briefing

PART II PROBLEMS IDENTIFIED: In the course of the conference, resource persons presented several papers on critical issues relevant to the conference theme. Oral presentations were also entertained with delegates baring their minds on issues pertaining to the theme. A visit was also paid to the Oru refugee camp in Ogun state in Nigeria, which afforded participants the opportunity of getting an eyewitness experience of some of the effects of war and armed conflict in the continent.

After much deliberation, 1.

The conference noted the gravity of the effects of war and armed conflicts in Africa and agreed that armed conflict was a continent wide problem.

2.

Especially, that children and women are the greatest sufferers of the effects of these conflicts.

3.

The conference was bewildered by the fact that despite the African Union, United Nations, ECOWAS and Civil Societies intervention, armed conflicts and the effect of armed conflict still continue to ravage the continent.

4.

The conference agreed that the prevalence of HIV/AIDS has increased especially among children and women as a direct effect of war and armed conflict.

5.

The conference noted that conflicts in Africa are largely due to poor leadership, drive for resources and

6.

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economic hardship.

The conference also observed with dismay the dwindling hope for sustainable peace in Africa following the present circumstances in the continent.

The conference unanimously agreed that medical students could and should do more than is presently done to avoid or reduce to a minimum, armed conflict in Africa.

It was regrettably observed by the conference that the scourge of refugees, which is a direct consequence of war, has led to a marked increase of the adverse effects of AIDS in the continent.

The conference also noted that refugee camps and settlements do not meet the minimum standards of hygiene, security, provision of basic amenities and food and drug supplies.

The conference surmised that the international community, the African Union, United Nations, ECOWAS, Civil Societies and Governments of individual African Nations need to scale up efforts to prevent or reduce war, AIDS, and their effects on African children.

That despite its laudable objectives, the NEPAD Initiative does not have a youth component.

PART III

RECOMMENDATIONS: Following further and thorough deliberations on the problems aforementioned, and considering their critical and urgent nature, the FAMSA regional conference unequivocally and unanimously recommends as follows: 1.

That Africa should henceforth take up the responsibility of ensuring sustainable peace on the continent; and Governments should hold themselves responsible for any disruption of peace in their countries.

2.

That African medical students act as stakeholders and be involved in peace advocacy.

3.

That Medical Students‘ Associations should make more concerted efforts especially at the grassroots to reduce the adverse effects of AIDS on children and women.

4.

That African Medical Students and Youth contribute to the success of the NEPAD Initiative.

5.

That colonialism has had significant contribution to the current state of conflicts in Africa. However, Africans and African Governments should view their problems as national security issues, solve them by all means possible and refrain from blaming colonialism for their woes.

6.

That groups intending to intervene in conflicts, should be fair in their assessment of the causes of the conflicts and should give opportunities to all parties involved to express their views and intervention should be impartial and devoid of insincerity.

7.

That the African Union, Civil societies, interest groups and African Governments should do all possible to immediately end genocide and the conflict in Dafur and other parts of Africa.

8.

That refugees be provided with basic necessities of life of at least minimum standards by the Governments of countries who accommodate them.

9.

That Governments and Inter-Governmental Agencies should expedite action to make conditions suitable for the return of refugees to their homeland.

10. That legislation and all available avenues should be explored to protect children and women in areas where there are wars and armed conflicts, particularly enforcement of the African Charter on The Welfare and Rights of the Child.

11. That as a matter of national security, available and affordable treatment be provided for people living with HIV/AIDS in Africa especially children and women.

PART IV RESOLUTIONS: During its final, concluding and business sessions, the FAMSA delegates with due consideration to the thematic issues of the conference made the following resolutions: 1.

To mobilize for effective youth action across the African continent by means of the FAMSA Youth Agenda.

2.

To advocate for and gain commitment from African governments and Heads of State for FAMSA and the

3.

4.

FAMSA Youth Agenda.

To remain focused on the resolutions made at the FAMSA 24th General Assembly.

To undertake activities to raise public awareness on the scourge of war and AIDS in Africa and to the fact disaster anywhere in Africa is a local issue everywhere in Africa.

PART V

CONFERENCE GUEST SPEAKERS AND RESOURCE PERSONS: 1.

Dr. Isaac Olawale Albert PhD, Senior Research Fellow, Peace and Conflicts Studies Programme, Institute of African Studies University of Ibadan.

2.

Dr. O.B.C. Nwolise, Senior lecturer Department of Political Science, University of Ibadan 3.

Professor Ademola Yakubu Faculty of Law University of Ibadan 4.

Dr. Owolabi, Peace and Conflicts Studies Programme, Institute of African Studies University of Ibadan.

5.

Dr. Brown Department of Paediatrics, College of medicine University College Hospital Ibadan 6.

Professor Ladipo, President Association for Reproductive and Family Health, Ibadan.

7.

Dr Adeniyi Ogundiran of the WHO Country Office, Nigeria.

8.

Mr. Ipoade Omilaju, Programme Adviser (RSH/HIV/AIDS) Actionaid Nigeria, Abuja CONFERENCE ADVISERS/TECHNICAL SUPPORT: 1.

Dr. Grace Kalimugogo Head Health, HIV/AIDS and Population Social Affairs Department Commission of the African union Addis Ababa, Ethiopia 2.

Dr. Isaac Albert, Senior Research Fellow, Peace and Conflicts Studies Programme, Institute of African Studies University of Ibadan.

3.

The Commandant, Oru refugee Camp, Ogun State Nigeria 4.

Prof. I.F. Adewole, Provost College of Medicine University of Ibadan, Executive Consultant FAMSA permanent Headquarters.

5.

Professor (Mrs.) W. Shokunbi Head, Department of Haematology, College of Medicine University of Ibadan, Executive Consultant FAMSA permanent Headquarters.

6.

Alagba Adebayo Faleti, Ibadan Nigeria.

7.

Department of Paediatrics, College of medicine University College Hospital Ibadan 8.

Action Group on Adolescent Health, UCH. 9.

Actionaid Nigeria, Abuja.

10.

Mrs Stella Akinso, Programme Advisor, UNFPA , Osun State Nigeria.

CONFERENCE SPONSORS/DONORS 1.

The Commission of the African Union 2.

The United Nations Population Fund Nigeria Office 3.

The Oyo State Government, Federal Republic of Nigeria.

4.

Actionaid Nigeria, Abuja.

5.

Peace and Conflict Studies Programme, Institute of African Studies, University of Ibadan.

6.

Professor Oluwole Adebo, Department of Surgery, University College Hospital Ibadan.

7.

Dr. Mrs. Ladipo, Staff Medical Services University College Hospital Ibadan.

8.

Dr. T. Lawal, Registrar, Department of Surgery, UCH Ibadan.

CONFERENCE OFFICIALS: BEKWELEM WOBO Head, Communiqué Drafting Sub-Committee.

OKEREKE EVELYN Head, Media & Publicity Sub-Committee.

OLABALU ‗WUNMI Head, Refugee & Cultural Activities Sub-Committee.

AKPEH ‗BUCHI Head, Logistics Sub-Committee.

OGINNI ADEYEMI Secretary, Organizing Committee.

ONI EBENEZER Under-Secretary, Administration, FAMSA Headquarters.

OLAGBENRO MICHAEL ADEOLA Administrator FAMSA Headquarters, Chairman Organizing Committee.

THE ROLE OF LEADERSHIP IN CONFLICT MANAGEMENT AND PREVENTION OF WAR Osisioma B.C. Nwolise, Ph.D. Snr Lecturer, Department of Political Science, University of Ibadan, Nigeria

INTRODUCTION Conflict which Lewis Coser conceptualizes as ―a struggle over and claims to scarce resources‖1 is as constant in human existence as change, and air. It is so because it is a product of human nature, and human interaction. Even between a pair of twins born by the same mother, there are conflicts. Two people or two groups of human beings can not always have the same interests, world outlook, or perception. These mean that there can at times be opposing views and interests, as well as different ways of interpreting principles. Some people also perpetrate injustice against others. These are some of the sources of conflict. 2 More importantly, as Stedman asserts, ―Conflict arises from … the tugs and pulls of different identities, the differential distribution of resources and access to power, and competing definitions of what is right, fair, and just‖3 The message then is that leaders should not perpetrate injustice for whoever does this or violates human rights, must expect violent conflict. 3 However, even though conflict is natural and can always arise between two or more people, or groups, it does not necessarily have to be violent. It is violent conflict, especially, wars, that lead to destruction of lives and property, retardation of the speed of development, diversion of development funds to war, damages to infrastructure etc. War generates refugees, and displaced persons, and brings out the beastly tendencies in human beings – cheating, rape, commandeering, robbery, greed, and murder. 4 ON LEADERSHIP Leadership is a concept that does not easily yield itself to a common definition. Different scholars writers, and commentators conceptualise it differently. Yet, people know good leadership when they see one. We must be able however to emphasise the point that a leader is not the same thing as a head, ruler, or manager. The different conceptions of these four terms have been highlighted in O.B.C. Nwolise and ORA Ohaemesi5, and need not delay us here.

However, it needs to be pointed out that while a head, ruler, or manager can be appointed or imposed by an outside force to his or her subordinates, a leader is of the people, for the people, by the people, in the people, and with the people he leads. A leader does not have the luxury of the rulers, or despots. For him, the words of Cicero (the Roman Orator) to the effect that ―the good of the people is the supreme law‖ is the guiding light. Rulers, despots, and heads do not necessarily worry about the good of the people, but a leader must worry about it.

This is because the essence of governance, which is why the leader is in office, is the Security, peace, development, welfare and happiness of the people. A leader is always in front, showing the light, the way, and the examples. To do this well, he must be a good thinker, good planner, a team man, courageous, brave, kind but firm, and fair. Above all, he must have integrity and humanity. He must be able to add value to the lives and living conditions of the people who bear the weight of his or her governance.

Without integrity, the leader has no moral ground to lead others, because he can not be trusted, and people can not have confidence in him. More importantly, he can not discipline his followers when they misbehave. Without humanity (genuine liking for people and readiness to serve them), there can be no leadership at all.

Leadership involves four basic elements: the leader, the followers, the circumstances, and the task. The nature of the leader determines the nature of the rest three. It determines whether the followers will be peaceful, hardworking, cooperative, or violent, indolent, and nonchalant or oppositional. The nature of the leader affects the nature of the societal circumstance and whether the task or goal of leadership will be successful or not.

THE ROLE OF LEADERSHIP IN CONFLICT MANAGEMENT AND PREVENTION OF WAR Osisioma B.C. Nwolise, Ph.D. Snr Lecturer, Department of Political Science, University of Ibadan, Nigeria

Where structural injustice reigns such as in Sudan, where the Arab North is imposing Sharia and inhuman conditions on the Christian or Atheist south; or where Arab Moslems are denying power to Moslem Blacks (Darfur), then violence and war must remain constants, or recurring decimals. A despotic leader who visits terror and socio-economic hardship on the people must harvest violence. A Leader who rigs elections must expect opposition and even violence and war. Examples abound in Uganda under Idi Amin, Germany under Hitler, Haiti under Papa Doc‖, and Liberia under Samuel Doe and Charles Taylor. Ukraine is boiling today over election rigging. Yesterday it was the Philippines under President Marcos who rigged elections. However, democratic leaders, who believe in dialogue, and peaceful ways of doing things, mast often, harvest peace, security, and stability. Examples are South Africa under President Nelson Mandela, USA under President Clinton etc.

THE ROLE OF LEADERSHIP From the foregoing, it becomes very clear that leadership has a great role to play in conflict Management and prevention of war. A good leader who uses dialogue, not naked coercion in governance and settlement of the great issues of the day; and who pursues the essence of governance which is the Security, Peace, Development, Welfare and happiness of the people, and who is just to all groups of citizens prevents 1000 wars within his country, and between his country and others.

It is the duty of leadership to prevent conflict among others through: 1.

Understanding power, its secrets, and how to hold and wield it safely.

2.

Peace education 3.

Confidence building 4.

Peace-making-mediation, conciliation, persuasion, negotiation, and arbitration.

5.

Mounting peace-keepers/enforcement while necessary.

6.

Peace-building 7.

Avoiding the fanning of the embers of ethnic and religious diversity.

8.

Avoiding injustice in the sharing of national resources including political positions (Chief Executive).

