Internal Migration in Cameroon

OBSERVATORY ON MIGRATION OBSERVATOIRE ACP SUR LES MIGRATIONS OBSERVATÓRIO ACP DAS MIGRAÇÕES

INternal migration in cameroon: Constraint for or driver of urban and health development? Dominique Meva’a Abomo Etgard Manga Engama Jean Roger Abessolo Nguema Jeanette Fotso Wougaing Bertrand Begoumenie Marcel Nkouandou Njiemessa Marie Louise Ba’ana Etoundi

Department of Study and Action-Research for Development (DSARD) Panafrican Society of Builders (PSB)

Research

N’Gaoundere hospital for HIV and AIDS - Copyright: Elin B @ Nordic Touch, 2007 Report Creative Commons - Attribution 2.0 Generic

An Initiative of the ACP Secretariat, ACPOBS/2013/PUB13 Funded by the European Union Implemented by IOM and with the Financial Support of Switzerland, IOM, the IOM Development Fund and UNFPA Panafrican Society of Builders Société Panafricaine des Bâtisseurs International Organization for Migration (IOM) Organisation internationale pour les migrations (OIM) Organização Internacional para as Migrações (OIM) 2013 ACP Observatory on Migration The ACP Observatory on Migration is an initiative of the Secretariat of the African, Caribbean and Pacific (ACP) Group of States, funded by the European Union, implemented by the International Organization for Migration (IOM) in a Consortium with 15 partners and with the financial support of Switzerland, IOM, the IOM Development Fund and UNFPA. Established in 2010, the ACP Observatory is an institution designed to produce data on South–South ACP migration for migrants, civil society and policymakers and enhance research capacities in ACP countries for the improvement of the situation of migrants and the strengthening of the migration–development nexus. The Observatory was established to facilitate the creation of a network of research institutions and experts on migration research. Activities are starting in 12 pilot countries and willbe progressively extended to other interested ACP countries. The 12 pilot countries are: Angola, Cameroon, the Democratic Republic of the Congo, Haiti, Kenya, Lesotho, Nigeria, Papua New Guinea, Senegal, Timor‐Leste, Trinidad and Tobago and the United Republic of Tanzania. The Observatory has launched research and capacity‐building activities on South–South migration and development issues. Through these activities, the ACP Observatory aimsto address many issues that are becoming increasingly important for the ACP Group as part of the migration-development nexus. Documents and other research outputs and ‐ capacity building manuals can be accessed and downloaded free of charge through the Observatory’s website (www.acpmigration‐obs.org). Other upcoming publications and information on the Observatory’s activities will be posted online.

Document prepared by Dominique Meva’a Abomo, Jean Roger Abessolo Nguema, Bertrand Begoumenie, Marie Louise Ba’ana Etoundi, Etgard Manga Engama, Jeanette Fotso Wougaing et Marcel Nkouandou Njiemessa, Department of Study and Action-Research for Development (DSARD) - Panafrican Society of Builders (PSB). This publication has been produced with the financial assistance of the European Union. The contents of this publication are thesole responsibility of the authors and can in no way be taken to reflect the views of the Secretariat of the ACP Group of States, the European Union, the International Organization for Migration (IOM) and other members of the Consortium of the ACP Observatory on Migration, the Swiss Federation or UNFPA. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the publisher. Layout by Pablo Escribano Miralles, ACP Observatory on Migration.

ACPOBS/2013/PUB13 OBSERVATORY ON MIGRATION OBSERVATOI RE ACP SUR LES M I GRATI ONS OBSERVATÓRIOO ACP DAS MIGRAÇÕES

INternal migration in cameroon: Constraint for or driver of urban and health development?

Dominique Meva’a Abomo Jean Roger Abessolo Nguema Bertrand Begoumenie Marie Louise Ba’ana Etoundi Etgard Manga Engama Jeanette Fotso Wougaing Marcel Nkouandou Njiemessa

Department of Study and Action-Research for Development (DSARD) Panafrican Society of Builders (PSB)

Foreword

This study on the links between internal migration, urbanization and health in Cameroon was conducted by the research team of the Department of Study and Action-Research for Development (DSARD) of the Panafrican Socitety of Builders (PSB). It constitutes the final report of the international research project ‘Internal Migration, urbanization and health in Cameroon’, launched by the ACP Observatory on Migration. Nowadays, internal migration in Cameroon is considered a rather decisive factor in the process of chaotic urbanization and urban health insecurity. Despite the limited attention given to internal migration, its contribution to development is tangible in terms of the improvement of migrants’ living conditions and through the emergence of an informal sector which facilitates the creation of many new jobs for the national economy. Stressing that internal migration is in fact a real opportunity for development, this study is part of a constructive approach for minimizing the negative effects of the interaction between internal migration, urbanization and health, which are increasingly visible in Cameroonian society. Ultimately, this study seeks to contribute to improved policy in this area and the transformation of internal migration into a driver of balanced national development, along with fair and sustainable human development. In order to strengthen institutional capacity as well as improve the programmatic framework and strategic management of internal migration in Cameroon, this document proposes a Framework for the Proactive Governance of Internal Migration, which includes seven innovative practical recommendations. The territorial integration and ownership of this plan should strengthen the sustainability of the specific regulation of internal migration, especially through the creation of a Method of Endogenous Potentialities and Opportunities during its operational phase. I would like to thank the ACP Observatory on Migration for the study of this issue at the national level, based on the needs identified by the National Consultative Committee, which has allowed incorporating the analysis of the interactive dialectic between the concepts of migration, urbanization and health to our research. Taking into consideration the poverty, marginality and

iii exclusivity of the topic in available literature, this paper promises to become the basis for greater scientific knowledge which will be of great interest and use to us.

Mr. Felix Mbayu Secretary General National focal point for migration and development issues Ministry of Foreign Affairs

iv Abstract

The present study raises the problem of interaction between internal migration, the urbanization crisis and health precariousness in Cameroonian cities. A qualimetric method was used in the framework of a multidisciplinary and systemic approach. Data was collected through a qualitative approach, namely through direct interviews. It has been analysed using three complementary techniques: qualitative (content analysis), quantitative and spatial (cartography). Overall, the study shows that internal migration is a determinant of the urbanization and urban health crises in Cameroon. This phenomenon is marginalized, stigmatized, trivialized and even manipulated. Even so, its contribution to development is tangible in many forms: improvement of the living conditions of migrants, emergence of an informal economic sector, which is a supplier of relevant jobs and dominates the national economy of Cameroon. Thus, internal migration is a real opportunity for development, which unfortunately, collides with a deep governance crisis. Therefore, this study recommends a Framework for the Proactive Governance of Internal Migration (F-PGIM). Its aim is to transform this societal phenomenon using balanced national development and sustainable and equal human development. Its objective is to reinforce the institutional capacities, that is, to enhance the programmatic and strategic management of internal migration. In practice, seven pioneer recommendations were formulated for its execution: the creation of a national institution; the elaboration of the judicial and legislative framework; the elaboration of a national geo-policy for the proactive governance of internal migration that is executed from two paradigms: the proactive geo-strategy in rural areas and the proactive geo-strategy in urban spaces; the integration of internal migration in every national poverty-reduction strategy and national development planning; the creation of the National Centre of Observation and Integrated Supervision of Internal Migration; the contextualized use of the Endogenous Potentialities and Opportunities Method in the implementation of the F-PGIM; and the promotion of collaboration and cooperation.

