Introduction 1

INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY Geography Eritrea is situated in the Horn of Africa and lies north of the equator between latitudes 12o22' N and 18o02' N, and longitudes 36o26'21" E and 43o13' E. It has an area of 122,000 square kilometers. To the east, the country is bordered by the Red Sea, extending about 1,212 kilometers from Ras Kasar in the north to Dar Elwa in the southeast. Djibouti borders Eritrea in the southeast, Ethiopia in the south, and the Sudan in the north and west. Administratively, the country is divided into six zobas (regions): Anseba, Debub, Debubawi Keih Bahri, Gash Barka, Maekel, and Semenawi Keih Bahri (see map). Eritrea is a land of contrasts with land rising from below sea level to 3,000 meters above sea level. There are three major physiographic zones: the Western Lowlands, the Central and Northern Highlands, and the Eastern Lowlands (also referred to as the Coastal Plains). Temperature varies with altitude: the mean annual temperature ranges from 16o-18oC in the Highlands to 28oC in the Lowlands to more than 30oC in the Coastal Plains (Ministry of Land, Water and Environment, 1997). Most of the Western Lowlands and Coastal Plains are associated with hot and dry climatic conditions, while the Highlands are relatively cool. The presence of flat land, relatively fertile soil, and a milder climate makes the Central Highlands a center of rain-fed agricultural activity. Several of the major urban centers of Eritrea, including the capital city, Asmara, are located in the Central Highlands zone. During good rains the Western Lowlands have a potential for cultivation and agro-pastoralism. The Coastal Plains is the location of the two major port towns of Eritrea, Massawa and Assab. In general, the Central Highlands is the most densely populated part of the country, while the Lowlands are sparsely populated. Rainfall in Eritrea ranges from less than 200 mm per annum in the Eastern Lowlands to about 1,000 mm per annum in a small pocket of the Escarpment; the annual rainfall in the Highlands ranges from 450 mm to 600 mm. The southern part of the Western Lowlands receives 600-800 mm per annum, but rainfall decreases substantially as one moves northward. The extremely low rainfall in the Eastern Lowlands causes aridity and a hostile environment for agriculture, grazing, and industry. There are two major periods of precipitation in Eritrea. One, from June to September, covers both the Western Lowlands and the Highlands. The second comes between October and March and covers the Eastern Lowlands. History Because of Eritrea’s strategic position on the Red Sea, it has fallen victim to many invaders and colonizers. The Ottoman Turks controlled the northern and coastal areas from the middle of the sixteenth century to the second half of the nineteenth century, when Egypt evicted them from their last stronghold, Massawa, in 1872. With the opening of the Suez Canal in 1869, the European colonizers became interested in the Red Sea and Horn of Africa. Italy, after establishing a foothold at Assab through a maritime company, Compagnia Maritimma Rubattino, extended its control, and declared Eritrea its first African colony in 1890. In 1941, Italy was defeated by the Allied forces, and Britain took over the administration of Eritrea. In 1952, after 10 years of British colonial rule, Eritrea was federated with Ethiopia by the United Nations against the will of the Eritrean people. A decade later, Ethiopia abrogated the federal arrangement of the United Nations and annexed Eritrea as one of its provinces. This led to the Eritrean struggle for self-determination, which resulted in a destructive war lasting from 1961 to 1991. Introduction | 1 Two years after the end of the war, a United Nations supervised referendum was held to determine Eritrea’s political status; 99.8 percent of the voters chose independence in that referendum. Independence was formally declared in May 1993. Thereafter, Eritrea became a member of the United Nations and many other international and regional organizations. Economy Agriculture and pastoralism are the main sources of livelihood for about 80 percent of Eritrea’s population. The agricultural sector depends mainly on rain, with less than 10 percent of the arable land currently irrigated. Consequently, productivity is low and the agricultural sector, including livestock and fisheries, accounts for only one-fifth of the gross domestic product (GDP). Eritrea is one of the poorest countries in the world, with GDP per capita of about US$ 200, well below the average US$ 270 for less developed countries (UNDP, 2001). The war for liberation destroyed most of Eritrea’s infrastructure and devastated its economy and environment. This compelled Eritrea to reconstruct its social, economic and physical infrastructure entirely. In an effort to place the economy on a path of sustainable development, the government had targeted the period 1998-2000 to complete the transitional phase of rehabilitation and reconstruction. Nonetheless, in May 1998, under the pretext of a border dispute, Ethiopia declared war against Eritrea