Each group must be given its due. In Nigeria, for example, the multiplicity of violent conflicts is a product of political injustices e.g. the neglect of the entire Eastern part of Nigeria especially Igbo land since the end of the Nigeria-Biafra war (1966-1970). This has given rise to MASSOB and the Niger Delta people‘s Volunteer Force.

Leadership must listen to its followers for conflict to be prevented. The followership in turn must give the leadership due recognition, respect, as well as discharge their obligations. The followership must however demand for better changes where necessary; demand good leadership; and play its part very well. However, where violent conflict has inevitably broken out, the leadership has to manage it adequately by taking urgent steps to initiate a peace making process. The peace to be arrived at must be honourable peace that will endure. All stake holders must be involved.

The management of war here refers to both steps taken to limit the theatre of war, and to remove the root causes of the conflict which is regarded as conflict resolution. Conflict can not be resolved without finding the root causes of the conflict, and this involves locating the truth of the matter.) and removing them.

CONCLUSION The problem in Africa today about leadership is that we do not have leaders in most of African nations. Instead, there are rulers, and heads of state, many of whom are despots. Africa is riddled with rulers and treasury looters whom as Karl Maier 6 observed are like company executives who locked themselves in the company‘s safe armed.

THE ROLE OF LEADERSHIP IN CONFLICT MANAGEMENT AND PREVENTION OF WAR Osisioma B.C. Nwolise, Ph.D. Snr Lecturer, Department of Political Science, University of Ibadan, Nigeria

Until Africa have leaders instead of rulers, there will be no peace, security, and development.

So long also shall Africans, especially, the children continue to be devastated by hunger, thirst, ignorance, HIV/Aids, and unnecessary wars. To have leaders, citizens must be able to courageously fight for and elect good people into officer as Chief Executives; and defend them. In the same vein, despots, corrupt looters, violators or human rights, murders, and weaklings must be voted out of office. Where they refuse to be voted out, they must be removed by the people‘s revolution in which the military must side with the masses of the citizens as done in the Philippines, Georgia; and now on-going in Ukraine (December 2004) where the incumbent rigged himself back to power in the November 2004 elections, and the masses at the encouragement of the opposition has taken over the streets despite the harsh winter weather, demanding that the incumbent government step down.

What is the role of students in general and medical students in particular in all this? Students constitute an active vanguard in the pursuit of the popular will, and general welfare of the people, all over the world. The history of Nigeria and Africa confirms this fact. (for the continent). Nigerian students were instrumental to the abrogation of the Nigeria-Britain secret defence Pact in 1960. In South Africa, we know the great role students played in the antiapartheid struggle, especially in Soweto. Students today are in a state of inertia all over Africa. They have been cowered by the three decades of military despotism. But they must not shirk their responsibilities. They must insist on the election of good leaders at all levels and blocking out of power looters who perpetrate arson and assassination, against the people.

Students must educate and enlighten the people in this direction.

Nigeria in particular and Africa in general today need our own brand of SOPHISTS. The sophists are the highly politically aware group of ancient Greece who in the face of selfserving political rulers of Sparta, Athens, etc. made it a point of duty to educate and enlighten the people. They taught the people their rights, and why it is important for them to insist on participation in the governance of their states. They taught the people the obligations of the state, and the essence of governance.

In the case of Nigeria, what we get today are religious preachers who further cause the people to be weak in fighting for their rights, and insisting on government meeting its obligations to the citizens. Thus, today, governments (federal, states, local) do not pay salaries, pensions, and gratuities to citizen as and when due; roads have become death traps; health services have collapsed; unemployment figure is in millions; hunger and starvation are wiping out the people; and poor nutrition is quickening the rate at which HIV/Aids wipe out the population. Yet, this country is very rich, so rich that some one once said that Nigeria‘s problem is not money but how to spend it. In the face of similar problems in Greece, the SOPHISTS arose to save the people through teaching, writing, and political preaching. In the case of Nigeria, we have religious preachers that worsen the situation. People now go to church in search of miracles to cure malaria, HIV/Aids, typhoid etc, because there is no money in their hands, and even when the money is seen, no body is sure of the safety or quality of drugs in our markets.

Medical students in particular also have roles to play. This is because the despots at times use medical doctors to commit murder, and to write wrong autopsy reports. The murderous late Idi Amin of Uganda shot a Bishop dead in his (Amin‘s) house, and ordered his doctor to write that the Bishop died in an accident. The doctor had written false reports before, but in this case, he said he will not lie against God‘s servant (Bishop). Instead he ran out of Uganda.

Some government doctors are used by despots to kill through administration of lethal injections. That was how Shehu Musa Yaradua was killed while in government detention in Nigeria in the days of General Abacha. Therefore medical students should know what awaits them as they rise in their career and profession, and begin now to build up principles that will guide them in the different conflict theatres of humanity. They must oppose man‘s in-

THE ROLE OF LEADERSHIP IN CONFLICT MANAGEMENT AND PREVENTION OF WAR Osisioma B.C. Nwolise, Ph.D. Snr Lecturer, Department of Political Science, University of Ibadan, Nigeria

humanity to man, challenge bad decisions of political leaders and offer instead constructive alternatives. Also, they should link up with or form Non-Governmental Organizations which will serve as platforms for peace advocacy, as well as campaign for good governance.

In these ways, they will be making leaders and others prevent wars, and also be contributing their own quota in conflict management and prevention of war.

Reference 1.

Lewis Coser, The Functions of social Conflict, New York, The Free Press.

Dougherty and Pfaltzgraf assert that conflict is a condition in which one group is in conscious opposition to one or more other groups, due to incompatible goals. (See J. Dougherty and R. Pfaltzgraf, Contending Theories Of International Relations: A Comprehensive Survey, New York, Harper and Row, 1981.

2.

For more details on the sources of conflicts, see F. Deng and L. Zartman, (eds), Conflict Resolution In Africa, Washington DC, 1991; J. Burton, World Society, New York, 1987; and R. Stagner, Psychological Aspects of International Conflict, Belmont, Brooks, 1967.

3.

S. Stedman, ―Conflict and Conflict Resolution In Africa: A Conceptual Framework‖, in F. Deng, and I. Zartman, (eds) Op. Cit., p. 368.

4.

For details, See O.B.C. Nwolise, The Nigeria Police In International Peace-Keeping Under The United Nations, Baden, Spectrum Books Ltd., 2004.

5.

O.B.C. Nwolise and O.R.A. Ohaemesi, The Essence of Political Leadership, Ibadan, CODAT Pub. 2001.

See Karl Maier, This House Has Fallen: Nigeria In Crisis, London, Penguin Books, 2000.

6.

CONFLICTS AND WAR IN AFRICA: WHAT HOPE FOR SUSTAINABLE PEACE OWOLABI Babalola Isaac Peace and Conflicts Studies Programme Institute of African Studies, Univ. of Ibadan - Nigeria E- Mail: commandideas@yahoo.com Ladies and gentlemen, I feel pleased and honored to have been asked to make this presentation to you distinguished students of medicine across Africa, on the occasion of FAMSA‘s regional conference, here in Ibadan, the epicenter of medical training and practice in Africa Please in the sense that you have sustained the quest for an adequate knowledge of medicine, and extending same across the frontiers of contemporary issues that provoke , into being your daily clinical encounter , as evidenced by the conference theme `` Wars, AIDS and the African child‘‘ .

FAMSA is the largest gathering of young and vibrant medical students, and potential leaders across our continent today, just as it is the largest affiliate to the international federation of medical students (IFMSA). Having been an active member, I my time, I feel honored.

My charge this afternoon, is to address the topic `` conflicts and war in Africa what hope for sustainable peace‟‟. As doctors, I presume an appropriate entry-point to the discourse, as in clinical practice is to apply the art of making a correct diagnosis of disease condition, it is the specificity or correctness of a diagnosis, or set of objective tools employed in making a diagnosis, that will eventually guarantee the outcome and efficacy of our prescriptions for a particular disease condition.

Nonetheless, if I must warn you, the fields of sociological sciences, to which such concepts as conflicts, wars and sustainable peace, belong, lie within, or indeed is in the heart of ``contested ‗‘ and ``mutually`` contestable concepts- the realm of individual/ group/ identities/ national and continental subjectivities, which are historically, culturally located. Peace does not and cannot have the same meaning to the disadvantaged, deprived, dehumanized exploited sons and daughters of Africa, and the hegemonic, arms –making, ammunition trading European metropolis, who seem to have conspired to make the plains and beautiful hillsides of mother continent, a testing ground for new arms and ammunitions from their military warehouses, and their latest products of military research and development.

As a student of medicine (you never can stop being one) and an African, I am certain you concern is the proliferation and escalation of conflicts from below the Limpopo to the bank of the Nile River. The intensity and multiplicity, of large scale conflagration, the amputations in sierra Leone, the genocide in Rwanda, the killing fields of Dafur, the hunger and thirst amidst plenty in the Congo, the recent atrocities of Liberia and the agonies of the Sharowoi people.

Conflicts are products of human association and inevitable outcome of individuals, groups or nations when goals are incompatible, it may emanate out of competition for scarce resources. According to Aristotelian philosophy, the history of man is the history of war, we therefore, do not deny, that indeed Africa, pre-mercantilism; Africa, prior to European expansionisms , had its own internecine wars , but I make bold to say it was never in our history , nor culture and character, that native wars , take such expeditive, inhuman and derogatory dimensions that has overtaken modern day Africa. Wars were fought, rarely to kill, and only in reciprocity. And this is the honest truth, in spite of western propaganda, and their afropessimism.

Distinguished medical students, ladies and gentlemen, permit me therefore to paraphrase your concern this afternoon, to read “colonialism, neo-colonialism, war and sustainable peace in Africa.‟‟ For if our concern is the differential increase in conflicts and consequent stigmatization of our continent, we must be bold to interrogate anterior events that invariably provoke, the present into being. The Aetio-pathogenesis and possible trajectories can be discerned, that we may write, as competent doctors, an enduring prescription and prognosis.

For the purpose of this brief discourse, I shall attempt analyzing contemporary conflict contours under two broad categories. The first has ebbed, the second wave ongoing.

CONFLICTS AND WAR IN AFRICA: WHAT HOPE FOR SUSTAINABLE PEACE OWOLABI Babalola Isaac Peace and Conflicts Studies Programme Institute of African Studies, Univ. of Ibadan - Nigeria E- Mail: commandideas@yahoo.com THE FIRST WAVE The first wave of conflicts that swept across our continent, was that associated with decolonization. The nationalist liberation wars against our colonial masters, and their stooges.

From the Mau-Mau insurrection in Kenya, the Congo war in the 60s‘ and Burundian revolution of 1959. The last phase of the liberation wars was that of the early 70s‘ in Mozambique, Angola and guinea-Bissau, the last ‗‘satellites‘‘ of the Portuguese empire. Zimbabwe (1980) and South Africa (1994) as settler –colonial projects with its differential racialisation (Apartheid) agenda, all ended, with essentially ‗‘pacted‗‘ transitional arrangements with millions of African lives.

Our liberation forerunners Kwame Nkrumah (Ghana); Patrice Lumumba (Congo) ; Amical Cabral ; Nnamdi Azikwe ; Leopold Senghor (Senegal ) ; Julius Nyerere ; Mandela Nelson and others; with due respects , may have equated political independence with economic liberation; they preached ``seek ye first political freedom, and every other shall be added to you‘‘ today we know better, the liberation struggles did not translate into economic freedom. Today, rather than feed from the natural bounties of our continent, African brothers bear arms against another, amputations , landmines and AK47s are more readily available than wheat millet and other staples to feed our people. We are at a cross road, searching for answers and adopting the selfish/dictates of the western superpowers; as prescribes by the Brenton Woods Institutions (World Bank, IMF), dealing with the superficial manifestations, rather than the root causes, of widespread conflicts amongst our people.

WHY STUDY COLONIALISM? Karl Marx could not have said it better: `` people make their own history `` but they do not make it under circumstances of their own choice; they make it under conditions received from their past, historicizing our past should enable us make an appropriate diagnosis of the aetiology of conflicts/ war that has bedeviled our continent.

