We stopped where the mountain ranges of the Great Rift Valley practically end. The immense fault, which runs from the Jordan Valley to Mozambique, in about ten million years will be an ocean, filled with salty water, a sea that will grow and grow in the middle of two pieces of land, leaving the Horn of Africa alone, floating away from its motherland. This is the cradle of humanity.

Great Rift Valley

The silence was one of those that wake you up from the lethargy of travelling for hours and hours following the straight line of a reddish track and hypnotized by the immense savannah that opens on both sides of it. That was what you heard when you stopped the engine: the language of the earth. The sound of acacia trees in the dry season and their hundreds of pods moving to the sound of the breeze from the nearby Indian Ocean, the almost imperceptible rustle of the dishevelled branches of the baobabs, the sound of the dry molasses grass that has given so much shelter and, still gives it, to the inhabitants of this central corner of the planet.

Baobab

Mírate. All of this happened in a place that was given the name of Mirate. From the administrative centre, located on a small hill, I could see the immense earth-colored plain dotted with some colonial buildings. At the top of the slope, a health centre that I had visited years ago. To my left, a camp for refugees. Zura, the director of the health centre, says that almost 3,500 have already arrived since the conflicts began in Cabo Delgado in 2017. And this, it is one of the areas that have taken in fewer people. Other districts have doubled in population.

The influx of refugees has stopped. There is no one left to flee in the northern region of the province. The insurgents, and the shock wave of fear they instil, occupied almost a third of the province. They attacked communities, villages, beheaded people and burned houses. The population fled to the south, and the land was left empty, as it “came into the world”, like a naked baby just given birth.

Just over a month ago, a Rwandan military contingent of about 1,000 men landed at Cabo Delgado. Fully equipped, Robocops “liberated” the guerrilla-occupied zone in a few weeks. One of the largest gas reserves in Africa, located in the north of the province, on the riverbed of the Rovuma river, will be able to operate again in a year. The French company TOTAL has the concession. Some international media suggest that France has subcontracted Rwandan troops to “cleanse” the area of insurgents and allow the mega project to continue. It is like a continuous chess match, an endless game for resources. The board is, once again, Africa.

Province of Cabo Delgado

There have been no relevant fights. The insurgents that some media, simplifying as always, has labelled jihadists, have disappeared. Many analysts point out that they have hidden in the savannah, in settlement camps, in villages or even in Pemba. The conflict is not overt yet. Months of lethargy are coming, but the local discontent is deep. The rage and anger has been building up for centuries. The deprived have learned that it is not so difficult to hurt to be known and instil fear. Attacking techniques are very likely to change. Peace, like a feline of the savannah, will not be seen so easily in the coming years.

Life does not stop and in the resettlement camos dynamism is picking up space. The refugees build new houses with reed structures, mud walls and roofs of molasses grass. Some receive tarps from UNHCR; or IOM;. Some children play “Ludo”, an African game similar to pachisi. A woman grills an antelope leg that has been hunted nearby. In some resettlement centres, brick structures, schools, health centres are already being built. In others, health is offered from trap tents and brigades of health workers going up and down.[1][2]

[1] UNHCR: United Nations High Commission for Refugees.

[2] IOM: International Organization for Migration.

Reed structure of a house under construction. Marocane Resettlement Center.

No one has returned to the “liberated” areas yet. There is a lot of fear and trauma. Nelson Ernesto, nurse and health director of Mocimboa da Praia, tries to organize his people from Pemba. He lives a double reality: he is a health worker and at the same time a refugee. He tells me that if the government tells him that he has to return, he will do so, but he confesses that he is afraid. Furthermore, he is from Inhambane, a province almost 2,000 km from here that was baptized by the settlers as “terra de boa gente”, a haven of peace. Likewise, he tells me about returning home, referring to Mocimboa: “no one has a plan” he comments. “It is possible that some family members begin to return and leave part of the family in the resettlement camps, until long-time passes and the population feel safe again, there will be no mass return ”. When I listen to him, I think of the many families that have been divided, of little ones who will not see their parents for a long time, I try to imagine, unsuccessfully, what it means to grow up in a settlement field that is not your land, pending the food sacks of the PMA. I think about the years to come, and I see chaos.

