Covid-19 And Humanitarian Crisis: A Look At The Conflict Hit North West And South West Regions Of Cameroon

Cameroon’s two English-speaking regions host about 4 million people and makes up approximately 20% of the country’s total population [1]. These two regions have been the stage of a violent and deadly unrest which begun in 2016 after a strike action by lawyers and teacher’s to protest government’s effort to impose the French language in the judiciary and educational sectors was met by violent repost. Protesters only got inflamed and a violent crackdown by security forces has resulted in a viscous cycle with uncountable losses in human lives from all sides of the conflict[2]. The conflict quickly became armed as both factions took up arms and engaged each other. On one side, separatist groups calling for an independent Ambazonia Republic and on the other hand, the Cameroonian defense forces which deployed the military and elite teams to crackdown on the separatists.[3]. The government’s response with a full-blown counterinsurgency operation executed by the military has not been without setback, as they have been accused of engaging in extrajudicial executions, excessive use of force, the torture and ill-treatment of suspected separatists and other detainees and the burning of homes and property [2].  In some villages as many as 80 % of the population is reported to  have sought refuge in the forest and other hideouts, where they have little or no access to shelter, water or sanitation. Schools were ordered shut by separatists while others were burnt and teachers attacked and maimed. Fear of retaliatory attacks have kept many shut till date. According to UNICEF, 9 in 10 children have been out of school for three years and between 23% and 65% of hospitals are not functioning in these regions [4].

COVID-19 SITUATION IN THE CONFLICT HIT NORTH WEST AND SOUTH WEST REGIONS

As of August 26^th, 2020, Cameroon had reported a total number of 19,142 COVID-19 cases; of which 17,651 had recovered (recovery rate of 92.2%) and 411 had died (case fatality rate of 2.1%) [5].

The conflict-hit Northwest and Southwest regions put together, have recorded a total of 1531 cases (795 in the Northwest and 736 in the Southwest) of COVID-19 by August 26^th, 2020. Out of the 795 cases registered so far in the Northwest region, 644 have recovered; thus, a recovery rate 81% registered so far in the region. Similarly, the Southwest region has registered 635 recoveries from the 736 cases registered and thus a recovery rate of 86.3%. Key points to consider here are that; 80% of COVID-19 cases are said to recover from the disease without needing special treatment [6] and the recovery rates registered in these two regions are lower the national value which stands at 92.2%. The worst recovery rates in the country are registered in the Eastern (79.5%), Adamawa (54.6%) and Far North regions (41.6%).

Furthermore, these regions (Northwest and Southwest regions) as of the above-mentioned date, had respectively reported 36  and 32 COVID-19 related deaths, translating to CFRs of 4.5% and 4.3% respectively; which are both above the global CFR (3.1% as of August 31^st, 2020) and twice the value for the national CFR (of 2.1%). The highest values for CFR are observed in the Northern (9.3%) and Western (5.2%) regions of the country.

Elsewhere, the Northwest and Southwest regions are among the regions with the highest number of health workers who have been infected with COVID-19. As a matter of fact, of the 812 health workers infected with COVID-19 in Cameroon (as of August 26^th, 2020), 204 (25%) are from the Northwest and Southwest regions. According to Cameroon’s COVID-19 Situation Report N°45, of the 20 COVID-19 health worker related deaths registered as of August 26^th, 2020 nationwide, 0(0%) was registered in the Southwest region, whereas 5(25%) were registered in the northwest region of the country.

A look at the COVID-19 infection rate by region puts the Northwest (34 cases per 100,000 inhabitants) and Southwest (40 cases per 100,000 inhabitants) regions in the 6^th and 7^th position out of the 10 regions. Using the benchmark of 50 cases per 100,000 inhabitants, which was set by the German government as a critical level for a possible reintroduction of COVID-19 restrictions [8], these regions are found to have a cumulative infection rate lower that the benchmark value. The Centre, Littoral, Eastern, Southern and Western regions are the regions within infection rates higher that the 50 cases per 100,000 inhabitants benchmark value. The high number of persons displaced from the Northwest and southwest regions into the Centre and littoral regions are suggestive of the high infection rates observed in the Centre and Littoral regions.