Aime Ceisaire (1955-10-11) had counseled in respects of the motive of European expansionism ``neither evangelization, nor philanthropic enterprise , nor the desire to push back the frontiers of ignorance and tyranny , nor a project undertaken for the greater glory of God , nor an attempt to extend the rule of law``, indeed , students of history are ag4reed that the African form of colonization in the 18th and 19th century , was provoked by the European capitalist expansion then characterized by goods surplus, that the earlier 14th , 15th century colonization of America and Australasia by surplus deviant Europeans in search of place of place to live.

Peter Ekeh in his all important inaugural lecture 1980 had summed the epochal dimension of colonialism, and its ``colonial situation `` fallout as having 3 principal, enduring legacies, namely the transformed socio-structures; the engrafted and emergent structures.

The central argument of my thesis is this, the notion of ethnicity, ethnic identity, being part of the emergent social formations in Africa, were the fallout of colonialism. It was colonial ethnographers that set the Tutsis against the Hutus, claiming they were superior to the Hutus. the same colonialist sets the Ovimbudu against the Abundu in Angola , just as the settler colonialist s of Apartheid south Africa set brothers against brother and christened it ``black on black violence``! Ethnicity, ethnic conflicts and mutual distrust were alien to pre -colonial Africa.

The second point of interest here is equally important, perhaps more important than the first. That which entails the ``engrafted social structures `` in Ekeh‘s words. Your bureaucratic systems; education; health; architecture, including your forefathers dresses must give way to the almighty ``faultless`` culture! The worst your language, my languages were taken, even our names. Distinguished medical students, how so we think? Is science itself, medicine; engineering etc, not evolved out of culture? The contradictions that presently provoke violent reactions, are they not locatable in our past, our ever failing attempt to manage, and speak a language, a civilization foreign to indigenous African? With its inevitable loss of coherence or shall w3e remain confused and hypnotized by our few brothers who‘d rather

CONFLICTS AND WAR IN AFRICA: WHAT HOPE FOR SUSTAINABLE PEACE OWOLABI Babalola Isaac Peace and Conflicts Studies Programme Institute of African Studies, Univ. of Ibadan - Nigeria E- Mail: commandideas@yahoo.com drink and dine with the white man? Assimilation?

As the hope and future leaders of Africa, you must engage these questions, and it forms the basis of understanding the root caused of the multiplicity of African conflicts.

The ``colonial situation `` has remained with us, like an Epoch , which cannot be washed away , the cry for micro nationalism; ethnic militarism ; hunger and deprivation that provoke violent reactions threatening African states ,and claiming millions of lives , lives you swear to protect by your Hippocratic oaths ; concerns that gives you sleepless nights; and make you wonder if indeed Africa is not doomed !

THE SECOND WAVE Whereas the first wave of African wars, I have attributed to so-called ``decolonization`` struggles, this finally ended with south African ``pacted`` transition to majoritarianism in 1990.

The revolutionary United Front (RUF) of S/Leone amputations; the Charles Taylor led National Patriotic Front of Liberia (NPLF) mass murder and its forceful child soldiering / conscription, the Ganda –Kwo against the pastoralist in Mali; the Oromo against the Amhara in Ethiopia; Dismembered Somalia, to the recent Dafur genocide etc. are contemporary corms of the second wave of African conflicts.

It has all evolved out of the inability of the state to meet its social chatter without ethnic/regional bias. The southern Sudan protracted war is neither different from the Saharawe self-determination nor different from the Tigreans quest for independent homeland in Eritrea.

The loss of state capacity, and so-called failed state syndrome is, in spite of the artificiality of territorial boundaries, demarcated by the 1884 Berlin conference , can be interlinked to the asymmetrical economic exchanges between African states and their European –metropolis . the extractive economies, producing only primary raw materials for the industrialized west has not changed since the colonial era. Population explosion, rural –urban drift, unemployment and underemployment have taken away our brotherhood, towards capitalist individualism.

Kinship and economics of affection, has given way to brute force with RPG, land mines and assorted light arms, succumbing to ancestral adjudication and forgiveness.

People denied , rejected and politically marginalized , as in the Niger –Delta of Nigeria, are not only prone to violence , they organize formidable Guerrilla wars , with the support of the colonial oppressors.

Ethnic and regional arithmetic makes even liberal democratic norms impracticable in Africa, as evidenced by recent events in L‘a Cote‘devoir, and the increasing the fragility of Nigeria, Uganda, Cameroon, Ethiopian nation –states.

Structural adjustments; free market economy as prescribed by the IMF and World Bank, continue to take effects on the poor, dispossessed and angry African youths, with `arms struggle `` as the only alternate resource.

CONCLUSION Distinguished ladies and gentlemen, because my audience are doctors and doctors to be , I have tried to aetiologise the nature and history of African conflicts , for once a doctor makes a correct diagnosis , the management of the disease condition becomes simple .

Even though the afro pessimist school has a long history, beginning with G.F Hegels assault on Africa as the dark continent of people without history ` but we know better now, we know our science and mathematics , contributed to the Greco –Roman civilization that mid-wived modern –day European civilization !

Finally, I wish to dovetail this presentation, charging you with the following prescriptions : Like Dr. Pixley Isaka Ka Sane, a law student at Columbia University in 1896, wrote to challenge African inferiority, set your pride in your race!

CONFLICTS AND WAR IN AFRICA: WHAT HOPE FOR SUSTAINABLE PEACE OWOLABI Babalola Isaac Peace and Conflicts Studies Programme Institute of African Studies, Univ. of Ibadan - Nigeria E- Mail: commandideas@yahoo.com ``I am African, and I set my pride in my race over against a hostile public opinion..`` for no single race or culture is better than another!

We must all agree to ``decolonize the mind, `` the use of our local languages, the vehicle of our culture must not die. The works of Nguigi ‗Wa thion‘go, Sapir; Boas and Whorf has elaborated on culture, language and thinking. To think correctly, let‘s do it in our mother tongue and preach the same.

As doctors and students that care for life, we should form anti –war ``cells``, network with groups of similar objectives, and ac locally, and non –violently, against all forms of terror, We must seek to apply non –adversarial approach to all conflict. The benefit of negotiation, towards any conflict outweighs the `` winner `` and ``loser`` zero-sum game of legal adjudication. A subdued opponent is only waiting for an opportunity to strike and tables turn!

You must take the responsibility of leadership in your community, province, state or nation. An informed, selfless leader is an in valuable asset to changing millions of lives times of timidity have passed. Take part in partisan politics and negotiate power.

It was the French social scientist of the 1950s that conceptualized ``development `, under development ``. My submission is that development is man‘s increasing capacity to extract a living and domesticate his immediate environment, thus, no nation is fully developed or non –developing; development is a continuous process. It follows therefore, that development must emanate from within, from Africans themselves.

Continue to advocate for the reduction of defense budget, African government s mist spend less on arms, evolve policies that produce for local consumption, than export, organize regional economies for exchange of goods and services – our needs will eventually catalyze our productive capacity, and once, the economic needs of the people are met (the collective security), conflicts and conflagrations will cease on the face of our beloved continent.

I thank you for your attention.

AN ADDRESS BY MR. MAJOK MALEK ROUM, VICE-PRESIDENT FEDERATION OF AFRICAN MEDICAL STUDENTS ASSOCIATION * Mr Majok is a student of Bahr-El-Ghaza University, Sudan.

ChairmanH.E Adolphus Wabara, Senate President of Nigeria Guest of honor- Governor of Oyo State Address SpeakerDr. Grace Kalimugogo Representative of Commission of the African Union Special Guests: Mr. Niangoran Essan Country Representatio, UNFPA Professor Ladipo President, Association for Reproductive & Family Health Hostess & Staff Adviser:Professor Mrs. Shokunbi Provost College of Medicine University of Ibadan.

I greet you all the name of our Saviour Jesus Christ.

I would like to take this opportunity to address this gathering of African leaders and potential leaders on behalf of my colleagues, the presido Mr. Isaka Camaye of Nigie, and on behalf of FAMSA executive committee. I welcome you all to this place, the first and the best University of Ibadan.

We‘ve going to spend four days in this college, brainstorming on burning issues: War and AIDS and their impacts on African Child.

We in FAMSA have shoulder the responsibility to take a lead in this fights, the war against war and AIDS. I have a vision that FAMSA will be a model and permanent message for love, humanity, peace and fighter against the killer and protect the continent from physical, social diseases and maintain health for all. Fellow colleagues; it is our duty today and not tomorrow to investigate, diagnosis and manage physical and social diseases such as War, AIDS and illiteracy.

We should not forget other infectious diseases that affect African politics that are their predisposing factors of war and war by-products.

It is out duty to take history and examination of the following: Why don‘t our leaders learn from their mistakes?

Why do they wait until things get out of hand before correcting?

Why do we (youth) follow them to the hell?

Why African people still continue as a Labour Slaves of the World in spite of our rich God given resources?

Why do other nations fly in the wing of technology and we are still left behind to fight for survival?

Can we consider all these as misfortune? Or a curse?

Why all these suffering, War War War everywhere in African.

In Sudan, in Rwanda, Ivory Coast………..etc.

Did we sin against God apart from our father Adam, the father of mankind?

There is something wrong some-where let us pray together Christians or Muslim or African traditional believes. There is a lot to be done in order to go out of the tragedy in which we live.

Ladies and gentlemen, there are about 33 countries affected by War most are in Africa, even children are trained militarily to serve dirty business of War people must be trained to kill War before War kills people.

Tribalism must be resisted, hatred and illiteracy must be eradicated. The right of every African child must be protected before our right is taken.

Concerning the scientific conference & the 25th G.A., we apologize for not carrying it in time and this goes back to the stigma of nepotism, malingering and the insecurity in our countryThe Sudan.

With the still on-going War in Sudan, we, the vice presidents office recommend and mandate

AN ADDRESS BY MR. MAJOK MALEK ROUM, VICE-PRESIDENT FEDERATION OF AFRICAN MEDICAL STUDENTS ASSOCIATION * Mr Majok is a student of Bahr-El-Ghaza University, Sudan. the transfer of the 25th G.A. to the one of African neighboring country to Sudan and Uganda preferable.

We therefore will, in the business meeting come up with a time frame for the forth-coming 25th G.A. In conclusion one feels guilty to terminate his speech without a word of thanks to College of Medicine University of Ibadan, FAMSA Headquarters who keeps FAMSA fit and alive. Thanks to everybody who made this occasion a success and thanks to Almighty God. Lord God give us the will to struggle, the power to preserve, the wisdom to understand and the heart to love. Amen.

Majok Malek Roum FAMSA Vice President-Sudan.

“INTEGRATION, DEVELOPMENT AND HEALTH IN AFRICA: CHALLENGES AND PERSPECTIVES” A KEYNOTE ADDRESS BY DR. GRACE KALIMUGOGO REPRESENTATIVE OF THE AFRICAN UNION COMMISSION

The Chairman of the Opening Ceremony Your Excellency Adolphus Wabara, Senate President of the Federal Republic of Nigeria.

Members of the Organizing Committee of the Regional Conference The Members of the Secretariat of the Federation of African Medical Students Association.

Representatives of Member Students Associations, Distinguished invited Guests Ladies and Gentlemen.

I feel very greatly honoured to be among you today, representing the Commission of the African Union (AU), the continental organization which is still in its infancy, having been lunched just in July 2002 to drive Africa‘s renaissance in the 21 st century. I am happy to bring you warm greetings and best wishes of the Chairperson of the AU Commission, Prof. Alpha Oumar Konare and those of the Commissioner for Social Affairs, Advocate Bience Gawanas.

The AU Commission is grateful for place at one of Africa‘s oldest universities. The Federal Republic of Nigeria is commended for hosting the Headquarters of the Federation of Conference itself. This is comes as no surprise, especially since H.E. President Obasanjo, the Head of State of the Federal Republic is also the current Chairman of the Assembly of Heads of State of the African Union as well as a leader in his own right for African integration. Your Excellency the Senate President, I wish to thank you very much for taking time from your busy schedule to open the Regional Conference.

The AU was established with the objective of, among others, creating a strong revitalized and effective organization, capable of integrating Africa and at the same time, keeping pace with the political, social and economic development taking place globally and African in particular. This was deemed necessary because Africa faces many diverse challenges.

These include poverty, unemployment, a heavy burden of disease, inadequate social welfare services, hunger, civil strife and armed conflicts, to mention but a few. One of the challenges the AU has to focus on is therefore, poverty alleviation and ensuring that every African enjoys a meaningful life.