Acknowledgments

This work would not have been possible without the contributions of certain persons and institutions to which we extend our sincere thanks. The first is the African, Caribbean and Pacific (ACP) Observatory on Migration/International Organization for Migration for the trust given to the Department of Study and Action-Research for Development/Département Etude et Recherche-Action pour le Développement of the Pan-African Society of Builders/Société Panafricaine des Bâtisseurs for financing and collaborating on this study. Secondly, we thank all the institutions and resource persons who have contributed to the achievement of this study.

vii

Table of contents

List of abbreviations...... xi List of tables and figures...... xiii Executive summary...... xv Résumé analytique...... xvii Resumo executivo...... xix 1. Introduction...... 1 2. General justification and framework of the study...... 3 2.1 Context of the study ...... 3 2.2 General framework of the study...... 5 3. Research methodology...... 7 3.1 Building a classic research reference for the study...... 7 3.2 Operational procedure...... 8 4. Analytical literature review...... 15 4.1 State of the internal migration issue in Cameroon...... 15 4.2 Current scientific view on the relationship between internal migration and urbanization...... 18 4.3 Urban health tested by internal migration...... 20 5. Results of the study...... 23 5.1 Characterization of the urban migration phenomenon in surveyed cities...... 23 5.2 Internal migration and urbanization...... 29 5.3 Internal migration and urban health ...... 35 5.4 Analysis of the results of the study...... 39 6. Conclusion and recommendations...... 47 7. References...... 53 8. Annex: Direct interview guide...... 59

List of abbreviations

3rd CSH 3rd Cameroon Survey of Households 3rd GCPHH 3rd General Census of the Population and Human Habitat ACP African, Caribbean and Pacific Group of States CBCPS Central Bureau of Census and Population Studies EU European Union F-PGIM Framework for the Proactive Governance of Internal Migration IOM International Organization for Migration NIS National Institute of Statistics UNFPA United Nations Population Fund

List of tables and figures

Tables Table 1: Distribution of the number of counting zones selected per city Table 2: Sampling diagram of counting zones and migrant households Table 3: Distribution of types of urban migration identified within the surveyed population (in %) Table 4: Assessment of housing ownership, possession of land titles and building permits in the surveyed migrant population (in %) Table 5: State of the prevalence of illness diagnosis types within the surveyed migrant households (in %) Table 6: Evaluation of requests for therapeutic treatment within the surveyed migrant households (in %) Figures Figure 1: Variation of the duration of urban migration (in %) Figure 2: Cumulative frequencies of duration in urban migration (in %) Figure 3: Proportion of migrant households willing to migrate to another city (in %) Figure 4: Proportion of migrant households in favour of return migration (in %) Figure 5: Variation of the conditions set for a return migration (in %) Figure 6: Distribution of the surveyed population by age and sex (in %) Figure 7: Cumulative frequencies distribution of the surveyed migrant population (in %) Figure 8: Evaluation of the marriage status of surveyed migrants (in %) Figure 9: Evaluation of the education levels of surveyed migrants (in %) Figure 10: Variation in household rubbish management methods within the surveyed migrant population (in %) Figure 11: Variation in domestic water waste management methods within the surveyed migrant population (in %) Figure 12: Variation in the proportion of migrant households having at least one mosquito net (in %) Figure 13: Schematic overview on the Potentialities and Opportunities Method, adapted to regulating the internal migration issue

xiii

Internal migration in Cameroon: Constraint for or driver of urban and health development?

Executive summary

The present study addresses the Overall, the study shows that problem of the interaction between internal migration is detrimental to internal migration, the urbanization the implementation of urbanization crisis and health precariousness projects in Cameroon and a factor of in Cameroon urban spaces. One urban health precariousness. It is a question emerged: what is the impact fact of marginal society: marginalized of internal migration on the dynamics in the sphere of public governance of urbanization and urban health and economic and social development in Cameroon? The main research planning. Furthermore, it has been hypothesis stipulates that internal found that internal migration is migration is a factor of the urbanization one of the main drivers of urban crisis and of health precariousness in development, given its contributions Cameroonian cities. The objective to the informal sector. Indeed, was to carry out a structured analysis 76.4 per cent of internal migrants of the dialectic of internal migration, interviewed work in the informal unmanaged urbanization and health sector, contributing to reduced precariousness surrounding urban unemployment, income generation areas by identifying the tangible and improved living conditions. In opportunities internal migration this sense, internal migration can offers to sustainable human be a driver of urban and national development. This structured analysis economies as well as of human was done with the aim of improving development of migrants themselves. the institutional and programmatic From this perspective, urban framework and influencing the migration becomes an opportunity to strategic management of internal promote development. Yet, improved migration in Cameroon. A qualimetric governance of urban migration is method was used following a necessary to fully take advantage multidisciplinary and systematic of the opportunities for human approach. In practice, data were development and decrease the collected using a qualitative approach related risks. (direct interview). They were This study therefore proposes analysed using three complementary a Framework for the Proactive techniques: qualitative (content Governance of Internal Migration analysis), quantitative (mono and (F-PGIM) in Cameroon. Its aim is bi-varied analysis) and spatial to transform internal migration (cartography). into a driver of balanced national xv ACP Observatory on Migration development and equal and urban areas; the integration of the sustainable human development internal migration phenomenon through the strengthening of in national strategies of poverty institutional capacities, the reduction and in every planning improvement the programmatic of national development; the framework and the strategic creation of a National Centre management of internal migration. for Integrated Observation and In practice, seven pioneer Supervision of Internal Migration; recommendations were formulated and the contextualized use of the for implementing the proactive Method of Endogenous Potentialities governance of internal migration: and Opportunities (MEPO) in the the creation of a national institution; operational phase of the F-PGIM, the development of a legislative promoting collaboration and and judicial framework; the cooperation. Finally, the F-PGIM is a development of national geo-politic management tool which is politically proactive governance implemented timely and socially expected, by the aforementioned institution economically feasible and culturally and based on two paradigms: the integrated. proactive geo-strategy in rural areas and the preventive geo-politics in

xvi Internal migration in Cameroon: Constraint for or driver of urban and health development?

Résumé analytique

La présente étude pose le problème Au total, l’étude révèle que la de l’interaction entre migration migration interne contrecarre le interne, crise d’urbanisation et projet urbain au Cameroun. Elle est précarité sanitaire dans les espaces un facteur de précarité de la santé urbains camerounais. Une question urbaine. Elle est un fait de société principale a été formulée à partir de marginal et marginalisé dans les cette problématique d’interaction : arènes de la gouvernance publique et quel est l’impact de la migration de la planification du développement interne sur l’urbanisation et la santé économique et social. Par ailleurs, il a urbaine au Cameroun ? L’hypothèse été constaté que la migration interne de recherche principale stipule que est l’un des principaux leviers du la migration interne est un facteur développement urbain, ayant un rôle privilégié de la crise d’urbanisation de précurseur dans le secteur auquel et de la précarité sanitaire dans les villes camerounaises. L’objectif ici est elle contribue. Il s’agit d’un secteur de de réaliser une analyse structurée de reconversion professionnelle à forte la migration interne, de l’urbanisation capacité de résorption du chômage. anarchique et de la précarité sanitaire Il est par conséquent un levier de en milieu urbain, en cernant les l’économie non seulement urbaine, opportunités tangibles que celle-ci mais aussi nationale. Il a également offre pour produire un développement été constaté que la migration humain durable. Cette analyse est un facteur incontestable de structurée est menée dans le but de l’amélioration des conditions de vie contribuer à l’amélioration des cadres ou du développement humain des institutionnel et programmatique, migrants. Sous cet angle, la migration puis de gestion stratégique de la urbaine devient une opportunité de migration interne au Cameroun. développement à promouvoir. Le La méthode qualimétrique a été problème se pose tout simplement exploitée suivant les approches au niveau de la gouvernance de ce pluridisciplinaire et systémique. fait de société. Dans la pratique, les données ont été collectées à partir d’une technique Cette réalité est à l’origine de la qualitative (l’entretien directif). modélisation d’un Plan-cadre Elles ont été analysées à partir de de gouvernance anticipative de trois techniques complémentaires : la migration interne (PC-GAMI) qualitative (analyse de contenu), au Cameroun dans cette étude. quantitative (analyse mono- et Son but est de transformer la bivariée) et spatiale (cartographie). migration interne en un moteur du xvii ACP Observatory on Migration développement national équilibré, l’intégration du phénomène de et d’un développement humain migration interne dans toute équitable et durable. Son objectif stratégie nationale de réduction de la est de renforcer les capacités pauvreté et dans toute planification institutionnelles, d’améliorer les de développement national, la cadres programmatiques et de création d’un Centre national de gestion stratégique de la migration veille et de surveillance intégrées de interne. Dans la pratique, sept la migration interne, l’exploitation recommandations pionnières ont été contextualisée de la Méthode des formulées pour sa mise en œuvre : la potentialités et des opportunités création d’une institution nationale endogènes / MPOE dans la phase de gouvernance anticipative de d’opérationnalisation du PC-GAMI, la migration interne, l’élaboration la promotion de la collaboration d’un cadre législatif et juridique et de la coopération. En définitive, de gouvernance anticipative de le PC-GAMI est un outil de gestion la migration interne, l’élaboration dont l’exploitation est politiquement d’une géopolitique nationale de opportune, socialement attendue, gouvernance anticipative de la économiquement réalisable et migration interne mise en œuvre culturellement intégrante. par l’institution susmentionnée et fondée sur deux notions : la stratégie géographique d’anticipation en milieu rural et la géopolitique d’anticipation en milieu urbain,

xviii Internal migration in Cameroon: Constraint for or driver of urban and health development?