Table 1: Stratification by region of some Key COVID-19 indicators in Cameroon

*HWs= Health Workers  *CFR=Case Fatality Rate  Data. source: Cameroon: COVID-19 Rapport de Situation N°45, 20 au 26 Août 2020

SIMILARITIES AND DIFFERENCES BETWEEN THE COVID 19 PANDEMIC AND THE ANGLOPHONE CRISES

Residents in Cameroon’s crisis- hit Northwest and Southwest regions are torn between insecurity and the rapid spread of the coronavirus. Frequent gun battles, lockdowns, road blocks and now the COVID-19 pandemic have made life difficult for the majority of inhabitants in the regions. The major difference between the COVID-19 pandemic and the anglophone crises is that fact that one is a natural or health crisis and the other a humanitarian crisis. On the other hand, both situations have some things in common: lockdowns which limit population movements, fear of the unknown (becoming target or victim of gun battles and risk of infection with the coronavirus), increasing number of deaths and increasing corporation between the government and the population to curb the further spread or escalation. In addition, security forces have had a major role to play in both crises where on one hand they enforce wearing of masks and lockdown measures in the context of the pandemic and on the other hand they are deployed to secure public and private structures, protect civilians and neutralize rebels. Although allegations of excesses in the execution of their functions have been reported in both crises situations, their presence on the field has no doubt contributed to preserve countless lives.

IMPACT OF THE ANGLOPHONE CRISES AND COVID-19 IN THE CONFLICT HIT NORTH WEST AND SOUTH WEST REGIONS

• Reduction in Medical activities and Humanitarian aid: For both the government of Cameroon and partners (NGOs and other organization), the presence of both a humanitarian and health crisis will require an adaptation of their activities. Lockdown measures imposed by both the health crises and the humanitarian crises will mean difficulty to transport medical supplies to areas where they are most needed as well as restriction of access for humanitarian projects. Elsewhere, there are limitations with respect to human resource as some health workers have been victims of attack and have had to run for their lives. In some areas, health facilities have been burnt down.
• Hunger and frustration: According to a recent survey carried out by the National Institute of Statistics (NIS) in Cameroon, the coronavirus pandemic did not only have perceptible effects on the lifestyle of the population but also negative impacts on their standard of living. According to the institute, the pandemic caused a slowdown in activities (customers/productions) for up to 74% of the population. Sixty-five (65%) of the people assessed indicate that as a result of this drop in their activities, their salary/income decreased. Furthermore, NIS further states that the pandemic has led to a deterioration in the standard of living of 60% of people. This deterioration is more pronounced among the very poor (79%), in the North-West (78%), in the South-West (77%), and in Douala (72%) [10].
• Disruption of routine healthcare activities: It will not require one to be rocket scientist to see that with the lockdowns imposed by both crises, restrictions in movement of persons, reduction in the purchasing power of citizens, burnt health facilities and reduced health workforce, have had serious negative effects on the continuum of routine healthcare activities (HIV, non-communicable diseases, vaccination, malnutrition, etc.). Additionally, some inhabitants have become scared of health facilities as they consider them as COVID-19 infection grounds. Elsewhere, focus in terms of resources (money, health workforce etc.), has been on COVID-19 with little attention given to routine non-COVID-19 related health care activities.

CONCLUSIONS AND RECOMMENDATIONS

1. Several similarities exist between the humanitarian crises in the NW and SW and the COVID-19 pandemic in terms of the impact and required action. We recommend that the similar efforts and means be allocated to fight both crises simultaneously paying attention to protection of basic civic liberties, human rights and security.
2. Mobilized efforts and concerted action of all players in society is required to bring an end to both the sociopolitical Anglophone crises and the heath crises. Collaboration between all factions of the Cameroonian society should be encouraged irrespective of political, religious or ethnic affiliations.
3. Both crises have significantly affected the lifestyle and living conditions of inhabitants of the NW and SW regions. The effect of both crises has been additive and probably multiplicative in certain regards. Government should play a leadership role and concert with experts and civil societies to develop context adapted measures that will allow people to go about their day to day activities in a way that will restrict the spread of coronavirus. This way, inhabitants will be able to improve their living standards and better their living conditions and decrease dependency on humanitarian aid which is more and more rare and inadequate.
4. Government, through its ministry of health should intensify efforts and come up with innovative ways (by means of research) to ensure the continuum of care as far as routine non COVID-19 related medical activities are concerned