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Graves of children who died from malnutrition, Dadaab <em>Picture: Andy Hall/Oxfam</em>

Graves of children who died from malnutrition, Dadaab Picture: Andy Hall/Oxfam

By Nicole Johnston

Secretly, I was rather dreading Dadaab. For weeks I’d seen the images on TV: babies so emaciated they looked like a bundle of twigs wrapped in cloth; elderly people dying, their faces shrouded in a cloud of flies. I was bracing myself, mentally preparing to try to bear the unbearable and do the best job I could.

I hadn’t reckoned on being buoyed by the incredible energy that is generated by the half a million people living in the world’s biggest refugee camp, by engaging with people as three-dimensional human beings instead of cardboard cut-out caricatures of suffering, and most of all by their hope.

This is not in any way to diminish the real tragedy that is unfolding in the Horn of Africa – and will continue to unfold if the famine worsens in Somalia, as the United Nations predicts. But while those terrible pictures of death and suffering – the “famine pornography” as it has come to be known – are undeniably part of the picture, they are not the whole picture.

What those images do not show is the incredible resilience of the refugees, their ability to envision a better life for themselves and their fierce dignity in the face of experiences that would leave most of us crushed.

What humbled me most were the many stories I heard about villagers who themselves had almost nothing, sharing food and water with the refugees as they fled Somalia, simply because their humanity would not allow them to turn starving people away.

I met a man who had walked for five days – in the “wrong” direction, against the streams of people leaving – to rescue his late brother’s child before turning around and collecting his own family for the 30-day trek to Dadaab.

In Ifo camp we met a refugee who had been been diagnosed with breast cancer, had a tumour removed in Somalia and subsequently lost her breast. She reminded me that being a refugee does not exempt you from the other horrors of life. Along with her four children and elderly mother she had been taken in by a member of the longstanding refugee community in Ifo, who has managed to build a brick house. “I couldn’t let this woman go stay in a tent – it is my responsibility to help her and make sure she is taken care of,” her host told me, surprised that I would even ask why she was helping.

Doctors in the camp say her cancer is too far gone and there is nothing more they can do for her, but that hasn’t stopped volunteers from Global Somali Emergency Response – a group of Somali students from the across the diaspora – raising money to try and help her access more specialised treatment.

We visited her several times, and each time we joined the road to her house, total strangers would flag us down and say “Are you going to visit the sick lady? Please try to help her.”

During Ramadan I was touched to see members of the long-term refugee community distributing dates, milk and maize meal to newly arrived refugees. Abdulahi Mohamed Sahal has lived in Dadaab for 20 of his 23 years, his family having arrived during the last major famine in the early 1990s. “This food is a welcoming gift from our community, bought with donations from mosques. We see people who are hungry, so we should help,” he explains simply.

Within days of arrival, those refugees who have the means will set up small shops, while others will sell their skills as tailors or teachers. Many will sign up for “cash for work” programmes run by NGOs such as Oxfam, where refugees and members of the local host community can earn money by digging trenches, laying water pipes and casting latrine slabs. Parents club together to pay a teacher to run a madressa, where children sit in the open air under the harsh sun. They have no books, blackboards or pencils, so they practice writing on wooden boards using home-made ink. No one I met was sitting around with their hands out: everyone was making a plan to improve their lives.

The reality is that people in Dadaab are as complex and human as anyone else, anywhere else: on more than one occasion we were told to bugger off by people who have had enough of foreigners with notebooks and cameras. Those who portray the refugees as either uniformly tragic, or as unvaryingly grateful happy people do not do justice to their humanity.

What the TV cameras cannot capture is the energy and commitment of the scores of aid workers in the camp. The majority of the people who work installing water tanks, processing refugee documentation and distributing food are Kenyans – a far cry from the stereotype of the “White and Western” aid worker who parachutes into a context they know nothing about.

Many of them are Muslim and I was awed by their capacity to work a full day in the field, in extreme heat and dust, while fasting. The feminist in me enjoyed the fact that our team is managed by a group of no-nonsense East African women, all experts in their technical areas – and nothing like the stereotype of the disempowered African woman.

It was gratifying to see their hard work bearing fruit and to witness how donations from across the world were transformed into tangible humanitarian aid: clean water running and latrines built, sleeping mats, soap and pots and pans for new arrivals. It was good to witness progress in improving refugees’ living conditions, as families were moved from Dagahaley into newly erected tents in the Ifo II camp, where there are much needed facilities such as schools and clinics.