Resumo executivo

O presente estudo aborda o (análise univariada e bivariada) e problema da interação entre espacial (cartografia). migração interna, crise de Em termos gerais, o estudo revela urbanização e precariedade sanitária que a migração interna compromete nas zonas urbanas camaronesas. o projeto urbano nos Camarões, A partir desta problemática de dado que constitui um fator de interação, levantou-se uma questão precariedade da saúde urbana; é fundamental: que impacto tem a uma realidade de sociedade marginal migração interna na urbanização e e marginalizada nas arenas da na saúde urbana nos Camarões? A governação pública e do planeamento principal hipótese de investigação do desenvolvimento económico e refere que a migração interna social. Além disso, constatou-se que a constitui um fator privilegiado da crise migração interna é uma das principais de urbanização e da precariedade nas alavancas do desenvolvimento cidades camaronesas. Pretende-se urbano, desempenhando um papel realizar uma análise estruturada da precursor no setor para o qual migração interna, da urbanização contribui. Trata-se de um setor de anárquica e da precariedade sanitária reconversão profissional com uma em meio urbano, identificando grande capacidade de redução do as oportunidades tangíveis desemprego. É, por conseguinte, uma proporcionadas pela mesma alavanca da economia não apenas para criar um desenvolvimento urbana, mas também nacional. humano sustentável. Esta análise Constatou-se igualmente que a estruturada é realizada com o migração é um fator incontestável propósito de contribuir para a da melhoria das condições de vida melhoria dos quadros institucional e ou do desenvolvimento humano programático, bem como de gestão dos migrantes. Nesta perspetiva, estratégica da migração interna nos a migração urbana torna-se numa Camarões. Foi explorado o método oportunidade de desenvolvimento qualimétrico, seguindo as abordagens que deve ser promovida. O problema pluridisciplinar e sistémica. Na coloca-se simplesmente ao nível prática, os dados foram recolhidos da governação desta realidade da a partir de uma técnica qualitativa sociedade. (entrevista diretiva). Esses dados foram analisados a partir de três Esta realidade está na base da técnicas complementares: qualitativa modelização de um Plano-quadro (análise do conteúdo), quantitativa de governação anticipatória da xix ACP Observatory on Migration migração interna (PQGAMI) nos a estratégia geográfica de antecipação Camarões objeto do presente estudo. em meio rural e a geopolítica de Visa transformar a migração interna antecipação em meio urbano, a num motor de desenvolvimento integração do fenómeno da migração nacional equilibrado, bem como de interna em qualquer estratégia desenvolvimento humano equitativo nacional de redução da pobreza e sustentável. Visa ainda reforçar e em qualquer planeamento de as capacidades institucionais, desenvolvimento nacional, a criação melhorar os quadros programáticos de um centro nacional de vigilância e de gestão estratégica da migração e fiscalização integradas da migração interna. Na prática, foram elaboradas interna, a exploração contextualizada sete recomendações pioneiras para do método das potencialidades e das a sua aplicação: a criação de uma oportunidades endógenas (MPOE) instituição nacional de governação na fase de operacionalização do proativa da migração interna, a PQGAMI, a promoção da colaboração elaboração de um quadro legislativo e da cooperação. Em última análise, e jurídico de governação proativa o PQGAMI é um instrumento da migração interna, a elaboração de gestão cuja exploração é de uma geopolítica nacional de politicamente oportuna, socialmente governação proativa da migração esperada, economicamente viável e interna executada pela instituição culturalmente integrante. supracitada e assente em duas noções:

xx Internal migration in Cameroon: Constraint for or driver of urban and health development?

1. Introduction

Human migration, predominantly Group of States, implemented by the internal, has become one of the IOM and financed by the European major concerns of public authorities Union. The aim of this programme both nationally and internationally. is to transform internal migration It is considered one of the essential from a constraint to a potentiality of factors of the urban explosion a sustainable human development. and of its negative effects. It is The mobilization of a consistent body inseparable from the generalized of scientific knowledge remains a matrix of causes of urban crises. mandatory condition to achieve this Long marginalized, today internal aim. migration occupies an important In this context, the ACP Observatory place in the planning of urban and on Migration’s objective is to conduct rural development. It is integrated case studies to produce knowledge into territorial planning policies, on South–South migration in inequality regulation, territorial its density, heterogeneity and divisions and human development. complexity. This approach highlights The best scientific knowledge and the specificities and particularities understanding of internal migration of the phenomenon in each State. dynamics thus become indispensable Cameroon, a State affected by to development. Developing the phenomenon of migration, countries are particular affected by was included in this programme. internal migration and constitute an The present document is thus the important area for studying internal final report of the project internal migration as a driver of development migration, urbanization and health in in the 21st century. Cameroon. It is structured into four This approach to internal migration chapters. The first one focuses on the is the basis for the international rationale and general framework of study programme: internal the study, the second on the research migration, urbanization and health. methodology, the third on an analytic This programme was launched by literature revue and the fourth on the the African, Caribbean and Pacific results obtained. (ACP) Observatory on Migration, an initiative of the Secretariat of ACP

Internal migration in Cameroon: Constraint for or driver of urban and health development?