Mr. Chairman, Your Excellency the Senate President, Ladies and Gentlemen, The Choice of the theme for the Regional Conference, ―Wars, AIDS and the African Child‖ is very appropriate in view of the challenges currently facing the continent, which threaten child survival, growth and development. Enjoying the highest attainable standard of health is one of the fundamental rights of every human being; yet, what percentage of Africa‘s children has access proper health as defined by the World Health Organization? The 2000 People‘s Charter for Health states that health is also social, economic and political issues, and that inequality, poverty, exploitation, violence and injustice are the root causes of poor health. With the limited gains in economic development that were recorded in the 1980s, improvement in literacy rates and the success of the Expanded Programme on Immunization, there was hope for the African Child. However, the indiscriminate spread of HIV/AIDS and the widespread civil strife and armed conflicts have not given the African child a chance to have a good start in life.

The Millennium Summit adopted eight Millennium Development Goals and set targets to be achieved by 2015, which is just over 10years away. These goals are all relevant to the theme of this conference and are directly or indirectly health related. However, it is already predicated that most African Countries will not achieve these goals. By 2015, you medical students will be senior doctors, politicians, parents or community leaders. It is encouraging to note that you are taking up these roles early. It is our hope that the current leaders will support and facilitate your in starting early to promote a shared vision, integration on the continent and improvement of the well being of African populations.

“INTEGRATION, DEVELOPMENT AND HEALTH IN AFRICA: CHALLENGES AND PERSPECTIVES” A KEYNOTE ADDRESS BY DR. GRACE KALIMUGOGO REPRESENTATIVE OF THE AFRICAN UNION COMMISSION

The first seven Millennium Development Goals (MDGs) and targets summarize the development challenges encountered by the world, particularly Africa whose populations are among the poorest and have the lowest health status. These goals are all interrelated and mutually reinforcing, and are directed at reducing poverty in all its forms. For the sake of those not conversant with the MDGs, their objectives are to: Eradicate poverty and hunger, through halving the population of people living on less than one dollar a day between 1990 and 2015 and reducing the prevalence of under-weight children. Poverty and hunger seem to be increasing rather that decreasing in Africa; Achieve universal primary education by 2015 for both girls and boys; Promote gender equality and empower women especially in the education sector by 2015.

Eradicate poverty and hunger, through halving the population pf people living on less than one dollar a day between 1990 and 2015 and reducing the prevalence of under-weight children. Poverty and hunger seem to be increasing rather that decreasing in Africa; Improve maternal health through reduction of maternal mortality by three- quarters between the 199 and 2015 ratios. This can only be achieved by increasing the proportion of births attended by skilled health personnel.

Combat HIV/ AIDS, malaria and other pandemics by halting and reversing their spread by 2015. HIV/AIDS, malaria and tuberculosis are currently the tree major causes of morbidity and mortality in Africa, as diseases do not respect borders; a concerted and integrated effort is the only way to fight these threats.

Ensure environmental sustainability through integrating sustainable development into country polices and programmes; and reverse loss of environment resources.

This requires reducing the proportion of people without access to safe drinking water and sanitation, improving the lives of slum dwellers, and reducing the proportion of people using solid fuels.

The eighth goal, ―to develop a global partnership for development‖ focuses on solutions to achieving the other goals and addresses globalization, promoting equity in trade, supporting least developed or landlocked countries, development and implementation of strategies for decent and productive work for youth, promoting access to affordable essential drugs in developing countries, and making benefits of new technologies especially in information and communication available to all.

I don‘t think I would be wrong to conclude that those who drafted these goals and targets had the state of African population in mind. Endeavors to achieve these goals are synonymous with programmes for political and socio-economic integration and development.

Unfortunately, as already mentioned, it is predicated that may countries will not achieve the set targets due, among others, to poor governance, civil countries and armed conflicts, the continuing spread of HIV/AIDS and inadequate maternal and child health services. It is not possible to discuss all the challenges but only to highlight a few.

Wherever people are and whoever they may be, they strive to have the best for their children and families, and to live in peace and harmony, enjoying economic, physical and psychological security, personal has seen an increasing number of countries with civil unrest, armed conflicts and wars. Consequently, government spending on the army is very high in some countries, thus sacrificing other important demands like children‘s needs. People in conflict destroy lives and infrastructure, The support. Children have their right violated and they are excluded from exploited and exposed to drug and substances abuse. Many inevitably also turn to a life of violence.

The 2001 world health report, which focused on mental health, most of them in developing countries as for other global challenges, Africa has the lions share of refugees

“INTEGRATION, DEVELOPMENT AND HEALTH IN AFRICA: CHALLENGES AND PERSPECTIVES” A KEYNOTE ADDRESS BY DR. GRACE KALIMUGOGO REPRESENTATIVE OF THE AFRICAN UNION COMMISSION

and replacement persons, who suffer greatly and consume resources rather than contributing physically and mentally, Recently, at the WHO Eastern Mediterranean Regional committee Meeting, the Health Ministers protested that the world was saving children through improved health delivery system, only to kill them later through war and conflicts.

Countries have to ensure that the rights of all their citizens are fulfilled. The root causes of insecurity which include exclusion, bad governance and lack of transparency should be addressed and the consequences of conflicts mitigated. This is the role of not only the governance community are trying their best to promote good governance and support countries and communities resolve conflicts by peaceful council and the pan African parliament were established. Many of you may be aware of the roles the AU and regional communities with the support of he international communities with the support of the international community are playing in solving conflicts in Cote D‘Ivoire, Sudan and other countries. Preventing violence and conflicts is also public health priorty. Medical students can contribute to this process individually or collectively.

Mr. Chairman, Ladies and Gentlemen, The statistics and extent of the devastation by HIV/AIDS on African communities and countries is common knowledge. Suffice it to mention that there are about 5 million new infections annually, 500,000 of these in children and most of the rest youths. This is about 8,000 new infections daily. Over 3 million people also die annually from HIV/AIDS and subSaharan Africa is the hardest hit continent, especially women. According to the 2004 report on the global AIDS epidemic, the proportion of femimsition of HIV/AIDS is more apparent in sub-saharan Africa where 57% of the young people infected adults are women and 75% of the young people infected are girls and women! The reasons for this include girls and women having much older male parterns, gender inequalities, sexual violence as well as biological and anatomical reasons. These women are likely to have children infected with HIV or more children orphans can no longer take for granted the extended family that used to automatically take over for orphaned children. They are also less likely to attend school due to lack of means or having to care the sick or younger siblings.

For children, educating especially of the girl child is the best defence against HIV/ AIDS as children at school in risky behaviour. As Carol Bellamy, Executive Director of UNICEF said, ―Education has the power to break the silence surrounding HIV/AIDS.” You doctors-in-the-making has an immense responsibility: first to protect yourselves from the virus and to be ethical, put the patient first and do no harm. One person living with HIV/AIDS said at the international Conference on AIDS held in Kampala, Uganda in 1997 that some doctors were like opportunistic infection, taking advantage of patients when they are most vulnerable. The Hipporacratic Oath you take when you qualify should not be the ―hypocritical oath‖, lacking commitment, empathy and honesty.

Africa has formulated a lot of policies and strategies at national, regional and continental level to promote health and development, laying emphasis on vulnerable programmes and activities on the sustainable resources. Some commitment at all levels of health and the African child include the African charter on the Rights and Welfare of the child, the African common position on the future of the child, Plan of Action on the Family in Africa, the Abuja Declaration and Plan of Action on HIV/AIDS, Tuberculosis and other related infections diseases and the Declaration on Health as a Foundation for Development which was later reaffirmed by the report of WHO commission or Macroeconomic and health Investing in health for Economic development. Had those been more effectively implemented, African

“INTEGRATION, DEVELOPMENT AND HEALTH IN AFRICA: CHALLENGES AND PERSPECTIVES” A KEYNOTE ADDRESS BY DR. GRACE KALIMUGOGO REPRESENTATIVE OF THE AFRICAN UNION COMMISSION

children would be assured of a healthy start in life.

However, all is not lost. There is evidence of best practices all over the continent, proof that countries and communities are determined to promote child survival and development are protect the rights and welfare of the child. Although HIV/AIDDS remains a serious challenge, strategies are in place to contain it and this is already bearing fruit. More and more people have access to treatment and prevention. May countries are, to some degree, implementation the Millennium Development Goals, in collaboration with various partners at national, regional and international level. Universal primary education is a reality for more and more children. The African Union is also determined to play its role in promoting regional integration and coordination and harmonizing development programme.

In 2001, the New Partnership for Africa‘s development (NEPAD) was adopted as a peoplecentered and eradiation of poverty. Its African peer review mechanism is proof of Africa‘s determination to build capable and stable states with good governance for sustainable development.

Once again, I wish to thank the organizers for inviting the African Union to this Regional Conference, and to inform you that the AU Conference of African Ministers of Health will hold its next Session in Botswana around September 2005. Your representatives should note it on the calendar.

I wish you very successful deliberations.

PAEDIATRIC AIDS Dr. Biobele BROWN Snr Lecturer, Department of Paediatrics, University of Ibadan Consultant Paediatrician, University College Hospital, Ibadan—Nigeria INTRODUCTION HIV is the greatest health crisis the world faces today.

Estimated 40million people living with HIV 2.7 million children under 15 years are estimated to be infected with HIV 700,000 children were newly infected in 2003 mainly mother to child transmission 90% of these infections occurred in sub Saharan Africa.

In 2003, an estimated 500,000 children under 15years died from AIDS In Nigeria, the 2003 sentinel survey among pregnant women attending ANC showed a prevalence of 5.0% ( compared to 5.8% in 2001) Prevalence studies in children are few 2.7% of paediatric admissions in UCH Ibadan were HIV positive ( Osinusi et al, ) 8.6% of paediatric admissions into UMTH, Maiduguri were also positive (Akpede et al) 3.1% of children in SW Nigeria ( Omotade et al) Aetiology Caused by the Human Immunodefiency virus Types I and II Type I - Worldwide Type II - Common in West African Transmission Majority (90%) infected children acquire the infection through MTCT This occurs during pregnancy, delivery and breastfeeding In absence of any intervention, the risk of MTCT is 15 – 30% in non breast feeding populations Breastfeeding increases the risk by 5 – 20% to a total of 20 – 45%.

MTCT rates are <5% in US and Europe with access of appropriate treatment In utero 25 – 45% Intrapartum 65 – 70% - most rapid course Postpartum 12 – 15% Other

Means

of

Blood transfusions, blood products and organ/tissue transplants Contaminated needles Scarification marks ?

Sexual intercourse Factors Affecting (Maternal) High maternal HIV RNA level Low maternal CD4+ T-lymphocyte count Chorioamnionitis Maternal vitamin A deficiency and malnutrition Co exciting sexually transmitted disease Urea of antiretroviral therapy Clinical states of mother Interpartum hemorrhage Vaginal delivery Artificial rapture of membranes Rapture of membranes >4hours Fetal scalp monitoring Episiotomy

Transmission

MTCT

PAEDIATRIC AIDS Dr. Biobele BROWN Snr Lecturer, Department of Paediatrics, University of Ibadan Consultant Paediatrician, University College Hospital, Ibadan—Nigeria

Placental Factors Placental malaria has been shown to increase the risks MTCT in Uganda and Kenya Factors Associated with MTCT of HIV –(INFANT) Prematurity Low birth weight 1st of a set of twins Breastfeeding Transmission Through Breastfeeding Risk is 14% if sero conversion occurs before birth Risk is 29% if during breastfeeding Highest in the first 6 months of life but continues throughout breastfeeding Transmission risk increased by Seroconversion during breastfeeding Mastitis/breast abscess Bleeding nipples High plasma viral load Oral thrush in baby Mixed feeding (including breast milk)

CLINICAL FEATURES CNS – microcephaly - progressive neurological deterioration or spastic encephalopathy - developmental delay/regression - predisposition to CNS infections Respiratory System - Recurrent infections (pneumonia, sinusitis, otitis media) - Tuberculosis - Pneumocystis carinii pneumonia or lymphoid interstitial pneumonitis Clinical

Features

2

CVS – cardiomyo pathy with congestive cardiac failure GIT- AIDS enteropathy (malabsorption, infections with various pathogens) leads to chronic diarrhoea resulting in failure to thrive -Abdominal pains, dysphagia, chronic hepatitis or pancreatitis Renal – AIDS nephropathy:the most common presentation being nephrotic syndrome Skin – Eczema, seborrheic dermatitis, candida infections, molluscum contagiosum, anogenital warts