and occupied some parts of zobas Gash Barka and Debub. As a result of this war, Eritrean villages, towns, bridges, power plants and public and private buildings were destroyed systematically through aerial and artillery bombardment. The impact of the war on the economy of Eritrea is more visible in the destruction of infrastructure, which had been painfully built in the seven years of peace. Although growth in GDP had reached about 7 percent over the period 1994-1997 (University of Asmara, 2000), it fell to about 3 percent in 1999 due to the border conflict. Government development efforts not only concentrated on rebuilding and rehabilitating war- damaged and destroyed economic and social infrastructures, but also on formulating numerous national economic and social development strategies and policies. Among these was the Macro Policy of 1994, which mapped out short-, medium-, and long-term reconstruction and development programs. In the Macro Policy, human capital formation through education and health was identified as the main strategy for long-term national development. Eritrea’s Macro Policy advocated adequate and sustainable economic growth and social development to reduce poverty and create a basis for all of Eritrea’s citizens to provide a better life for themselves and their children. Eritrea has abundant natural resources including arable land (26 percent of the total area) of which only about 4 percent is under cultivation (World Food Programme, 2002). Although surface water is inadequate in Eritrea, there are adequate supplies of ground water, particularly in the Western Lowlands and in some parts of the Coastal Plains, that can be used for both household and industrial purposes. Eritrea is also believed to have varied and extensive mineral resources including copper, gold, iron, nickel, silica, sulfur and potash. Good quality marble and granite also exist in large quantities (Ministry of Land, Water and Environment, 1997). The Red Sea offers opportunities for the fishing industry, for expanding salt extraction industry, tourism, and possibly extraction of oil and gas. At present, most of these natural resources have not been fully exploited. 1.2 POPULATION No population census has ever been carried out in Eritrea. As a result, there are no reliable estimates of the population currently residing in Eritrea or the population of Eritreans living abroad, many of whom are potential returnees. However, based on a population count, the Ministry of Local Government estimated the total population of Eritrea to be about 3.2 million as of 2001. As there is no 2 | Introduction reliable information about population size, the population growth rate is not known with precision. The population is essentially rural with about 80 percent of the people living in the countryside. The urban population is characterized by rapid growth, partly as the result of returning refugees from the neighboring and other countries, and partly due to high rural-urban migration. The population of Eritrea is not uniformly distributed throughout the country. About 50-60 percent of the population lives in the Highlands. The age distribution is typical of high fertility regimes in which a larger proportion of the population is to be found in the younger age groups than in the older age groups. Eritrea is a multi-ethnic society with nine different ethnic groups speaking nine different languages and professing two major religions, namely, Christianity and Islam. Great efforts have been made by the National Statistics and Evaluation Office (NSEO) to collect demographic, health, and socioeconomic information through surveys. The first nationally representative survey conducted by the NSEO was the 1995 Eritrea Demographic and Health Survey (1995 EDHS) (National Statistics Office and Macro International, 1997). The 2002 Eritrea Demographic and Health Survey (2002 EDHS) was carried out by the same office. These surveys provide detailed information on fertility, infant and child mortality, health and nutritional status of women and children, breastfeeding, and contraceptive use, among other topics. 1.3 HEALTH SERVICES AND PROGRAMS The introduction of modern health services into Eritrea is relatively recent. The first hospital was established in Asmara by the Italians at the end of the nineteenth century. In the period prior to federation with Ethiopia, Eritrea had a relatively advanced health care system at least by the standards of the time. However, during the three decades of the war for independence, almost all existing health facilities were destroyed, medical supplies were disrupted, and health professionals abandoned their posts. Since independence, the Ministry of Health (MOH) has made significant progress in ensuring access to health care services through restoration of health facilities damaged during the war, the provision of adequate supplies of drugs and equipment, the expansion of available health services to communities where they are lacking, through the construction of new facilities and the training of qualified health personnel.

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