2. General justification and framework of the study

Introduction of a number of crises attributed to, or caused by, the same migration Completing the research project dynamics. The crisis of urbanization on internal migration, urbanization and urban health is an example. This and health in Cameroon required a contrast is the basis of the present framework of theoretical elements international research programme from previous research. This is the on internal migration, urbanization objective of this chapter which is and health of the ACP Observatory structured into two main parts. The on Migration, an initiative of the first part is based on presenting the Secretariat of the ACP Group of States context of the study in four areas: implemented by the International general context, political context, Organization for Migration (IOM) economic and social contexts, and and financed by the European Union. scientific context. The second part This programme therefore opens focuses on presenting elements such discussion on the dialectics of internal as problematic research questions, migration/national development. the hypothesis and research To achieve this objective, the ACP objectives. Observatory promotes the analysis of case studies of human mobility in ACP States. 2.1 Context of the study Located in the Gulf of Guinea General context between the second and thirteenth Human mobility in ACP countries has degree of latitude North and the sixth always been considered a challenge to and sixteenth degree of longitude the development of those countries. If East (Amou’ou Jam et al., 1985), this meaning is given to international Cameroon is an example of an ACP migration (brain drain, selective country where urban development immigration and so on), nevertheless, is subject to the test of management it remains to be reconsidered in the of internal migration flows. Here, the context of internal migration. There national population was estimated at is no doubt today that the internal 19,406,100 on 1 January 2010 (Central mobility of the Yoruba in Nigeria, Bureau of Census and Population the Dioula of Côte d’Ivoire and the Studies - CBCPS, 2010). That same Bamileke in Cameroon, is a driver year, the urban population was of local development. Nevertheless, evaluated at 10,091,172 inhabitants this is contrasted by the emergence versus 9,314,928 of the rural 3 ACP Observatory on Migration population. The urbanization rate of against migrants in Douala (Deido Cameroon in 2010 was estimated at crisis of 2012) and Ebolowa (uprisings 52 per cent. This urbanization rate against the Bamoun community in implicitly reveals an intense mobility 2010) following the assassination of people and goods between of motorbike taxi drivers in the two cities and between cities and the towns, and the indictment of migrants countryside. This migration generates in Yaoundé during the riots of 2008, are societal facts and phenomena that all illustrations of internal migration have captured the attention of the governance crises. When legislation scientific community. Ultimately, is protective of native minorities, the present project operates in a migrants are both object and subject context characterized by mitigation, of various types of exposure and stigmatization and the accusation vulnerability. Nevertheless, public that internal migration is a suppressor political instigators of many youth of urban planning and a supporter of employment and rural development precarious urban health dynamics. programmes have a regulatory effect on the rural exodus and a catalyst effect on return migration. Political context This research project on internal Economic and social context migration, urbanization and health in Cameroon operates in a political Cameroon is currently undergoing context of national integration that undeniable economic recovery. Every guarantees the safety of people and citizen legitimately desires to benefit goods across the country. This state from the dividends of this growth and of affairs has a negative impact on the to transform their lives. Cities and phenomenon of internal migration sites of large structural projects are through the emergence of a deep perceived as places of excellence in sense of being at home. This study achieving these transformations. If the was carried out in the context of a economic crisis (1980–1990) triggered governance crisis of urban migration migratory survival flows, the decade at the origin of divisions, distances of growth recovery (2000–2010) and tensions between different intensified, and then reconfigured sectors of the urban population them. The present project operates in and among migrants, non-migrants the context of non-mastery of these and public authorities. The uprising new configurations of the migratory against the forced eviction of phenomena based on the social internal migrants in the MAGZI zone and economic transformation of the of Douala, the uprisings of natives country. 4 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Scientific context Gaps in migration management have many different consequences. The literature review conducted as Imbalances between urban and part of this study shows that internal rural areas, the problem of social migration is a marginal object of study cohesion and integration in general in Cameroon. The marginalization and the dysfunction of urban units is evident through a significant are all consequences of mitigated, lack of scientific research on this stigmatized and, at times, manipulated theme despite it being essential migration flows. Another issue in this for human development. This regard relates to the challenge of the scientific context is characterized by role of driver of human development a lack of control over structural and attributed to cities. This reality is functional configurations of internal the basis of the present study which migration, and the dialectic between raises the problem of integration this phenomenon and health and among internal migrants, urban crises urbanization, in the context of the and precarious health conditions in current recovery growth. Moreover, it urban areas of Cameroon. The main is marked by the reporting of internal issue is the transformation of internal migration as a constraint to urban migration from a constraint to an development. The transformation opportunity for human development of internal migration to a force for which cannot happen in a context development remains a real challenge of mitigation, stigma and accusation for scientists at the local level. towards migrants and the migration phenomenon. Two main questions emerge here: 2.2 General framework of the study What is the impact of internal migration on the dynamics of Research problems urbanization and urban health in The status of constraint to urban Cameroon? development which researchers and How can we transform internal decision makers attribute to internal migration from a constraint migration is undeniable in Cameroon. into an opportunity for urban However, it is a foreseen result of development in Cameroon? the migratory managerial logics applied so far. This reality makes Cameroon ripe for the observation Research hypothesis and study of internal migration, a phenomenon defined by its intensity, The two aforementioned questions its heterogeneity and its complexity. are at the basis of two research 5 ACP Observatory on Migration hypotheses. The first stipulates that migration at the urban level. The internal migration is a determinant second focuses on reconstructing of the urbanization crisis and the possible impact of migration on the precarious health facilities in urbanization and health. The third is Cameroonian cities. The second to develop a F-PGIM in Cameroon. stipulates that: strategically planned All this work is accompanied by a and proactive governance of internal thematic mapping for the variables of migration is a transformation engine the study objectives. of this societal phenomenon from a constraint to an opportunity for urban development in Cameroon. Conclusion This study addresses a developmental issue. The context of the study is a Study objectives real opportunity for decrypting a The aim of this study is to contribute poorly understood social problem, to improving the institutional, which seriously constrains national programmatic and strategic development. Theoretical elements framework for managing internal such as those presented led to migration in Cameroon. To achieve results which could contribute to this, a main goal and three secondary a social, economic and political objectives were set. The main and cultural transformation of objective is to achieve a structured Cameroon. Noticeable results analysis of the dialectic of internal are better scientific knowledge of migration, unmanaged urbanization migration issues and contribution and precarious health facilities to strengthening institutional and in urban zones, while identifying managerial capacities. Therefore, is the opportunities that it has to the experimented methodology a offer as a trigger for sustainable guarantee of expected results? human development. The first specific objective is to achieve a situational analysis of the structure and characteristics of internal

6 Internal migration in Cameroon: Constraint for or driver of urban and health development?

3. Research methodology

Introduction is part of the multimodal synthetic Achieving the expected results in current that, as underlined by Aktouf a research intrinsically depends (1992:10), encourages a bi-directional on the relationship between the analytical approach. A first analysis methodological planning of the study goes from the general to the and the study aims. It extrinsically particular (hypothetical-deductive depends on the way the methodology approach). A second analysis goes is used. The main objective of from the particular to the general this chapter is thus to present the (empirical-inductive approach). In a methodology in two ways: the second stage, the issue was to clarify construction of a classic research the methodological framework reference and a detailed explanation used in the synthetically multimodal of the operational procedure. approach. The methodological framework is a specific, operational procedure, 3.1 Building a classic research both exploitable and explained in reference for the study a classic research framework that The classic reference for the research tries to develop scientific ideas. Two is the structural foundations of a main methodological frameworks research that determine the choice of of the classic research model were specific methods and techniques for used in this study: functionalism each phase of the study. In practice, and empiricism. Functionalism is it is the methodological approach based on the perception of the in which the study is embedded, object of the study, as a system with the methodological framework several components and functions. applied, the general research method In practice, the task is to reconsider adapted to the previously defined the aim of this study on internal methodological approach and migration, urbanization and health framework. Interaction as a system structured in various components (migration, urbanization and urban health). Methodological approach and Afterwards, the issue is to identify research frameworks and analyse each component The methodological approach is a individually, based on the logic and classic framework in the production strategies of its main participants. of scientific knowledge. The study The reconstruction of the dialectic 7 ACP Observatory on Migration between these components in terms 3.2 Operational procedure of interaction, interinfluence and The operational approach is presented interdetermination is a last resort. in two main areas: the collection and Empiricism is based on the principle analysis of data. that the scientific knowledge sought is found in the facts studied. In practice, the study of the logic and the Data collection strategies of its components can be The qualitative approach was applied positioned without bias in the heart during data collection in accordance of the object of study. It also helps to with the qualimetric method. build a structured explanatory model The research employed a direct on the relationship between internal interpersonal interview technique, migration, urbanization and health in from a non-progressive interview Cameroon. guide comprised of questions. Previously, sampling was required at two levels when preparing the Adopted research method: the field visit. This concerns sampling qualimetric method following a geographic research areas and multidisciplinary approach sampling individuals in the statistical population studied (migrant The qualimetric method was more households). appropriate for the heterogeneity and complexity of the study. It is a Geographic sampling took place in scientific research method based on three phases: the combination of both qualitative a) Sampling research regions, and quantitative techniques for the preceded by a geographical collection and analysis of data. Its structuring of the national territory operation in this study recommends based on the administrative the use of qualitative techniques division of regions. The quota in data collection. It is based on a sampling method was used for simultaneous use of qualitative and the non-random selection of quantitative analysis of the data administrative research regions. collected. It uses a dual approach for Four regions (Coastal, Central, interpreting the analysis results: a Far North, South) out of ten were classic interpretation and a predictive selected from the superposition interpretation. Finally, it is based on of several previously defined using a multidisciplinary approach eligibility criteria. This resulted in a given the transdisciplinarity of the strong quantitative representation study’s objective. (40%) of the administrative regions of the national territory.