Opportunistic infections pneumocystis carinii pneumonia

PAEDIATRIC AIDS Dr. Biobele BROWN Snr Lecturer, Department of Paediatrics, University of Ibadan Consultant Paediatrician, University College Hospital, Ibadan—Nigeria Cyptosporidium Epstein Barr Virus - Measles - Cryptococcus meningitis - Toxoplasmosis Malignancy Non Hodgkin‘s Lymphoma Primary CNS lymphoma Kaposi sarcoma WHO CLINICAL CASE DEFINITION OF PAEDIATRIC AIDS 2 major + 2 minor Criteria MAJOR Weight loss of failure to thrive Chronic diarrhoea > 1 month} Prolonged fever > 1 month } Major

CDC Immunologic categories based on CD4+ and % Total lymphocyte counts

Immune Categories

< 1yr

1 – 5years

6 – 12years

>1500

>1000

500

>25%

>25%

>25%

750 – 1499

500 – 999

No Suppression

200 -499

Moderate Suppression 15 – 24%

15 – 24%

<750

<500

<200

<15%

<15%

<15%

Severe Suppression

Diagnosis

of

HIV

Infection

Diagnosis of HIV infected children over 18months can be made by antibody test (ELISA and confirmatory tests) Specific diagnosis in children less than 15 -18months can be made by virologic tests HIV DNA polymerase chain reaction (PCR) HIV RNA Assay Standard and immune complex dissociated p24 antigen Viral culture Tests should be performed at 48 hours of age -14 days -1 – 2 months - 3 – 6 months

PAEDIATRIC AIDS Dr. Biobele BROWN Snr Lecturer, Department of Paediatrics, University of Ibadan Consultant Paediatrician, University College Hospital, Ibadan—Nigeria

TREATMENT MODALITIES Antiretroviral Therapy Goal is to maximally suppress viral replication to on detectable levels for as long as possible The antiretroviral drugs fall under 4 major categories Nucleoside reverse transcriptase inhibitors (NRTIs) ZDV, ddI, 3TC, d4T Non-nucleoside RTIs, Nevirapine, Efavirenz Protease inhibitors: Nelfinavir, Ritonavir Fusion inhibitors: Enfuvirtide Antiretroviral Therapy 2 When to initiate ARV All HIV infected children less than 12 months Clinical AIDS Mild to moderate clinical symptoms Mild to moderate immunosuppression Good response to 2NRT1s +1 protease inhibitor Some studies have shown comparible result with 2NRT1s + 1 NNRT1 Nigeria ARV – Stavudine,Lamivudine, Nevirapine Prevention

of

MTCT

In 1997, a joint WHO, UNAIDS, and UNICEF policy Statement called for giving women access to voluntary counseling and testing and information to allow them make informed decisions regarding infant feeding.

2001 – (WHO) If a woman has tested positive when replacement feeding is affordable, feasible, acceptable,sustainable and safe (AFASS) avoidance of breastfeeding is recommended Otherwise, exclusive breastfeeding is recommended. It should be short with abrupt cessation Mixed feeding is discouraged as its promotes transmission Prevention of MTCT 2 Other options Heat treatment of expressed breast milk at 62.5oc for 12 – 15 mins inactivates HIV Breastfeeding by HIV negative wet nurse Use of milk banks .

Prevention of MTCT 3 Pregnant women who need ARV treatment should receive it in accordance with WHO guidelines HIV – infected pregnant women who do not have indication for ARV treatment or do not have access to treatment should be offered ARV prophylaxis to prevent MTCT using one of the several regimens know to be safe ZDV from 28wks of pregnancy + single dose NVP during labour and single dose NVP and one week ZDV for infant.

Prevention of MTCT 4

PAEDIATRIC AIDS Dr. Biobele BROWN Snr Lecturer, Department of Paediatrics, University of Ibadan Consultant Paediatrician, University College Hospital, Ibadan窶年igeria Nevirapine tab 200mg given to the mother during labour and the syrup 2mg/kg given to baby within 72 hours of life reduces transmission by half This is current practice in Nigeria Immunization All HIV-exposed infants should be fully immunized Infected and symptomatic infants should receive all vaccines including measles and hepatitis B but not BCG or Yellow fever vaccine Infected and symptomatic children should receive IPV instead of OPV Outcome Patterns 15-25% : rapid course median survival 6-9mo if untreated 60-80%: median survival 6yrs <5% : long-term survivors with minimal or no progression, low viral loads for > 8yrs Conclusion Paediatric HIV infection is contributing increasingly to childhood morbidity and mortality Most cases result from MTCT Effort should be made prevent MTCT complete care provided for infected children and their families

THE ROLE OF MEDICAL STUDENTSâ&#x20AC;&#x; ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

ABSTRACT Africa has passed through different stages of interaction with the West: a stage of primordial relationships, a stage of gradual growth with greater interaction for economic purposes and a stage of gradual colonial incursion crowned with a never-ending one of colonial occupation. Today, post-independence, Africa is in a stage of neo-colonialism and indirect control. It is rational that any people in such a state of turmoil will have unbalanced communities, characterized by conflicts of variable scales.

Conflicts in Africa have different origins: corruption, personalization of authority, lack of transparency and accountability, absence of rule of law, lack of peaceful transition mechanisms, human rights abuses, poverty, lack of education, and deep rooted mindsets- ethnic and religious.

Conflicts in turn, have their effects on the health and social life of the people: from depletion of health services, sexual violence, spread of diseases (like HIV/AIDS, malaria, meningitis, typhoid, cholera, acute respiratory infections), malnutrition, psychological disorders, among other health effects; social effects like child soldiering, food shortages, dislocation of people (refugees), and poor economic development. Women and children are the most harmed by these wars, both health-wise and socially.

An ideological reformation and reorientation appears to be the starting-point for proper reorganization of the African situation â&#x20AC;&#x201C;the African Renaissance. Elements of the African Renaissance include: a renewal of our mores and values, a rejuvenation of our culture and its integration with the educational system, a greater democratisation of our political system, based on the African understanding, economic transformation, conflict resolution, technological advancement, and integration of African nations.

This paper attempts to advocate the central role of African medical students in the face of all the happenings in our environment. It includes a study by Campus Renaissance Club (CRC) of Lagos State University College of Medicine (LASUCOM) on the level of awareness of medical students about the needed change and its implementation.

Our principal role in the African Renaissance, as students generally, is to prepare and train for future leadership of the African continent in a pragmatic manner. As medical students, we should learn social responsibility through community development projects, and be responsive to the plight of the rural populations around us OBJECTIVES The aim of this paper is to: 1.

Identify the problems faced by Africans and African nations concerning armed conflicts and the health implications there from.

2.

Briefly outline the causes of the conflicts and propose panaceas to the problem.

3.

Expose medical students to the African Renaissance debate 4.

Outline means to be employed by African medical students through our associations as part of our contributions towards the implementation of the said change

PART 1:

THE IMPACT OF CONFLICTS ON HEALTH

TENSION & CONFLICTS IN CONTEMPORARY AFRICA Conflicts are not new to the African setting, like in any other. The spate of armed conflicts in the contemporary African society, however, is what is worrisome; and the gross effects on our people. No less than 28 Sub-Saharan African states have been at war since 1980. By the end of 1995, conflicts had been running in Angola for over 30 years, in Somalia for 7 years.

These wars were and are fought without regard for international ethics or the health of the people. Women and children suffer the greatest effects of these conflicts. They experience several conditions during the wars, some of which will be highlighted in the course of this paper.

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

CLASSIFICATION OF CONFLICTS IN AFRICA 1.

We will employ Tom Lodge‘s classification of post-cold war African conflicts: 2.

Ethnic competition for control of the state; for example, Nigeria 3.

Regional or secessionist rebellions; for example, Sudan, Senegal 4.

Continuation of liberation conflicts; for example, Angola, Western Sahara 5.

Religious opposition to secular authority; for example, Algeria 6.

Warfare arising from state degeneration or state collapse; for example, Somalia, Sierra Leone, Congo-DRC 7.

Border disputes; for example, Ethiopia-Eritrea 8.

Protracted conflicts within politicised militaries, for example, Congo-DRC, SierraLeone.

Conflict types can be major or minor, superficial or deep-rooted, short term or long term, and they can overlap. A country like Nigeria, for example, has a variety of low-grade conflicts that result in chronic bloodletting without the country actually being in an open, declared state of war. These keep the country off-balance.

FACTORS CAUSING AFRICA‟S WARS Scholars have identified some factors as enabling conflicts in Africa and they include: 1.

Historical legacies of European colonialisation –for example, the Berlin conference of 1885 where there was the scramble for Africa by European powers (leading to the creation of artificial boundaries without regard for ethnic realities), and the establishment of commercial and political structures designed primarily to extract resources. For instance, when the Belgians scuttled away from Congo in 1960, they let Patrice Lumumba out of prison, held a short conference in Brussels, ran elections one week and left the country almost the next. In its 75-year rule the colonial power had produced fewer than 30 Congolese graduates. There were no Congolese army officers, engineers, agronomists or doctors. Automatically, Lumumba was to run a state bound to collapse.

2.

Results of the cold war, Africa being one of the proxy battle fields –Both sides supported and armed dictators through out Africa. Some possibly promising leaders in the early days of the independence movements throughout the Third World were overthrown. Orchestrated by the United States, within months of Lumumba‘s takeover, the young army commander, Joseph Mobutu staged the first military coup in Black Africa 3.

Economic motives on the part of arms merchants, foreign state and non-state actors including multinationals. Corporate interests and activities in Africa have contributed to exploitation, conflict and poverty for ordinary people while enriching African and foreign elites.

4.

Nature of power concentration on the continent, a winner-takes-all mentality, zerosum political games 5.

Centralization and personalization of authority 6.

Corruption, lack of accountability, lack of transparency, absence of rule of law 7.

Lack of peaceful transition mechanisms 8.

Absence of human rights 9.

Poverty 10.

Lack of education 11.

A primordial background of deep-rooted ethnic and religious mindsets making the arousal of ethnic and religious sentiments very easy in several parts of Africa. And like Lateef Jakande, former governor of Lagos State once said, ―Religion and region are deep in the Nigerian heart and cannot be swept away by fiat‖.

12.

Environmental problems such as water and land shortage, environmental degradation and desertification

THE ROLE OF MEDICAL STUDENTSâ&#x20AC;&#x; ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

2.

CONFLICTS: THE IMPLICATIONS FOR HEALTH Conflict in Society is a Public Health issue. Generally, in relation to war, a fall in the standards of health and health care occurs, even in safe areas. The health consequences of war are several. The very obvious ones are death, injury and long-term disability and these are easy to appreciate, though difficult to measure. This paper will not consider these ones. We will however view health impacts of war in the following manner: 1.

Depletion of Health Services The ratio of patient to available services or service providers such as doctors increases, due to increased incidence and prevalence of disease and due to dislocation of health personnel or even destruction of health facilities by armaments.

2.

Sexual violence The incidence of rape cases increase during conflicts. Hoodlums utilise the atmosphere of turmoil for unlawful sexual expression. An increased spread of sexually transmitted diseases (STDs) occurs and this is an important effect of sexual violence.

3.

Spread of Diseases The incidence and prevalence of disease increase during wars, especially STDs e.g. HIV/ AIDS and communicable diseases such as cholera, meningitis 4.

Malnutrition Children suffer the greatest here. They are unable to move around, fend for themselves, and do odd jobs or even move to where food aid is being distributed, unlike adults. Consequently, children presenting with clinical features ranging from kwashiorkor to marasmus and its associated conditions are therefore common sights in most African countries with extant conflicts or recently resolved ones.

5.

Post-traumatic stress and psychological illness Trauma, resulting from sexual violence or otherwise, could lead to depression, numbness, nervous irritability, sleeping disturbances, extreme anxiety, among other conditions of mental stress and illness. Victims of war-trauma must be helped to express suffering and to confront bad memories, with the support and guidance of an empathetic and informed person.

The very acts of talking or writing about or even acting out traumatic events are a way for healing to begin. Psychosocial assistance is vital for helping our child-soldiers, post-combat; to make the transition back to civilian life possible.

6.

