When Muhammadu Buhari was elected president of Nigeria in 2015 — amid a wave of disgust towards the corruption that plagues his giant nation — he promised to put a stop to politicians flying abroad for medical treatment. It was a popular pledge, especially after revelations that the state spent $1bn a year on health tourism for rich elites while offering dire services for almost everyone else. He underlined his stance soon after taking office, telling a doctors’ conference he did not want “hard-earned resources” frittered away on officials seeking care abroad when it could be delivered at home.
Such fine and righteous words. So there was fury the following year when this leader in his seventies flew to London for treatment of an ear infection. This was “a tragic blot” on Nigeria’s image, thundered Dr Osahon Enabulele, a former head of its medical association. The new president, he added, should have used his minor ailment to focus people on the urgent need for domestic health reform.
But Buhari was not listening. He went off on several more trips and, by the end of his first term last year, had spent at least 170 days in Britain on health grounds.
Buhari is far from the only African leader to display such lack of faith in his own nation. Robert Mugabe died last year aged 95 in a Singaporean hospital, having so wrecked Zimbabwe and its medical system that life expectancy plummeted by 26 years at one point. “It is very symbolic the former president who presided over the system for three decades can’t trust the health system,” said one doctor after his death. Other physicians complained of carrying out surgery without even putting on protective gloves.
Meles Zenawi ruled Ethiopia for 21 years, suckering Western admirers who overlooked his savage repression as they fell for his talk of development — yet this wily despot died in a Belgian hospital. Omar Bongo ran Gabon for 42 years, then died in Barcelona having plundered his country’s wealth obscenely while leaving his tiny 2.2m population trapped in poverty.
Jose Eduardo dos Santos, who ruled and ripped off Angola for almost as long, travelled to the same Catalan city for treatment. Algeria’s former president went to a Swiss hospital after running his nation for 20 years, then suffering a stroke. Benin’s president went to France for surgery. Two Zambian leaders died abroad while receiving medical attention.
I could keep going with this list of shame — and these are just the leaders. All are surrounded by teams of aides and layers of acolytes, many showing similar hypocrisy as they fail nations filled with impoverished citizens then flit abroad to foreign clinics when falling ill. Almost one in six of the world’s population lives in Africa — yet according to the Brookings Institution think tank, the continent accounts for just 1% of global health spending. Now coronavirus has arrived, with 10,000 confirmed cases and 500 dead so far — which is terrifying, given the creaking state of public services and crowded living conditions in many places.
Yet if there is one glimmer of hope in these torrid times, perhaps the virus might force a few more African leaders to face up to the awful state of their health services. For suddenly many of the continent’s self-serving elites must stay at home if sick. More than half of Africa’s international airports have either closed or limited flights. Lockdowns are being imposed.
Even if the leaders could escape, there are restrictions on movement in many richer nations, while private medical services and doctors are being pressed into action on the pandemic frontline. And there are strong private facilities in some places. But if they or their families become infected, these rich and powerful plutocrats may have to confront the horror of seeking treatment alongside their fellow citizens in local hospitals, relying for salvation on medics who have complained for so long of being forsaken.
In Nigeria — which identified its first case in February and where a key presidential aide has already been infected — borders have been closed, international airports shut down and private jets grounded. The first fatality was an oil executive in his late sixties who had just returned from medical treatment in Britain.
“It’s going to be a lesson for those who think they can neglect the health system,” said Francis Faduyile, head of the Nigerian Medical Association. “The highest of the government officials, some of them will be infected, and they’ll have no option but to get local treatment.”
When Buhari flew off in 2018 on his fifth health tourism trip, he left behind a strike by healthcare workers. They were angered by the failure to spend adequate funds on medical facilities in Africa’s most populous nation. “There has long been medical tourism because our hospitals are grossly underfunded,” said a union official.