8 Internal migration in Cameroon: Constraint for or driver of urban and health development? b) Sampling research stations in the economic capital and most the selected regions was done populated city in the country; through the non-probabilistic Yaoundé, the political capital of the sampling technique in two phases. country; Maroua, the main town The first phase was characterized of the most populated region of by geographically structuring the the country bordering Nigeria and selected research regions into two Chad; Ebolowa, the main town of main types of basic sociospatial the region that shares a boundary structures – urban and rural with Gabon, Equatorial Guinea, areas – to orientate the study and Congo, a subregional transit objectives to urbanization. The and traffic town. If, quantitatively approximate sampling technique speaking, the sampling of these is justifiable for selecting urban four cities is not representative spaces as research stations. The of all the cities in the country, the use of this technique was based four selected towns are relevant on the eligibility criterion of from a qualitative point of view thematic orientation in reference regarding the object of study. to urbanization. The second phase Moreover, the presence of Douala consisted of selecting a sample of and Yaoundé among the four stations (cities) in urban areas of selected cities is justifiable due to the pre-selected administrative the strong representativeness of regions. The quota sampling the national urban population in method was used when selecting this sample. cities in each region. A quota of one city per region was selected c) Sampling sociospatial data for the economic feasibility of collection structures in the the study. The non-random selected research stations was sampling technique, based on the done in two stages. The first stage superposition of a certain number used the geographic structure of of qualitative eligibility criteria, the urban space or the division was used to select the researched of the city into basic sociospatial city. The main cities of the region structures. The counting zone were selected due to their strong defined by CBCPS (RGPH-3) and representativeness of all the cities later updated by the National in the country in terms of spatial- Institute of Statistics (NIS) in demographic size, demands the frame of the 3rd Cameroon of urban migrants, magnitude Survey of Households (CSH) was of the urbanization crisis and chosen as the basic sociospatial urban health issues: Douala, structure for data collection. Each 9 ACP Observatory on Migration

city was thus split into counting second assumption was applied in zones in accordance with the most Maroua and Ebolowa where six and recent NIS’ database. The quota four counting zones were researched sampling technique was used for in each of these two towns. The the determination of the number passage from 10 to 20 per cent in of counting zones in each town. this last case allows us to reduce the The counting zones quotas were dispersion to relate the differences in determined in proportion to the the number of investigated counting total number of counting zones zones between the big and small used in the 3rd CSH. In practice, the towns studied. It enhances the high dispersion or very significant statistic representativeness of small differences between the number cities’ counting zones in the counting of counting zones in major cities zone sample of the present study. In (Douala: 100 counting zones, total, from table 1, the number of Yaounde: 100 counting zones) and selected counting zones (30 counting small cities (Maroua: 28, Ebolowa: zones: 10 in Douala, 10 in Yaoundé, 16) substantially compromised 6 in Maroua and 4 in Ebolowa) is the reliability and relevance of statistically representative (12.3%) the systematic determination of the population of counting zones of homogenous counting zones researched during the 3rd CSH in quotas in each city. the studied cities: 244 counting The basis for determining the zones. In practice, the approximate counting zone research quotas was sampling technique, based on the firstly, in cities with a high population superposition of a certain number of density, where more than 50 counting eligibility qualitative criteria was used zones were researched during the for the actual selection of research 3rd CSH, the sample of counting counting zones for each city: type zones represents 10 per cent of of area hosting the counting zones, the total sample of counting zones geographic location within the city, used during the 3rd CSH. This first the issue of the counting zones assumption was applied in Douala in relation to the object of study. and Yaoundé where 10 counting Selecting counting zones was not zones were finally researched in random. each of the two cities. Secondly, in The sampling of individuals of the small cities having a low population statistical population studied is in density, where less than 50 counting function with the identification of zones were researched during the 3rd the said individuals and migrant CSH, the sample of counting zones households. The sampling of the represents 20 per cent of the total researched migrant households has sample used during the 3rd CSH. This also been done in three phases: 10 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Table 1: Distribution of the number of counting zones selected per city

Total number of Rate of determination Number of Towns counting zones of counting zones counting zones (3rd CSH) (in %) selected Douala 100 10 10 Yaoundé 100 10 10 Maroua 28 20 6 Ebolowa 16 20 4 Total 244 - 30 a) The determination of the sample b) The distribution of the sample size of researched migrant between the researched cities households which has faced a involves the determination of major challenge to its intelligible a sampling rate (t) from the deduction for unavailability of ratio between the total number accurate migrant households of migrant households to be figures (parent population). It researched, that is, n = 500 and was therefore appropriate to the total number of houses in use the formula for determining the selected counting zones, that the minimum sample (n) when is m = 54,012 (according to the the sample size of the parent nomenclature document of the population is ignored: where: 3rd CSH in reference to RGPH 3). n = minimum size of sample; The quota of migrant households e = desired error. Admitting that surveyed in every station/city of the desired error is 5 per cent research is the product of the (0.05). Therefore the minimum number of households in the said sample should be of 400 migrant city and the sampling rate (t): or; households for the result to be p = number of migrant households extrapolated with an accuracy or to be surveyed in each city; certainty of 95 per cent. The size v = total number of households of n = 500 migrant households in the city; t = rate of sampling. In adopted by the study is thus a total, the proportional distribution of 500 migrant households is 202 proven, meaningful and relevant in Douala, 194 in Yaoundé, 54 in statistical representativeness, Maroua and 50 in Ebolowa. and allows the extrapolation of the results with a 95 per cent of c) The distribution of samples of certitude. migrant households per counting 11 ACP Observatory on Migration

zone was done using the method and development of an analytic of quota sampling. Quotas were literature review on the study’s changed in function with the total objectives; defining a variable- number of migrant households analysis profile; emphasis on a needs selected in the city and the matrix; preparing a data collection number of researched counting document; testing the data collection zones. In practice, the number of tools; readjusting and producing data migrant households surveyed in collection tools; preparing teams every selected zone in each city is for the field; fieldwork, recruiting proportional to the total number and enabling data collectors; data of migrant households surveyed collection; and recording interviews in the said city and inversely on digital media (CD). proportional to the number of counting zones selected to this effect or: number of the migrant Analysis of the collected data households surveyed in each of The processing and analysis of the counting zones selected in the collected data was structured in city; p = total number of migrant three phases. The first phase was households researched in the based on processing the data using said city; z = number of counting two complementary techniques: zones selected for the research. manual and digital processing. The average number of migrant Manual processing uses the interview households surveyed in each transcriptions and prepares individual counting zone is 20 in Douala, 19 records for pre-codified counting, in Yaoundé, 9 in Maroua and 13 in manual counting of transcribed Ebolowa (table 2). interviews is entered into individual In the field, the random sampling pre-codified counted forms. Digital technique was used to select migrant processing uses slip encoding, editing households. The selection was the input template via a statistical random and non-discriminatory. data analysis and counting interview The general procedure, including data from the individual records of document research, can be structured the transcription count. into nine phases: document research in three academic cities of the country (Douala, Yaoundé, Dschang)

12 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Table 2: Diagram of sampling of counting zones and migrant households

Sample of counting zones Sample of migrant households Average Total Rate of Total Num- Total number number num- determi- number ber of of households of migrant ber of nation of of migrant Towns counting (RGPH3 household counting counting household zones exploited by to survey zones zones to survey selected 3rd CSH) by count- (3rd CSH) (in %) (1) ing zone Douala 100 10 10 21,850 202 20 Yaoundé 100 10 10 21,040 194 19 Maroua 28 20 6 5,797 54 9 Ebolowa 16 20 4 5,325 50 13 Total 244 - 30 54,012 500 -

(1) Rate of determination: 0.000925. The second implementation phase quantified typologies. It also led to consists of analysing processed identifying geographic patterns and data following three approaches: spatial variations of internal migration qualitative, quantitative and spatial. in relation to health and urbanization. The qualitative approach utilized The third operational phase of data content analysis. It reconstructed processing hinged on interpretation explanatory and analytical models of following a dual approach: classical the study objectives from associations and predictive interpretation. and categorizations, deep meanings, and intentions, very often latent and not directly perceptible from the Conclusion simple reading of the document. The quantitative approach is based on the Despite being well planned, the mono-variable then multi-variable methodology struggled due to time data analysis and spatial approach. constraints. The division of labour, a It resulted in the quantification of significant increase in human capital categorization, structuring, and and simultaneous data collection in typologies issued from a qualitative four cities by teams trained for the analysis. Finally, spatial analysis task all helped to complete the study allowed the representation of on time. At this stage, it is legitimate qualitative variables quantified to ask if the obtained results reflect in space. It resulted in spatial the previously set objectives and categorization, structuring and goals. 13

Internal migration in Cameroon: Constraint for or driver of urban and health development?