Poor Sanitation & Environmental degradation Obviously, in war zones, no one cares about the state of the environment or about the discharge of pollutants into the environment. Explosions from the use of weapons of mass destruction like bombs lead to the release of all kinds of materials, toxic, lethal, into the environment.

7.

Effects on Primary Health Care All primary health care activity stops; for example, no immunisation can take place in war zones.

WAR & THE SPREAD OF HIV/AIDS Violent conflict and HIV/AIDS have both been on the rise in the past decade and the number of states at war or with significant conflicts in sub-Saharan Africa has doubled from 11 in 1989 to 22 in 2000. Fighting militia men, peacekeepers and aid workers have all been implicated in available reports. Militias in war-torn zones sexually harass and exploit displaced populations; and contaminate communities and villages when they return to their

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

homes. But the relationship is complex and certainly not recent. One factor contributing to the high rate of AIDS in Uganda, for example, could be that some women had to trade sex for security during the country's civil war.

Important also in this regard is the question of peacekeeping and HIV/AIDS infection. Rates of HIV infection in African militaries may be as high as 60 percent in Angola and the Democratic Republic of Congo where actual fighting has occurred and probably even more in Zimbabwe, Namibia and South Africa, that have only been involved in peacekeeping operations.

The Kenyan Army buries at least two (2) soldiers every week as a result of AIDS. In Nigeria, President Obasanjo announced that 11% of returnee soldiers from West African peacekeeping operations were HIV positive. More recently the UN has made it mandatory for peacekeepers to be provided with condoms along with their rifles.

WAR & SEXUAL VIOLENCE In Sierra Leone for example, a 1999 study found 1862 female victims of sexual abuse during the January 1999 offensive against Freetown. 55 percent of them were gang raped and 200 got pregnant. In Rwanda, rape has been systematically used as a weapon of ethnic cleansing to destroy communities. In some raids, virtually every adolescent girl who survived an attack by the militia was subsequently raped. In the Renamo camps in Mozambique, young boys, who themselves had been traumatized by violence, frequently inflict sexual violence on young girls—threatening to kill or starve them if they resisted. Nigerian peacekeepers serving with ECOMOG, for example, were alleged to have left 22,000 babies behind when they departed Liberia.

SOCIAL IMPLICATIONS OF ARMED CONFLICTS CHILD SOLDIERS IN AFRICA What appears to be the singular most important effect of war on children in Africa is the question of child soldiering. Recently, it was estimated that about 300,000 children are currently participating in fighting, in more than 35 countries. Child soldiers have been utilised in African countries both on government and rebel side. In some countries, young children of 10 have been conscripted. One reason for this is the proliferation of light weapons. As soldiers, they are easier to intimidate and they do as they are told. They are also less likely than adults to run away and do not demand salaries.

In war zones, a military unit can be something of a refuge for a child —serving as a kind of surrogate family. At a more basic level, joining an army may also be the only way to survive.

In Liberia in 1990, children as young as seven were seen in combat because, according to the Director of the Liberian Red Cross, ―those with guns could survive.‖ Finally, children may also have active reasons to want to fight. Like adults, they too may see themselves fighting for social justice—as was often the case in South Africa—or they may want to fight for their religious beliefs or cultural identity. In more personal terms, they may also be seeking revenge for the deaths of their parents, brothers or sisters. Many children, therefore, want to become soldiers and offer themselves for service. Others are deliberately recruited.

The effects on children of active participation in war are legion. Grave psychological trauma usually accompanies such participation. The children are also exposed to violence of all sorts. Injury and long-term disability, which follow for adults, also come in here. An often overlooked problem is regarding the demobilization and reintegration into society of these children, who are often severely traumatized, after a conflict has ended –especially when that society may be the very same one where these young children may have been forced to fight and kill.

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

The UN Convention on the Rights of the Child bans children less than age 18 from being drafted into combat. It came into force on Tuesday Feb 12, 2002 FOOD SHORTAGES According to the Food and Agricultural Organisation (FAO), as of December 2000, some 28 million people in sub-Saharan Africa were facing severe food shortages. Eastern Africa (Eritrea, Ethiopia, Kenya and Sudan) was the most precarious due to the combined effects of drought and/or civil strife.

Most of the children who die in wartime have not been hit by bombs or bullets but have succumbed to starvation or sickness. In African wars, lack of food and medical services, combined with the stress of flight, have killed about 20 times more people than have armaments.

One 1980 study in a war zone in Uganda attributed only 2 per cent of the deaths to violence—whereas 20 per cent were caused by disease and 78 per cent by hunger.

DISLOCATION OF PEOPLE -REFUGEES People are forced to leave their homes by conflict and tension of different magnitudes. The result is that they lose their jobs, their homes, their families, friends and social networks, and all that makes life worth living. The effects of dislocation of people are gross. Usually, the movements of the people are en masse. The influx of refugees into a place has great effects on the host-community. Overcrowding is one of such and the spread of tuberculosis is a consequent.

In the course of this paper so far, we have raised some critical health issues arising from tensions, conflicts and wars in Africa. For Africa to move on in the search for the way forward towards repositioning and renaissance, the identified problems have to be permanently solved and the issues raised addressed.

Towards this repositioning, we would now move to the next part of the paper which attempts to expose the reader to the African Renaissance and its elements. This part also attempts to advocate what the pivotal role of MSAs individually and FAMSA as the umbrella organisation should be.

PART 2:

THE ROLE OF MSAs IN DEEPENING THE EMERGING AFRICAN RENAISSANCE CHANGE –THE WAY FORWARD Having established the evil effects of war on health and our overall life as humans, the question now is: should we sit back and watch the events play out before our very eyes? Or should we take the bull by the horns and lead our people out of this mess that we find ourselves? It is worthy of note at this point that conflicts are just one class of the problems faced

by Africa. Poverty and disease are on their own of great, if not greater magnitude than conflicts.

But Ngugi wa Thiongo asked in his book, Writers in Politics: ―What gift shall we the living bequeath to the unborn? What Africa shall we hand over to the future?‖ The answer that comes to the lips of almost everyone who truly understands the depths of the problems highlighted and who sincerely hopes for the best for the Africa of our future will necessitate CHANGE, RENAISSANCE. Without mincing words, it is necessary that it be here clarified that change is an ideological concept that should not be considered superficially. Let our minds go to the episodes in the lives of people of different backgrounds and orientation where change became necessary. History avails us of stories of those who rose up to the challenge and of those who were weak, and who shied away from their responsibility.

The question now is: will we, the African people shy away today from our responsibility?

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

Will we entertain fear, and procrastination, and be lethargic at the expense of the African future?

Change in Africa is not only necessary today; it has become inevitable. And like Thabo Mbeki noted in his speech in Virginia, April, 1997: ―Those who have eyes to see let them see. The African renaissance is upon us. As we peer through the looking glass darkly, this may not be obvious. But it is upon us.‖ (Reproduced in his collection of speeches, Africa: The Time has Come.)

This brings us to the concept of an African Renaissance first used by Nelson Mandela in 1994 at an OAU summit in Tunisia. Thabo Mbeki and a growing number of other African leaders have since been using the concept. The concept is increasingly being used at African regional and continental gatherings. Centres and Institutes are being established to support and further develop the idea.

In summary, at the core of the African Renaissance is that we make this change the raison d‘etre for most activities of a social, cultural, economic, and political nature. Only with such a large goal, with each individual contributing his quota based on the niche he occupies at any point in time, can we achieve this transformation.

ELEMENTS OF THE AFRICAN RENAISSANCE What should this renaissance constitute for it to really benefit our people? A few points have been identified as required and they are herein described as the elements of the African Renaissance. We will discuss these briefly: 1.

Moral Renewal & African Values At the centre of the African Renaissance Struggle is the need to reform the values we hold dear and our moral expectations from one another. Till date, we have taken values for granted and therefore lack workable philosophies for our national governments. The National Orientation Agency, an agency of the Nigerian government is supposed to function in this regard. But the question is how effective has the agency‘s work been? The work of the agency has to be reassessed and given focus. Other African governments should maintain similar agencies, too. The job of reorientation must start however from the home of the growing child. Therefore, this renaissance is for the whole to participate in. The core of the African ideology, as should be preached, as a matter of urgency should be social responsibility. A socially responsible leader will not go to bed until food is on the table of his countrymen and their security is assured, etc. A socially responsible doctor will not leave his job at the expense of the health of his people, except in extreme exigencies.

2.

Culture & Education Our socio-cultural behaviour requires review. Our culture should be made more technologically relevant and the emphasis on superstition should be reduced in our daily life. Our thoughts go a long way to affect the results of our actions. Improvement of cultural assets based on African realities and the needed change such as movies, dance, art, improving traditional musical instruments, pottery, brass and gold works, and other aspects of creativity and craftwork must be aimed for. Our culture should be entrenched in our educational system and our languages given greater relevance in this regard.

3.

Political & Economic Transformation African nations will require a greater democratisation of our public institutions. Participation in governance should be improved, at least through our legislative assemblies. Our politicians will need to resist the temptation of mobilizing based on ethnic and religious sentiments. This tendency has led to continued strife and endemic disunity, especially in the more diverse countries like Nigeria. African political parties need to be restructured along ideological lines. The elections in Nigeria in which participation was greatest was that organ-

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

ised along a bipolarity of Democrats and Republicans. Our economic behaviour will have to be reviewed too. Our government must discourage wasteful spending while reviewing their economic policies. Infrastructure such as road, rail, airport, seaport and harbour that enhance business must also be improved. The stringent policies governing cross-border transports should be reviewed. Great efforts have to be made to make our economies more production-oriented rather than service-oriented.

4.

Science & Technology We need to work towards technological independence of about fifty percent. If we are able to achieve this, our negotiation power among other things will be improved, and other matters (like the democratisation of the UN Peace & Security Council) that African governments have been clamouring for will come to pass.

5.

Media, IT & Telecommunications Information is power. The truth in this maxim has been illustrated by the trend of events in the past few years, within Africa and indeed the entire world. In Africa, we are witnessing the effects of better information systems. Presently, the work of the media, the availability of telecommunications services (especially mobile) in most parts of Africa and Internet services have all complemented themselves in making work easier and less costly. We need to make the services more accessible, even to the rural population, improve the quality and begin to look out for locally available resources that we could use, instead of importing all the needed equipment for this activity. A free and responsible press will go a long way in providing information for the people and ensuring good governance. The media among other institutions of the society ought „to produce appropriate solutions to our problems‘ and thereby ‗assist in the process of democratic consolidation‘. Such institutions help in monitoring good governance, pointing out weaknesses and transgressions, and otherwise, offering constructive criticism.

6.

Health, Poverty eradication & improved welfare work Poverty alleviation and eradication has been the thrust of the work of several governments in Africa in recent years, but it is obvious to all that these projects have not been successful.

We need to re-evaluate our policies in this area and possibly, restructure them.

The place of health in society cannot be overemphasized. Any thing that disrupts the order in the environment will disturb the health of the people living in it. Healthy people are required for sound and progressive economies to be built. More medical personnel should be trained and continuing medical education should be encouraged in all parts of the continent.

Research into medical technology must be encouraged by African governments especially with emphasis on the use of locally available resources.

7.

International Relations & Cooperation, Integration Greater cooperation must be encouraged by African nations. For without this, the international community cannot hear our voice. Africa must stand, speak and fight as one. The allegory of the broom and the broomsticks should come in here.

The African Peer Review Mechanism (like other instruments and concepts of the AU and NEPAD) is a brilliant idea, but its implementation requires the support of every African nation. This will serve for political integration.

Economic integration is equally important. The developed North and the under-developed South would have to see the need to develop Africa together as important. The governments should encourage greater access to goods to and from both parts.

8.

The role of NGOs, Pressure groups, etc The role of non-governmental organizations is to facilitate the propagation of ideas and the implementation of community development efforts. On AIDS for example, NGOs have been doing a nice job in Africa with regards to educating the populace concerning what Africa is

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

up against. The keyword in NGO-work is strategic intervention. Relevant government agencies should give these NGOs their support and provide direction for their efforts.

Pressure groups, like students‘ and workers‘ unions, willing to participate actively in the African Renaissance will have to be concerted in their efforts and should focus on progressive solutions to their problems and to the welfare of the society. They should not be selfish in their approach to issues of societal interest.

Campus Renaissance Club, LASUCOM, carried out a study in October, 2004 on the consciousness of medical students concerning the plight of Africa and the African Renaissance.