But most of all, as an African this crisis has also increased my conviction that we can make a difference. It has galvanised our sense of ubuntu, with ordinary citizens across this continent showing solidarity with fellow Africans. The fundraising efforts of groups such as Kenyans for Kenya and Gift of the Givers have encouraged people to dig deep for the crisis, with citizen contributions often surpassing the amounts donated by national governments.

While the amount pledged by most African governments in Addis Ababa recently was – as civil society coalition Africans Act 4 Africa put it – “paltry”, the bright spot of the day was an address by 11-year-old Andrew Adansi from Ghana. He became a media darling when he was so moved by TV reports on the plight of Somali children that he raised money from his school friends. To date, he has raised $4,000, and wasn’t taking any prisoners at the African Union: he warned the leaders who hadn’t coughed up that he would visit them personally to collect their cheques.

There is a Somali proverb that says “If people come together, they can even mend a crack in the sky.” It won’t be easy, but my experience in East Africa has shown me that the will and the courage are there.

Nicole Johnston is an Oxfam regional media and communications coordinator for Southern Africa.

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Rikers Island <em>Picture: US Geological Survey</em>

Rikers Island Picture: US Geological Survey

Sometimes I think that that the day of rationality has dawned and that humanity has finally achieved civilisation.

I had one of these epiphanies when I heard the radio tell me that the Head Bean Counter of the International Monetary Fund, Dominique Strauss-Kahn, had been imprisoned on Rikers Island.

At last, I thought, somebody is asking hard questions about the IMF’s doggedly monetarist approach – especially to do with the minor issue of brown people getting food.

About time, I thought, as I reached for the Cohiba cigar (Che’s favourite smoke) that I had been saving for just this occasion. I savoured the prospect of this phenomenon cascading, with David Cameron and Nick Clegg throwing each other to the shower daddies in Joliet. And Tony Blair starring in a new reality TV show called: “Britain’s got life sentences”.

But the radio bulletin explained that the less-than-delightful Dominique is being held not for his IMF activities but for attempted sexual assault. He was (allegedly) trying to do literally to a hotel employee what his organisation has done metaphorically to developing nations the world over.

Reality crashed in. Rampant unfree corporate capitalism roams unfettered. I extinguished my Exquisito in a mug of Campaign Coffee (it made it taste better) and put on the telly to make myself feel better.

What was on? The Scheme – a documentary about everyday folk in the charming Kilmarnock suburb of Orthanc.

For the first ten minutes I was convinced it was a work of dark comic genius dreamed up by Chris Morris and the Chewin’ the Fat team. “Recovering drug-addict Marvin is pinning his hopes on a stable life with a former girlfriend … when she gets out of prison.” (A high point for Marvin is when the methadone-addicted teenager gets her electronic tag changed so they can live together. I don’t think even Clintons have a card for that romantic milestone.) How about the chubby lassie who utters the immortal line: “I’m a pole dancer. If any of you want a go of me. £10 a go”? And who could forget: “He’s never been arrested sober”, or “He called him aw the Bin Laden bastards so they done him for a racial”?

All the comedy staples are there: unusual dentistry, Old Firm tops and Burberry aplenty, pregnant teens smoking heavily and disabled spaces for the clearly able-bodied. Every one a coconut. As for the use of the C word: less is more, chaps, especially in front of a five-year-old who’s supposed to be at school.

It is so tempting to laugh at these people off as neds, chavs, pikeys, schemies and junkie scum. It would be so easy to crack open a bottle of Tempranillo and ponder ethnically cleansing “them” through a combination of sterilisation and dramatically increasing the purity of street drugs.

It is also tempting to take the other course, pursing one’s right-on lips and writing off The Scheme as “poverty porn” that misrepresents the Onthank community or exploits the yadda, yadda, yadda.

We need to stop pretending that The Scheme does not happen on streets all over Scotland. And we need to realise that it isn’t funny. The bottom line is that there are many, many Scots who lead miserable lives made chaotic by an excess of drink, drugs, violence and crime and a deficit of education, opportunity and responsibility.

The tragedy is that many of these Scots are children: with a quarter of under-16s north of the Border living in poverty. 150,000 Scottish children have to deal with substance-abusing parents. Our care system sees too many young people graduate to prison – with more than 25 per cent of those in “jile” having been through it.