4. Analytical literature review

Introduction and differences. The combination of objective variables such as sex, The aim of this chapter is to critically profession or occupation, itinerary, analyse the literature on internal social status, etc. are thus considered migration in relation to urbanization relevant. The main idea behind and health in Cameroon. This is a this study is that there are social review of the analytical and structured determinants in migration, further literature, based on three main affected by urbanization and health. areas of interest, which support the objectives. The main problem stems This way of thinking is at the heart from the literature’s contribution of characterizing internal migration, to the constructive logic theory which is the movement of people of internal migration. Migration is from one region of the country to seen as a cause and/or challenge to another, in order to establish a new development in general and health residence (IOM, 2011). The place of and urban development in particular. residence refers to the area where The primary focus is on the state of the migrant has continuously lived internal migration. The work here for at least six months and one day, is to make a comprehensive review not counting temporary absences of the existing literature on internal due to holidays or work assignments migration. Analysis of the literature (UN, 2008:111). The term ‘region regarding the relationship between of the country’ includes several internal migration and urbanization meanings: political, administrative, on the one hand and between cultural, historical and geographical. internal migration and health in The major internal migration trends urban areas, on the other hand, are in Cameroon help to highlight the respectively the second and the third magnitude of the phenomenon. focus of interest. According to the statistics published by the CBCPS (2010), internal migrants represent 20.5 per cent of 4.1 State of the internal the population of the West, 18.9 per migration issue in cent of the Central Region, 13.9 per Cameroon cent of the Far North and and 3.9 per The existing scientific literature aims cent of Adamawa. From a historical at identifying the state of urban or perspective, many archaeologists rural migration and then profiling show that human beings have been it using a directory of similarities in the present territory of Cameroon 15 ACP Observatory on Migration since 5000 BC (Corvevin, 1993). The of numbers are determinants of the main settlements occur between the displacement of several populations 17th and 19th centuries and led to in connection with environmental the current geographical distribution constraints. of population. The population’s Interest in this sociohistorical reading movement – seeking places to live – lies in the emphasis on internal within national borders have shaped migration as a cultural value in certain the ethno-spatial configuration of regions of the country, such as West Cameroon. Therefore, some cities Cameroon (Dongmo, 1980:168). The owe their creation to these migrations predominance of migration among – Douala, Bamenda and Foumban. the people of West Cameroon, due to Beyond the settlement process and the installation of a large number the lack of land, overpopulation and of groups of people in pre-colonial a sort of moral community-orientated Cameroon, internal migration economics, may not apply to the continued throughout the 19th and overall population of the country. 20th centuries. Internal migration, Many people in Cameroon live in the observed during the colonial period, same situation as those in the West, was linked to three main factors. but they prefer to stay in their natural environments for security reasons, Firstly, there was the flight from personal convenience, etc. (Van colonial persecution and repression Santen, 2012:255-288). Nonetheless, due to forced manual labour the Second Survey on Employment constructing roads and railways and the Informal Sector (EESI-2) in Cameroon: both German and underlines that certain populations French-British. Many people were are more willing than others to displaced for territorial planning: migrate, but it is not always the construction of roads and creation of same factor which is the precursor agro-industrial plantations. Secondly, element of each migratory route (NIS, the suppression of subversive people 2011). In fact, an individual can feel during the struggle for independence at ease in a relatively difficult social in Cameroon led to several internal milieu. Hence, there is an ambiguous migration movements: several ethnic relationship between migration and groups are now scattered across life expectancy, urbanization and the country. Thirdly, social and health. environmental factors caused further displacement as people searched for Spontaneous migration has intensified fertile lands in West Cameroon. In since independence in the 1960s in addition ethno-spatial proximity of many African countries. It continues people, ethnic tensions and the effect today, even if migrations which are 16 Internal migration in Cameroon: Constraint for or driver of urban and health development?

‘controlled’, planned or organized (Meka’a, 2007), urban and rural have taken more importance. Planned economies are intertwined. Small migration is also underpinned by a rural region centres (such as Bazou, specific logic. This form of migration Balengou, Baména, in the West) allows us to understand and better provide urban infrastructures (Gubry, appreciate the official theory that 1996:437). Migrants from these characterizes the migration policy regions may have the possibility to implemented between 1960 and perform income-generating activities 1982 in Cameroon. The phenomenon when they return to their villages. of migration directed by the Furthermore, these populations government is one of the causes of can move to other centres to meet conflict in the North1 (Alawadi Zelao, their needs, but not permanently; 2006:324). Land conflicts between hence the term “pendulum migrants” migrants and landowners seems to (Meka’a, 2007:152). Living in a region be a major concern for specialists in is not just a matter of residence: with internal migration (Watang Zieba and mobile phones and the development Lieugomg, 2006; Van Santen, 2012). of urban/interurban transportation, migrants move easily and symbolically Toupouri migrants move to karals mark the space with their presence (vertisoils) that favour the cultivation (De Brujin et al., 2001). of mouskwaris (seasonal sorghum) or to rice farms managed by the The observed trends, based on Expansion and Modernization of Rice retrospective data from recent Cultivation in the Yagoua Company, national surveys, show that return in the extreme North of Cameroon migration now tends to stagnate, (Watang Zieba and Lieugomg, 2006:6). and even decline, whereas urban Therefore, return migration is also migration progresses2 (Evina, 2009). a component of urban growth. It is Urban migration is strongly influenced part of the process of urbanization, by natural factors, since there are rural as the population movement into and areas environmentally predisposed out of the cities reflects the capacity to abandonment: the mountain of urban economies to attract assets dwellers of North Cameroon cannot from rural economies. However, as continue to live among the rocks evidenced by the transfer of funds where they are exposed to risks. from urban migrants towards other It is the same with the inhabitants cities or their regions of origin 2 The 1976 census has shown that in towns of more than 10,000 inhabitants, the 1 Great North or ‘North-Cameroon’ refer to proportion of internal migrants in relation the set of three regions: North, Adamaoua to the entire urban population is very high; and Extreme-North. more than 50 per cent. 17 ACP Observatory on Migration of the equatorial forest where the given the presence of more elaborate presence of trees and the lack of infrastructure without taking into working tools, such as chain saws, consideration the cost (Gubry, makes food cropping difficult. The 1996:12-13). extended argument according to which the rural exodus contributes to the impoverishment of abandoned 4.2 Current scientific view on cities and villages (Lututala Mumpasi, the relationship between 2007:7) is therefore reduced. All small internal migration and occupations carried out by migrants urbanization serve to mitigate the weakness Internal migration is not the same of increasing urbanization. If it is in all regions of Cameroon. A paradoxical to question the return of descriptive study of migrants can migrants to their place of origin and lead to an impasse on the issue of urbanization, we must nevertheless the relationship between internal reserve the right to make conclusions migration and urbanization in on return migration.3 Cameroon. Under this relationship, the existing literature agrees that Rural exodus can be disastrous in the the rural exodus is the main issue. sense that in Cameroon, as elsewhere Migration is presented either as a in Africa, there is “urbanization cause or consequence in terms of without development” (Cheru, the crisis of urbanization (Gubry, 2007:49). We should consider what 1996). This second view is widely the concept of “urbanization without shared by urbanization specialists, development” means, suggesting who through the specificity of urban that the Cameroonian post-colonial systems described, illustrate that city is mostly a creation of political migration in all its forms (temporary power (Mimché and Fomekong, or permanent) contributes to the 2008:244), but it should be noted urbanization process. that in the city, a migrant may benefit from relatively better living conditions Three categories of cities can be distinguished in Cameroon: 3 Due to the complexity of return migration, which has increased since the mid-1990s, pre-colonial (Foumban, Maroua), during the period of strong economic large villages transformed by colonial recession in Cameroon, specific research powers (Limbe); rural centres was done on the theme (Research on Migration Return or IMR) by the Ministry transformed to administrative of Scientific and Technical Research, with headquarters through presidential CEPED and IFORD, with the support of Mission of the ORSTOM of Yaoundé in decree, which gave them the status 1992. of cities (Hamadou, 2012:328-329). 18 Internal migration in Cameroon: Constraint for or driver of urban and health development?