And it is not just politicians who have fled the system: almost half of Nigeria’s registered doctors have reportedly moved abroad to find better-paid or less stressful work. Many have moved to Britain. They leave behind a land with low life expectancy, high infant mortality and dire shortages of skilled staff to treat suffering patients.
Despite the massive oil wealth — much of it stolen by those elites who fly abroad when they fall ill — a baby born in Nigeria is likely to live more than three decades fewer than one born in Britain. One study published three years ago by Bangladeshi and Nigerian public health experts concluded that many of the nation’s citizens were dying from preventable conditions. Among them, they highlighted the worst tuberculosis rate in Africa, with almost half a million cases annually. Yet even basic things such as gloves, masks and paracetamol are often missing from frontline services. Only five laboratories could test for coronavirus in this nation of 190m people.
As I write there have been six recorded deaths and 254 registered cases, although as with many countries this will be a fraction of the real number. “This crisis has exposed in the worst possible way the evident weaknesses of our health system,” said Femi Gbajabiamila, speaker of the House of Representatives. “After this is over and moving forward, we must do everything in our power to ensure that we will never again come upon a moment such as this, as ill-equipped as we are now.”
Many countries are in a much worse state than Nigeria, where its thriving technology hub is springing into action to plug some deficiencies. Africa has about one doctor per capita for every 16 per head in Europe. Kenya has 130 ventilators for 50 million people. Compare this with Wales, which has more than three times as many for its three million citizens, and just bought another 1,035 to cope with this crisis.
Yet the east African country is better prepared than Sierra Leone — still recovering from the ebola epidemic that killed so many medical workers six years ago — which has one ventilator for 7.5 million people. Or the conflict-torn Central African Republic, which has three for a population of five million. Almost 20 countries have warned the World Health Organisation that they have no intensive care beds for their most severe cases.
African nations are often used to battling infectious diseases. Nigeria’s rapid reaction to ebola six years ago demonstrated an exemplary public health response, with effective screening, tracking and isolation. Populations are also comparatively young, so less likely to die from this disease. Yet there will still be horrible numbers of fatalities; the economic pain could be even more intense than in richer nations, with vital remittances already falling; and it may prove even harder to dampen down pandemic in the continent’s packed cities.
Already the aid industry is gearing up to beg for more funds, although the decrepit state of many African health services offers grotesque proof of persistent failure. The former aid secretary, Rory Stewart, pointed out Britain has pumped £4.5bn into Malawi over half a century yet the country became poorer. Now we discover it is so badly corroded by corruption and bad governance that it has only about 25 intensive care beds in public hospitals that cater to 17 million people.
We hand about £100m a year to Uganda — which is run by a repressive kleptocracy and deceived donors over refugee numbers to obtain more funds — yet reportedly it has just 55 emergency beds for its 43 million citizens.
These numbers indicate pitiful health systems, even before the virus strikes to expose their deficiencies, and despite the noble efforts of many local health teams. Two weeks ago the pop star Bobi Wine, who has bravely challenged Yoweri Museveni’s festering regime in Uganda, sent me a bouncy new song called ‘Corona Virus Alert’ that aims to spread a message of prevention, social distancing and hand washing. In an interview with a news agency, he argued that Africa’s leaders needed to build better health systems to serve all society instead of spending so much on weapons and silencing their critics.
“For a long time we have been calling out the government of Uganda, like many governments on the African continent that have neglected health care systems,” he said.
“This is the time for them to remember that a functional health care system is not only a benefit for the poor but also the rich, because right now, as we stand, they can’t travel abroad for medical care. They have to face the same ailing medical care to deal with them. And this should be a message to them.”
Bob Wine is right, like many other activists making similar points in other parts of the continent. So dare we hope that amid the fears and tears of this vile pandemic, some of Africa’s most venal politicians and grubbiest elites might finally be forced to accept the devastating consequences of their selfish actions? Or will they just waltz away again once their dance with this deadly virus has ended?