The study involved about hundred medical students of LASUCOM spread over both faculties of basic medical and clinical sciences. The results of the study revealed that medical students in this part of Africa knew little about the gross effects of war on the African society.

Only about 16% thought conflicts was one of the factors affecting the social state of Africa.

Surprisingly, religion and ethnicity, these students thought, had little relevance as factors affecting the political state, with 27% and 52% respectively, compared to leadership with 92%.

When asked whether they pondered or talked about the plight of Africa with friends and associates, 82% said they did frequently (often, very often or most often) but when asked if their thoughts or discussions lead them to make practical contributions, the percentage dropped to 71%. On what kind of practical contribution they usually came up with, 61% of respondents chose educating people about the needed change.

Now, if several of us are ready to educate people about the needed change, then we have to be concerted about our efforts, lest we waste them. This brings us to what the role of MSAs should be.

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS The importance of medical students‘ associations in the society is a consequence of the dual niches that they could fill in the society. MSAs could function as welfare organizations or pressure groups, canvassing support for pro or anti-government efforts, or merely standing up against injustices in their immediate society (medical schools) or in the larger society. Suffice to say that so far the welfare role has been adequately filled in many medical schools all over Africa. Medical students have performed feats as activists in the past during the struggles of their national people. The story of Stephen Biko during the apartheid struggle of South Africa comes to mind. He entered the University of Natal in 1966 to study Medicine but was expelled for his anti-apartheid activism.

Contemporary situations however request MSAs to go beyond this level. MSAs in Africa need to redirect their focus to: a). project-oriented efforts b).

Leadership training and capacity building activity The principles of FAMSA on paper, being the umbrella body for African MSAs, suggest a trend in this direction. The implementation appears however to have been absolutely absent.

We shall come to issues about FAMSA later. But what problems have militated against the implementation of the lofty ideals associated with a large network of medical students like FAMSA? Funding and the problem of poverty in Africa Low levels of participation in MSA activities at the local level Lack of social relevance which apart from open up sources of funding, will make other activities of the MSA possible, e.g. professional and research exchange activities.

Nature of the curriculum of medical schools Other problems

THE ROLE OF MEDICAL STUDENTSâ&#x20AC;&#x; ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

It is therefore imperative to make clear what African MSAs stand to gain from a more project â&#x20AC;&#x201C;oriented approach to affairs: 1.

Sources of funding will open up for the MSAs both for the specific projects and for other projects of the MSA that are not community-based. Remember however that in this regard community-based project are better favoured, especially if original, or if it is directly supplementary to the efforts of an organization like the World Health Organization (WHO).

2.

Experience will be gathered by individuals who are directly or indirectly involved in the planning and coordination of these projects. The experience so gathered will certainly be useful for the work of the MSA, or even for the individuals themselves.

3.

The capacities of those working on these projects will be improved and this will definitely help them in future activities.

4.

The relevance and social capital of the MSA in its homeland will also improve.

Sources of funding will increase for the MSA in its homeland and this will instigate healthy competition among sister-MSAs; and this is good for Africa.

5.

The curriculum vitae (CVs) of the medical students involved in project-oriented MSAs will be bettered. Several individuals have gained a lot from interacting with FAMSA and IFMSA in the past, merely by having these names on their CVs, regardless of the capacity they occupied.

6.

Participation will be increased in each individual MSA. This is better for the MSA and will reduce workload on the people working for the MSA. The society stands to gain a lot from project-oriented MSAs. What is gained in concrete terms depends on the type of projects the MSAs participate in. For a Village Concept Project that relates to HIV/AIDS Awareness Campaigns, the society gains increased HIV/AIDS awareness, and definitely decreased spread of the disease. The society also produces leaders that would be useful for its future, thereby ensuring a better future.

The choice of projects should depend on what the society requires. All over Africa, as part of the African Renaissance, capacity building and leadership training ventures should be embraced by all MSAs. How then should we go about the projects? We cannot afford to be lethargic; neither can we afford to allow any medical schools in the whole of Africa to be uninvolved. We have to be concerted and focused in our actions, so that we can achieve better results. Collective coordinated action seems to be the way forward.

Already, we have a document prepared by the FAMSA Headquarters for the future of African MSAs: THE FAMSA YOUTH AGENDA (FYA). A thorough look at this document reveals that the Administrator of the FAMSA Headquarters and his team should be commended for their efforts in this regard.

The increased conflicts, among other things, between the drafting of the FYA and now necessitate a review of the FYA, before adoption. As indicated by the Headquarters Board, the FYA would serve to empower medical students with information, skills, contacts network and database for effective functioning in their respective localities. The greatest attention of the FYA would be focused on knowledge and the development of needed skills and attitudes. The reviewed FYA that we are now advocating should be three-pronged in action towards technical skills training in: HIV/AIDS and reproductive health matters Conflict resolution and management Leadership training and capacity building

THE ROLE OF MEDICAL STUDENTSâ&#x20AC;&#x; ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

The implementation of the FYA should be well planned; for he who fails to plan, plans to fail.

We should set up a FYA Coordination Board to review the activities of the MSAs in this regard. In line with the three-phase plan sought by the Headquarters, we hereby propose that the three phases should include as follows: 1. Training of a FAMSA Core * Five (5) participants per MSA, at least two (2) from the pre-clinical classes * Organization of FAMSA Core Training Sessions and workshops, possibly along regional lines (a kind of training for the trainers and Coordinators of FAMSA Projects) 2. Projects at MSA level * Community development projects * Local health promotion exercises, nutrition, etc * HIV/AIDS prevention and awareness activities and formation of HIV/AIDS Units in each MSA * Village Concept Projects * Peace Advocacy Workshops and projects * Capacity Building seminars for medical students * Activities aimed at ideological reorientation of medical students for more socially responsive doctors 3. Review of the progress or otherwise of the FYA during special sessions of the GA. The FYA Coordination Board earlier advocated may have the following functions and roles towards a successful implementation of the FAMSA Youth Agenda: Plan the FAMSA Core Training Sessions, in conjunction with the Headquarters Create templates for programmes and projects at MSA levels Evaluate the projects based on the objectives of the FYA agreed to at the GA Coordinate networking of students working for FAMSA and for member MSAs Create a database of experts that MSAs could reach as speakers at programmes and consultants for projects Produce handbooks, training manuals and other project materials required for training and project work, or obtain these materials from relevant organizations, like UNICEF, WHO, etc Coordinate fund-raising and international media participation for the FYA Report to the GA on the progress of the FYA The FYA could be scheduled for four years, as proposed by the Headquarters, but the question of fixing the time for each phase may cause technical problems. The FYA Coordination Board should be left to decide how long each phase should last, and whether one phase should or should not commence before one is completed. These decisions will depend on the effectiveness of the methods used. The FAMSA Core Training Conference may take place twice yearly, in each of the regions â&#x20AC;&#x201C;South, North, Central, West and East.

A CALL FOR RESTRUCTURING The lofty ideals of the FYA may be unachievable with the present working structure of the federation. The present Standing Committee structure of our federation appears not to be adequate, and something has to be done about this. The following reforms are proposed with reasons: 1.

The FAMSA Headquarters should form Headquarter Annexes that relate directly with it to help it in its pivotal role in the federation. Hitherto, the Headquarters does not perform any role during periods when FAMSA EXCO is balanced and working. Now, the Headquarters and its annexes should be saddled with the role of working with the Standing Committees and Support Groups of FAMSA, and now, with the FYA Coordination Board.

The Headquarters and its annexes should serve as a store of information that would be useful for FAMSA activities. The concept of FAMSA organs working individually should be stopped for it has not paid us in the last few years.

THE ROLE OF MEDICAL STUDENTSâ&#x20AC;&#x; ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

2.

The FAMSA Headquarters should be saddled with the role of creating a database of activities of all MSAs for each year. MSA Presidents too should readily volunteer information to the Headquarters Board periodically at Gas and whenever required. The Headquarters in turn should make this information available to MSAs in other parts of Africa. Knowing what happens in sister MSAs will automatically lead to integration and greater cooperation. Some MSAs will set standards for others to follow and this is good for the African Renaissance.

3.

FAMSA should set up Liaison Offices to international organizations like the WHO, UNICEF, AU etc in strategically chosen countries. MSAs in this country should contest for the hosting of the office at FAMSA GAs, and where there is only one MSA in this country, then it hosts permanently the Liaison Office. Securing steady support and collaboration, financial, moral and social, from the international organization would be the first duty of these Liaison Teams. The formation of these Offices should be like that of the Standing Committees.

4.

Workshops and seminars on capacity building and organizational development should form part of the training sessions to be scheduled during GAs. MSA Presidents should not be given precedence in the formation of the FAMSA Core or in any other FAMSA activity, because most MSA Presidents are clinical students who graduate within months or even weeks of leaving office. Making them part of the FAMSA Core will unduly increase the cost of training. The youths of MSAs are the trustees of the posterity of FAMSA. Beyond political and administrative concepts, we have to view as critical the future of FAMSA, and limiting the cost of ensuring that future should be our primary concern.

5.

The FAMSA Headquarters should appoint statutorily an Alumni Support Officer who is responsible for creating and maintaining a network of doctors who have worked for FAMSA in any capacity, even as members of adhoc committees. Alumni dinners or cocktails should be organised during FAMSA GAs for FAMSA alumni to re-unite and to meet the present FAMSA workers. This would ensure continuity in FAMSA. 6.

At MSA level, we have to work hard to increase participation in activities of the MSA. Project oriented MSAs will only survive if there are enough hands to do the work.

MSA Presidents and their EXCOS should not treat colleagues as subjects but rather as team players. The objectives of the FYA can never be achieved in an MSA with less than twenty percent student participation.

7.

The FAMSA statutes should clearly state what it would take to create or liquidate any FAMSA Standing Committee. The Standing Committees should be reviewed with a view to making them more contemporary, and more functional. Areas of possible funding should be identified before Standing Committees are set up, or maintained; for without funds, no organization will survive.

Without achieving these reforms, and others to be proposed by other FAMSA workers, it may be difficult to move on. We should first realize that this period is a period of reform, and reform is indeed necessary for progress to be recorded in our federation.

CONCLUSION The health effects of wars and conflicts are indeed great and diverse. The relationship between conflicts and HIV/AIDS spread, as earlier depicted, and the epidemic nature of conflicts and HIV/AIDS in Africa makes it imperative that decisive action be taken by all to arrest this wave of disease and tension.

All African organizations, political, religious, social, etc ought to contribute in this regard.

From the African Union (AU), to NEPAD, ECOWAS and other regional organizations, national governments, NGOs, studentsâ&#x20AC;&#x2DC; and labour unions, etc. Our FAMSA comes in here.

Our actions ought to be decisive and efforts concerted for us to achieve much in this regard.

Our FYA is a panacea in this direction. All MSAs should adopt the reviewed FYA early and begin to work towards the achievement of its ideals. We should increase participation in our local MSA activities for without this our projects cannot survive.

THE ROLE OF MEDICAL STUDENTS‟ ASSOCIATIONS IN DEEPENING THE EMERGING AFRICAN RENAISSANCE : The Impact of Conflicts on Health Omotayo M. Olanrewaju, Abioye I. Ajibola, Okuneye Taofik A. (Authors are Students of The Lagos State University College of Medicine, Nigeria)

REFERENCES Microsoft ENCATA Reference Library 2002 OMOIGUI Nowamgbe A.: Public Health Implications of Conflicts in Africa (nowa_o@yahoo.com) www.dawodu.com H.E. JACOB ZUMA: The African Renaissance: From Vision to Reality (Zuma, Deputy President of South Africa in a speech delivered at the African Renaissance Conference) THABO MBEKI‘s Speech at The Guardian Lecture delivered at the Nigerian Institute of International Affairs, Victoria Island, Lagos.

A Blueprint to create the African/Black World Renaissance (Nubian Empire News, January, 1st 2000) MBULELO VIZIKHUNGO MZAMANE: Where there is no vision The people perish: Reflections on the African Renaissance ANUP SHAH: Human Rights Abuses Committed by the RUF (http:// www.globalissues.org) GEORGE WRIGHT: Mobutu was chaos (Z Magazine) DEREK INGRAM: Lumumba Still Haunts the West (Gemini News Service, http:// www.oneworld.org/gemini/freebies/GAR275.html.)