The implementation of public action this ensemble, and 53 per cent of programmes in certain regions of the the agricultural sector (NIS, 2011). country has led to the outbreak of The study “Impact of development of exponential population growth and urban agriculture on the demographic rapid and uncontrolled urbanization of transition of southern cities: the case new areas around construction sites, of the Mbanya watershed in Douala industrial sites, and agro-business. (Cameroon)” reveals that 95.8 per The management of State land assets cent of urban farmers are migrants, is part of the present political issue. 97.5 per cent have no qualifications The draft study by the National and 70 per cent are women (Meva’a Monitoring Network of Public Policy Abomo et al., 2011). and Strategies for Cooperation/ The informal sector provides massive Dynamic Citizen called “Plea for the employment without reversing the fight against forced evictions in the city trends in insecurity and banditry. of Douala, reported cases of forced Many sources of police or journalist evictions in the MAGZI industrial information, reporting on the many zone of Bassa-Douala in Cameroon”, faces of urban crime, highlight produced in 2011, showed that 88.3 how gangsters use informal sector per cent of inhabitants in areas at risk services to commit their crimes. of forced eviction are migrants from The work on urban crime does not other regions than the Littoral zone. find migration to be a factor of that phenomenon. Urban crimes are In general, disadvantaged migrants supported by traditional or modern live in slums with high exposure criminal logistics and by consumption to risks. The occupation of land of narcotics (Mbarkoutou Mahamat, precedes urban planning (Meva’a 2012:165). Instead of being Abomo, 2011; 2006b). The result is presented as a factor of insecurity, the crystallization of a land crisis, urban migration is concomitant from which results the idea of urban with insecurity, given the number eco-paralyses in Douala (Meva’a of offences or crimes committed Abomo, 2006a). In Cameroon, the in areas of high concentration of informal sector often compensates migrants. Urban migrants use the for the inability of the government to same itineraries as (urban) bandits, improve the living conditions of urban but the assimilation migrants/bandits populations. The NIS notes that 90.4 should be avoided at all costs. per cent of the active population is employed in Cameroon, the informal sector representing 90.5 per cent of 19 ACP Observatory on Migration

4.3 Urban health tested by urban spaces. It is also responsible internal migration for the risk associated to the health The link between internal migration of households. Exacerbation of and urban health is not developed in the holo-endemism of several the scientific literature in Cameroon. insalubrious pathologies, for example This theme is treated implicitly or in the increasingly penetrating urban a derivative manner. The literature malaria, is hence registered (Meva’a informs about the social conditions Abomo, 2011). In view of the rapid in which internal migrants live and urbanization and disorder, insufficient represent their stay. The authors pay supply and the quality of the health particular attention to the health service, the development context profile of the migrant, the prevalence of internal migration provides some of diseases, and public action understanding of the dynamics of the concerning health and quality of care. cholera epidemics during 2004 within In Cameroon, previous studies on the Cameroonian territory (Assako et migrant health (in the region of origin al., 2005). The different phases of the or previous place of residence) are epidemic show the spread of cholera almost absent. While other research in two weeks from a non-equipped objectives can be set, studying the well in an insalubrious neighborhood health of migrants before their of Douala to the economic capital of departure could help avoiding Cameroon through contamination generalizations, made without and transmission processes mainly empirical basis, on the systematic based on the intra-urban migration increase of disease transmission due of infected subjects and objects, to the migration process. the water run-off and the use of One of the crucial problems of infected objects. Subsequently, the migration is the mobility of social epidemic spread to other parts of diseases and illnesses. One of the country. In the end, seven of the the migrant quarters in Douala ten administrative regions were hit (Bepanda TSF) was a main focus of by this epidemic. Nevertheless, the the national epidemic of cholera in opposite evolution may be possible, 2004 (Assako Assako et al., 2005). as the mode of land occupation also The city, which is the principal point determines the state of migrants’ of the fall of internal migration in health. Cameroon, is full of diseases from the In addition, the socialization of health migrants’ region of origin. The spatial risks due to the multiform pollution demographic explosion in Douala can also be observed in quarters has led to a chaotic occupation of with a high population of indigenous 20 Internal migration in Cameroon: Constraint for or driver of urban and health development? people, as was seen during the migration goes back to pre-colonial cholera epidemics of 2011 in Yaoundé. Cameroon with the settlement of Despite this, the internal migration of populations. the illness and patients has retained Critical views mentioned in this residual attention from Cameroonian research. However, the migration analysis should not be misunderstood, of patients helps to evaluate health as they are meant to be positive and and medical engagement (Meva’a constructive. This study analyses Abomo, 2006c; 2011). More complex the content of documents to feed and ambiguous phenomena are a political debate that is socially likely to mislead researchers. All the expected and scientifically legitimate. regions in Cameroon do not receive The avenues opened for discussion the same attention, as a result of will enrich the debate. Finally, this the singularity of their social systems state of scientific knowledge is the (urban migration and health). starting point for the production of new knowledge about the The results of the case studies carried internal migration of people in the out so far are likely to provide some framework of the project on ‘internal understanding of the social processes migration, urbanization and health in at work in the entire country. Due Cameroon’; a project whose purpose to that, it is convenient to carry out a careful reading of the different is to stimulate the integration of existing works in order to draw out internal migration as fundamental in the essential aspects by asking the the planning of human development following questions: “What do these in Cameroon. studies allow us to know or to think? What directives or guidelines does the existing ligerature suggest to us? What does it make us hope for?” (Eboussi Boulaga, 2012:7).

Conclusion At the end of this study, it appears that the existing scientific literature on the topic: internal migration, urbanization and health in Cameroon, is not negligible despite the lack of sufficient qualitative and quantitative studies so far. The study of internal

Internal migration in Cameroon: Constraint for or driver of urban and health development?

5. Results of the study

Introduction State of the factors and types of urban migration The study ‘internal migration, urbanization and health in Urban migration is maintained in the Cameroon’ was conducted in four surveyed cities by six main factors cities sufficiently representative acting individually or in combination. of the urban environment of Based on these factors, the present Cameroon: Douala, Yaoundé, Maroua study has revealed eight types of and Ebolowa. Data collection was migration: labour migration, health carried out among a sample of 500 migration, educational migration, migrant households proportionally migration due to social conflict, distributed in the researched cities environmental migration, professional based on demographic criteria. The migration (job assignment), objective of this chapter is to analyse forced migration (following the these results in four main areas: expropriation of land for public the characterization of migration in purposes) and asylum migration the surveyed cities, the analysis of from poverty4. If the term ‘asylum the internal migration/urbanization migration of poverty’ is original interaction, the study of the internal to this study, this phenomenon migration/urban health interaction, is observed in many other cities and finally the formulation of realistic worldwide. Socioeconomic migration and achievable recommendations. (job search and asylum from poverty with job search), and social migration (health management, education and 5.1 Characterization of social conflicts) are predominant the urban migration with 64 per cent and 21.6 per cent phenomenon in surveyed respectively of migratory flux towards cities the cities studied. The intense urban The present analysis characterizes migration experienced in the studied the phenomenon of urban migration regional capitals mainly happens in from five determinants: migration factors, migratory itinerary, duration 4 Asylum migration from poverty is the of the migratory adventure, act of migrating to urban areas with the objective of searching for a piece of land, migration intentionality, and the constructing a house to live in permanently sociodemographic characteristics of without returning to the place of origin. Many urban exiles are buried in this area urban migration. after their death. These migrants search for work or develop activities that yield revenue for their lives. 23 ACP Observatory on Migration the context of efforts carried out to of the internal migration to urban reduce poverty and improve living areas in Cameroon. In geographical conditions. terms, a spatial variation in migration patterns was observed between the Despite the problem of qualification, cities studied (table 3). According to urban migrants constitute an the summary analysis, socioeconomic impressive human capital. The and social migration are predominant widespread process of changing in all cities studied, being respectively occupations in the informal sector 62.4 per cent and 17.7 per cent in reflects a problem of canalization and Douala, 64.9 per cent and 25.1 per valorization of this human potential cent in Yaoundé, 75.9 per cent and for development, either urban or 16.7 per cent in Maroua and finally, 54 rural. National development must per cent and 28 per cent in Ebolowa. therefore be adequately governed However, touristic migration in the to anticipate and capitalize on the preceding sense declined, which possible benefits of internal migration. also varies due to the functions of Touristic migration is considered the cities, being respectively 37.6 as a form of non-socioeconomic per cent in Douala, 37.1 per cent in migration. Now, if socioeconomic Yaoundé, 24.1 per cent in Maroua to migration is 64 per cent, touristic 46 per cent in Ebolowa. migration represents 36 per cent

Table 3: Distribution of types of urban migration identified within the surveyed population (in %)

Search Shelter School Job Terri- Social Environ- for from Health atten- assign- torial conflict mental work poverty dance ment planning Douala 37.6 24.8 5.2 10.1 2.4 0.5 18.8 0.5 Yaoundé 46.9 18.0 6.1 13.4 5.6 0.5 9.3 0.0 Maroua 74.1 1.8 0.0 13.0 3.7 0.0 7.4 0.0 Ebolowa 42.0 12.0 4.0 16.0 8.0 0.0 18.0 0.0 Percentage of the total number of 45.6 18.4 5.0 12.2 4.4 0.4 13.8 0.2 surveyed migrants

Source: Field enquiry, November 2012.