People in Scotland – one of the most advanced countries in the world – die of malnutrition. We drink too much, eat garbage and die younger than we need to. Our mental health problems cost the country more than £10bn a year. We have a disgracefully high suicide rate.

Ah, wha’s like us?

And what the hell are we doing about it? Poverty does not seem to be high on the political agenda, despite being the root of crime, ill-health, drug abuse and all the associated costs to society.

But by tackling these issues we’d slash billions from the health, welfare and crime budgets. Where are the radical ideas to solve these problems? As the tragi-comic Scheme shows us, we’re getting nowhere fast.

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Sir Robert Peel, 1788–1850

Sir Robert Peel, 1788–1850

By Elizabeth McQuillan

Scottish physicians, as early as the eighteenth century, recognised that poverty was inextricably linked with poor health. Whether in the overcrowded industrial centres, or working the land, the effects of poor diet, overwork and inadequate shelter led to “debility”.

In 1846, the potato blight that had caused the Irish poor to suffer the pain of starvation arrived in Scotland. The areas hardest hit were the Highlands and Islands, where the people relied on a successful crop for sustenance. The result was a Highland famine.

The humble potato provided a high yield on the small plots of land left for cultivation due to the Highland Clearances. With little other food being grown to sustain the local people, the failure of the potato crop proved disastrous.

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The crofters looked to their chiefs to provide help at their time of greatest need, but help was often not forthcoming, with the landlords by now looking to replace their tenants with sheep at the earliest opportunity. Many turned a blind eye, some simply evicted their tenants (many were reduced to living on the streets of Inverness), and a few hired boats to transport their tenants off their own land to foreign territories.

The government did eventually intervene and provided rations of oatmeal – 680 grammes for men, 340g for women and 280g for children – but not without the crofters showing that they were still working for their food. Despite having a calorie input that barely sustains basic physiological function, the crofters were expected to work eight hours per day, six days per week.

Unsurprisingly, the people suffered terribly with the many medical problems that famine brings: malnutrition, scurvy, typhus and cholera. This lasted for a full ten years while the crops failed. There was little, if any, medical help available.

The Poor Law in Scotland did not make provision for the care of the walking sick (which most of the victims were) in the local parish. William Pulteney Alison, Professor of Medicine at Edinburgh University, along with other Scottish social reformers of the time, demanded in the House of Commons that the Poor Law must be altered to ensure that every parish had the services of a resident medical officer.

Sir Robert Peel, the prime minister, was not keen, but the pressure remained on and Peel eventually (in 1848) conceded a compromise. An annual grant of £10,000 was made to the Board of Supervision of the Poor Law to finance a subsidy for any parish that agreed to finance the formal appointment of a medical officer.

The people of the Highlands and Islands needed particular help. Following the Napoleonic wars, cattle prices had dropped to make their meagre stock worthless, the kelp industry that provided employment collapsed, herring fishing failed and there was a general recession in Scotland. The potato blight simply compounded the problem of abject poverty.

Ultimately, the Poor Law did not help much. The doctors who relocated to the Highlands and Islands as medical officers, hoping to make a living, soon realised that life was tough. Attending patients was difficult due to the large distances and inhospitable landscape, as well as bad weather and the problems of having to often travel by boat. Most patients were so poor that they could not afford to pay. Many doctors returned home.

Sympathy for the plight of the suffering Highlanders was not overwhelming from lowland and English quarters, and the notion of state handouts was not encouraged. Many ideas were put forward to deal with the problem, but the physician Coll MacDonald could see the way forward:

“The simplest and cheapest plan to give medicines and medical aid to tens of thousands living in the Hebrides would be to employ a few sober men of good character and energy, provided with medicines and instruments and a small steamboat (as the Marquis of Salisbury has done for Rum) to move constantly about among the people when they could conveniently assemble to be cured of their diseases. By this plan [salaried medical practitioners] would more economically and efficiently be brought into contact with the sick and the maimed than by the establishment of stationary practitioners.”

This idea was ahead of its time, but in 1913, the same ideas reappeared in the creation of the Highlands and Islands Medical Service, the first comprehensive and free state health service in Britain. Though the advent of world war one delayed the roll-out of the Highlands and Islands Medical Service, more than 300,000 people across Scotland were covered by the 1930s. It offered a model for the wider national scheme, the National Health Service, which finally came into being on 5 July 1948.

Reference: Royal College of Physicians, Edinburgh

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