UNICEF REPORT: Children at War FAMSA YOUTH AGENDA (www.famsa.8m.net) STEPHEN SAPIENZA & RACHEL STOHL: Child Combatants: The Road to Recovery (Centre for Defence Information)

REFUGEE CRISIS Mansur Ramalan

(Author is a Student of The Jos University College of Medicine, Nigeria) INTRODUCTION Violence and instability in Africa has been a major cause of refugee crisis in Africa. ―The arc of instability in Africa is linked together. The violence is interwoven‖ an analyst for an international humanitarian organization explained. The effect of this on civilians and the populace has been devastating. Fourteen years of warfare and pervasive human rights abuse against civilian populations throughout the West African region alone have cost up to a quarter million lives and left at least 1.1million people living as refugees or internally displaced persons as of mid 2003.

In a separate report by UNHCR, more than 3 million Africans were refugees at the end of 1999-about 200,000 more than that the previous year. Approximately, 10.6 million were internally displaced all over Africa.

We shall take a soft and smooth cruise around Africa to see the magnitude and impact of this violence starting from West Africa.

LIBERIA- CIRCLE OF VIOLENCE The journey starts from Liberia whose descent into civil war in late 1989 spilled into Sierra Leone in 1991, triggering a brutal 10-year armed insurgency there that remained closely linked to Liberia‘s conflict. Combatants from Sierra Leone and Liberia inevitably attacked border communities in neighboring Guinea in 1999-2001 pushing the violence into the otherwise peaceful country. Civil war finally engulfed Cote D‘ivoire in late 2002 after a decade of rising political and social tensions there. The violence in Cote D‘ivoire early this year attracted armed groups from Liberia and Sierra Leone. Now West Africa‘s blood shed has again returned to Liberia, from where it whence it began.

In Sierra Leone alone, 10 years of civil war left 50,000 people out of 5.5 million people dead and approximately a million people living as refugees or internally displaced and some 4,000 civilians deliberately maimed by rebels.

Sierra Leone herself currently hosts about 50,000 Liberian refugees in seven camps.

COTE D‟ IVOIRE- Cote D‘ ivoire has had her own share of the disaster since violence erupted in the once peaceful and stable country in September 2002, when rebel soldiers seized homes in the Northern half of the country in just a matter of days. The war pushed about 600,000 people from their homes.

An estimated 700,000 Liberians were uprooted as of late July, including at least 500,000 within the country and more than 200,000 living as refugees outside Liberia.

GUINEA- Haven for refugees and combatants‘ Guinea remains the primary asylum country for West Africa‘s refugees. Refugee influxes turning the 1990s were so overwhelming that, for several years, Guinea hosted the largest refugee population on the continent. About 120,000 Liberians and upto 50,000 Sierra Leoneans. Guinea Bissau erupted with fighting on June 7th when the army mutinied against President Joao ‗Nino‘ Vierra, after he had suspended and sacked then Ansumane Mane as chief of staff, virtually the entoke population of 300,000 of the capital Bissau was forced to flee towards the Western regions of the country.

UGANDA In Uganda, the anti-government, the lords resistant Army (LRA) consigned it‘s rampaging of terror, brutalizing civilians, destroying property, and abducting children in Northern Uganda in June this year, the LRA attacked a school and abducted thirty nine girls. The majority of people in North continued to line in protected camps, with inadequate access to housing, water, food, health care and education. In Western Uganda, the allied defense forces (ADF), another guerilla group waged war against the Museveni government. The ADF was reportedly responsible for numerous abuses against civilians including abduction of children.

BURUNDI In Burundi, a new constitutional arrangement between government and the leading opposition party followed by a peace agreement and projected cease fire led to hopes that the four

REFUGEE CRISIS Mansur Ramalan

(Author is a Student of The Jos University College of Medicine, Nigeria) year old civil war in that country might be brought to an end factions of some the parties that signed the agreement disavowed it, however and attacks by rebels and reprisals by the military continued, particularly in the Western part of Burundi. As elsewhere in the county side, civilians bore the brunt of suffering in this conflict, through attacks of both sides and through deprivation of food, medical attention and other services disrupted by the combat and economic decline.

ANGOLA The odds worsened for Angola‘s peace process and the country seemed dangerously close to renewed was. As a result, chances of any turn around regarding the plight of refugees and the internally displaced faded fast. Some 300,000 refugee into DRC, unrepatriated, the renewed belligerence caused further flows of refugees into the DRC, Namibia and Zambia. By September 2003, Angola an approximated 1.3 million internally displaced people.

During 1998, alone 142,000 people were registered as internally displaced.

LESOTHO Lesotho plunged into what appeared to be its worst crisis in its troubled post- independence history when South Africa and Botswana troops intervened to restore order after a long simmering dispute concerning the elections in May. Lesotho‘s capital Maseru and surrounding towns were seriously damaged by looting and aroon, largely carried out by civilians up to one hundred soldiers and civilians died and the thousands of refugees salt scurrying across the border into South Africa.

REFUGESS AND HEALTH Large influx of refugees places serious strains on the environment and social infrastructure. Health infrastructures are also over stretched and insufficient.

A large scale of the health problems of refugees results from the following: Destruction of health care structure Lack of access to health care Inadequate responses by health care providers.

Some of the problems faced by refugees are as a result of disruption of food supply.

This obviously leads to severe malnutrition. The gathering of food in the bush (e.g manioc, roots and mangoes) does not provide a complete diet.

Malnutrition brings about high mortility and morbidity and are thus the and result of conflicts.

Refugees are also faced with problems ranging from unusual infections to problems associated with migration and transition.

In many situations refugees are concentrated in urban areas which are usually over populated thereby exercebating the level of health problems in such areas. Therefore, the refugees themselves are not only the health problem victims but also their respective host communities can also be endangered to an extend.

SOLUTION TO THE REFUGEE AND WAR PROBLEM According to Bonaventure Rutinwa, this would entail a ‗political and economic agenda aimed at eliminating ethnic strife and conflict, curtailing arms trade, establishing a firm foundation for democratic institutions and governments, respect for human rights and the promotion of economic development and social progress‘.

Finally, meaningful solutions to the refugee problem should include initiatives aimed at enhancing international burden sharing both in emergencies and assistance to refugees.

ROLE OF MEDICAL STUDENTS Medical students can be mobilized to assist in war situations to assist refugees.

Nurse refugee victim of war and attend to those in camp We can also be a part of the voice against war and generation of refugees.

This can be achieved by: Education; through repeated paper presentations, talk shows and workshops like the African Regional Conference of FAMSA.

REFUGEE CRISIS Mansur Ramalan

(Author is a Student of The Jos University College of Medicine, Nigeria) Advocacy, advocating for viable legislation to protect the rights of refugees.

Networking; collaboration with other medical students associations to share information of work together.

CONCLUSION War is a big hindrance to progress in any society. Apart from creating refugees, the environment is worst affected even with the creation of refugees.

My African Brothers and sisters let us voice out against this unnecessary bloodshed and live in peace with one another.

REFERENCES 1. Dr. Bob Mtonga ―War the Mozambican experience‖, march 2003 at the African Regional congress of IPPNW Abuja, Nigeria 2. Ramalan Mansur Role of medical students as ambassadors of peace, march 2003 at the African Regional congress of IPPNW Abuja, Nigeria 3. Ramalan Mansur Youth violence and violents conflicts in Nigeria, march 2004 NADESTU conference Bayero University,Kano, Nigeria 4. Ramalan Mansur Nov. 2002. .‖How environmentally healthy is Nigeria?‖ A report to International Federation of Medical Students Associations (IFMSA) 5. International Federation Of Medical Students Associations (IFMSA) Standing committee on refugees and peace (SCORP) www.ifmsa.org/scorp 6. .Dr. Ime. J.A Youth violence in Nigeria, March 2003, Abuja Nigeria 7. Dr. Ime. J. A Effects of war on health, NIMSA SCOPEA Seminar presentation, 4th July Jos Nigeria 8. Dr. Ime J.A. Proliferation of small arms in west Seminar presentation. August 27 th 2004, Jos Nigeria 9.Africa, a continent in chaos- perspectives vol. 102,number12 December 10.IPPNW WEBSITE www.ippnw.org

*** RAMALAN MANSUR ALIYU STUDENTS NATIONAL REPRESENTATIVE INTERNATIONAL PHYSICIANS FOR PREVENTION OF NUCLEAR WAR (IPPNW), NIGERIA. ADDRESS DEANS OFFICE DEPARTMENT OF MEDICINE AND SURGERY, FACULTY OF MEDICAL SCIENCES, P.M.B 2084, UNIVERSITY OF JOS, PLATAEU STATE Nigeria PHONE +234-8036783737 E-MAIL; mansurfati@yahoo.com WEBSITE; www.mansur.faithweb.com

HIV/AIDS and The African Child Dr. Adeniyi Ogundiran MBBS, MPH, DrPH WHO Country Office, Nigeria HIV/AIDS and The African Child Presentation to FAMSA Regional Conference 27th October 2004 Dr Adeniyi Ogundiran MB.BS., MPH, Dr PH. Leading causes of death in Africa, 2000 Leading causes of disease burden in Africa, 2000 Burden of Disease in the African Child-1: Six countries account for over 50% of all worldwide deaths in children Three of these countries are in Africa Democratic Republic of Congo-DRC Ethiopia Nigeria Burden of Disease in the African Child-2: Most of the deaths in the African Child are due to : Malaria 22% ARI (Pneumonia)

21%

Diarrhoea

20%

AIDS

8%

Neonatal

25%

* Malnutrition is underlying cause in over 50% of all deaths Global summary of the HIV/AIDS epidemic, December 2003 Adults and children estimated to be living with HIV/AIDS as of end 2003 Children (<15 years) estimated to be living with HIV/AIDS as of end 2003 AIDS and The African Child Over 90% of the 3.3 million children living with HIV (in 2003) are in Sub-Saharan Africa Number of children living with HIV continue to escalate Majority of these children are infected through Mother to Child Transmission The under-five mortality has risen steadily since the HIV/AIDS pandemic began AIDS and The African Child HIV infection is associated with an increased frequency of common childhood infections In Africa Mother to Child Transmission of HIV is eroding the gains in Child survival in many countries The number of orphans has increased drastically since the HIV/AIDS pandemic Post natal transmission of HIV poses a threat to breastfeeding promotion efforts

AIDS and The African Child WHO and its partners (based on in-depth review of evidence) has defined 3-pronged strategy for the prevention of MTCT: Primary HIV prevention especially among young women

HIV/AIDS and The African Child Dr. Adeniyi Ogundiran MBBS, MPH, DrPH WHO Country Office, Nigeria Prevention of unintended pregnancy among HIV infected women Specific intervention to reduce HIV transmission from infected women to their infants AIDS and The African Child Specific intervention to prevent MTCT Use of Antiretroviral drugs-ARV Safe delivery practices Safe infant feeding practices *VCT services is crucial for success of the above interventions * WHO places high priority on working with countries to prevent HIV transmission and to care for persons living with HIV HIV prevalence in military personnel in Africa Nigeria: 11% among peacekeepers returning from Sierra Leone and Liberia vs 5% in adult population South Africa: 60-70% in military vs 20% in adult population Trends in HIV prevalence among pregnant women in Kampala, Uganda: 1991-2000 Initiatives to reduce Child Mortality IMCI PMTCT Code of marketing of BMS Neonatal care- IMPAC BFI-Breastfeeding Initiative Safe Motherhood and MPS VCT Infant and Young Child Feeding and HIV AIDS OVC Policies * All these will contribute to achieving the MDG4- of Reducing Child Mortality AIDS and The African Child Major constraints in managing children affected and/or infected with HIV: In most countries HIV/AIDS programmes are mainly donor driven Limited capacity for many governments to support: Free or subsidized VCT HIV test kits Accessibility and utilization of Paediatric ARV Grave economic and social-cultural problems Poor care & support for those affected and infected with HIV/AIDS AIDS and The African Child Children affected or infected with HIV/AIDS are a vulnerable group and at higher risk of death AIDS and The African Child Children infected and affected with HIV/AIDS need: Counseling and psychosocial support Enrolment in school Access to: shelter, good nutrition, health and social services on equal basis with other children Protection from abuse, violence, exploitation discrimination, trafficking and loss of inheritance THANK YOU FOR

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