How to restructure a health system, which was already insufficient, in such a volatile and unpredictable reality? Where to build the new centres? How to mobilize resources? Where to allocate the workers? I feel like we have gone back almost thirty years, when the civil war in Mozambique ended and everything had to be done. Every day I see dozens of humanitarian aid organizations running up and down, serving the population and, sometimes, brushing, just sometimes, the health system itself. I feel the information opacity. I live incoordination.

Team in Cabo Delgado identifying a new project. From left to right, Ivan Zahínos, Xavi Modol, Justo Calvo and Daniel Rodríguez.

It had been a long time that, working in Africa, I had not felt the contradictions, the doubts, and also the anger so strongly. I have had flashbacks that have taken me to the wildest Angola back in 2005, when little by little I began to be aware of the vast resources that existed in the subsoil, to see the opulence of those that accumulate, both those from here and that ones who negotiate with them from western capitals, to feel anger at the ridiculous crumbs that are invested in the population, to the circus that international cooperation and aid often becomes, to reach the conclusion that we are a drop in an ocean of disinterest, to ask myself many times what the hell am I doing here?

Yes, this trip I have also asked it myself, every day. When you have put in a brutal effort to attract investment, build health centres, train personnel, etc. and you see that everything comes to nothing, it is difficult to find the meaning to continue. When you know that we are nothing more than ants running through African lands, at the mercy of the warlords and businessmen who have always worked the same, from elite to elite, I think you ask yourself what the hell am I doing here? It is pure mental health.

In Mirate, in that silence, I look at Xavi[1]. He started our work here in 1994, living, working and practising as a doctor for years. He knows the system from the inside. It left him ranking, but working, at his pace, growing slowly, with its lights and shadows, with a government that never gave it the priority it needed and with donors who cackled like chickens in a corral, without order or concert, each one with his vision of what should be done. He left it to go to work in conflict zones: Afghanistan, Yemen, Syria … I look at him and wonder if he ever imagined that he was going to return to a Cabo Delgado at war.

[1] Xavi Mòdol. Specialist in Health Systems in Conflict Zones. Former medicusmundi employee, currently an international consultant. Hired by medicusmundi to carry out an evaluation of the impact of the armed conflict on the health system and a proposal for reinforcement.

Xavi Módol

In an almost rhetorical question, since I was the one who brought him here, I ask aloud: Xavi, what the hell are we doing here again? With the calm that the years offer, he replied, “to help keep the system alive, if we don’t let it die, it will still be able to serve some of these people.” I needed to hear it. I recap. Furthermore, I think about the network of health centres that we have helped to build, more than half of the southern and central areas of this province. Indeed, it is time to go further, it is time to deepen the information, to map, to plan, to restructure, to reinforce, not to drop the little that exists. At the same time, there is no other option but to offer immediate services, temporary health centres, basic livelihoods… It is perhaps time to continue, even though we are aware of how little the future of this continent will change, but without that makes us stop.

I imagine the ocean that will cover this earth in ten million years. A human life is nothing, not even a second, compared to the life of the universe. I don’t know if the idea terrifies or comforts me. After all, we may not be able to end the planet, no matter how hard we try, and perhaps this temporary irrelevance is what helps me get the most out of every second of my life, aware that it is very short and that I will not have another. Maybe it’s what keeps me here.

I think of all the “failures” of my life. In which it did not turn out as expected. How good it was to try!

I would repeat everything. That is what I am doing.

Iván Zahínos
International Relations Coordinator
medicusmundi mediterrània

Translated from Spanish into English by Susanna Pujol Clivillé