24 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Analysis of migratory routes are the dominant movements. A The qualitative analysis of internal predominance of migrants from migration routes towards urban the Central region (30.4%) and areas led to singling out two West region (23.2%) was recorded major dynamics: intraregional in the city. Conversely, in Maroua, and interregional migration. Each city-city intraregional migration dynamic has three main migratory (40.7%) and city-city interregional movements: village-city migration migration (29.6%) are the dominant (rural exodus), city-city migration movements. Those from the Far North (inter-urban migration) and village- regions (50%) and the Northwest city-city migration (mixed internal (13%) predominate in the secondary migration). Six types of urban pole. Finally, in the town of Ebolowa, migration have been identified based city-city interregional migration (60%) on the migration routes. The study and city-city intraregional migration identified a predominance (59%) (16%) are the dominant migration of dynamic interregional urban patterns. A predominance of people migration routes. Analysis of the from the Centre (36%) and South origin of migrants shows that 26.2 per (28%) was recorded in the city. cent of internal migrants are originally from the West region of Cameroon. Assessment on the duration and Spatial analysis of migratory routes stability of urban migration and migrant origins reveals a spatial variation in these two variables Analysis of the migration duration of internal migration. City-city shows that 1.6 per cent and 1.8 interregional migration (34.2%) and per cent of migrant households intraregional migration (23.8%) have spent 50 and of 40-50 years are the dominant migration forms in urban migration respectively in Douala. The surveyed migrant (figure 1). However, almost 60 per households are heterogeneous cent and more than 75 per cent of in terms of region of origin. The migrants had settled in the last 10 predominance of migrants from and 20 years respectively (figure 2). the Western and Central regions, The improvement of migrant living respectively 37.1 per cent and conditions proved to be the main 17.3 per cent of the migrant driver of this strong urban settlement. population surveyed, was recorded A high percentage (51.2%) of in Douala. In Yaoundé, city-city displacement to other cities of the interregional migration (40.2%) country offering more opportunities and city-city intra-regional (20.1%) was registered near the population 25 ACP Observatory on Migration of the surveyed migrant households. girls operates in a context of lack of Figure 3 shows that the percentage material and financial means. It is a of inter-urban migration is high in lever of poverty perpetuation and Maroua with 62 per cent of favourable rapid demographic growth in cities. It migrant households. Furthermore, is a vector of the mismatch between not all migrants find satisfaction in demand and supply in infrastructure cities. An average of 43 per cent of and sociocommunity facilities. If by migrant households favour return nature, the town attracts people migration. Figure 4 shows that the through the opportunities it offers percentage is greater in Ebolowa with (formal and/or informal employment, 66 per cent of migrant households access to health facilities and favouring return. Nevertheless, medication, education, etc.), this return is conditional and the unmanaged urban migration is today conditions vary by migrant household a real issue for urban development in and by city surveyed (figure 5). The the cities studied. conditions for return migration vary In general, 41.9 per cent of migrants according to cities and individuals. wish for guaranteed work, 21.9 per Most surveyed migrants (59.2%) have cent want financial help to relocate, at least one child. A high number of 19.1 per cent seek subvention young mothers were registered in the from a revenue generator project. migrant population. However, this These conditions are generally fact may be related to sociocultural socioeconomic. Overall, this analysis registers and the economic context provides information about the of poverty. A total of 38 per cent of migration perspectives of the migrant migrant households have at least population surveyed. It thus can be one migrant girl of school age who used for prediction and forecasting. is already a mother. This high birth rate among school age migrant

26 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Figure 1: Variation in durations of urban migration (in %)

20 18.2 18 16.4 16 14 12.4 11.8 10.6 12 10 8.4 8 6.8 6.2 6 3.8 4 2 1.2 1.6 2 0.6 0

Source: Field enquiry, November 2012.

Figure 2: Cumulated durations frequencies in urban migration (in %)

100 100 97.8 98.4 94.6 96.6 80 90.8 84.6 77.8 60 69.4 58.8 40 40.6 20 24.2 12.4 0

Source: Field enquiry, November 2012.

27 ACP Observatory on Migration

Figure 3: Proportion of migrant Figure 4: Proportion of migrant households willing to households favourable to migrate to other towns return migration (in %) (in %)

N N

WE WE

S S 0 100 200 Km Maroua 0 100 200 Km Maroua 0-19% 20-39% 60-79% 40-59% 40-59% 60-79% 20-39% 0-19%

Yaoundé Yaoundé Douala Douala

Ebolowa Ebolowa

Source: Field enquiry, November 2012. Source: Field enquiry, November 2012.

Figure 5: Variation of conditions for return migration (in %)

WE 4.59% 13.33% 4.58% S

0 100 200 Km Maroua 77.5% Subvention of reinstallation Guarantee of work

Taken charge of children 9.72% 29.44% Subvention of an 8.33% economic project 1.11% 32.5% 32.5% 24.72% Other condition 20.1% Yaoundé

32.77% 2.77%2.77% 8.9% 24.73% Douala

9.45% 60.28% Ebolowa

Source: Field enquiry, November 2012.

28 Internal migration in Cameroon: Constraint for or driver of urban and health development?

5.2 Internal migration and population was observed. According urbanization to figures 6 and 7, the majority of The analysis of the impact of internal the population is young with more migration on urbanization conducted than 70 per cent of individuals being in this section is based on five under 30 years old. Figure 8 indicates points: sociodemographic dynamics, that surveyed urban migrants have planning, environment, economy and a marital profile dominated by urban security. singletons (48.2%). 30.8 per cent are married migrant households, 38.7 per cent are single parents. The Internal migration and low educational level of migrants sociodemographic urban dynamics predisposes precariousness. Figure 9 shows that 60.2 per cent of surveyed A total of 1,790 migrants were migrants have at least a general identified in the 500 surveyed secondary education level. The high migrant households with an average proportion of migrants with higher of 4 migrants/migrant household. The levels of education (39%) shows the populations of migrant respondents dropout phenomenon of migrants at were mainly male with 53.1 per cent university level. men and 46.4 per cent women. A strong variation by age and sex of this

Figure 6: Population distribution of surveyed migrants by age and sex limit (in %)

30 13.13 25 13.4 11.06 20 15 6.7 13.69 10 11.68 3.18 10.39 2.06 5 6.93 0.78 4.08 0 1.78 1.06

Men Women

Source: Field enquiry, November 2012.

29 ACP Observatory on Migration

Figure 7: Cumulated frequencies of population distribution of the investigated migrant by age limit (in %)

120

100 98.13 100 94.28 80 87.02

73.39 60

40 46.56

20 23.81

Source: Field enquiry, November 2012.

Figure 8: Evaluation of the marriage status of surveyed migrants (in %)

No answer, 1.4 Widower, 4.2 Married, 30.8

Single, 48.2 Divorced, 1.8

Free union, 13.6

Source: Field enquiry, November 2012.

30 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Figure 9: Evaluation of the education levels of surveyed migrants (in %) Never been to No answer, 2.4 school, 2.8

Primary, 16.8

Higher, 39

Secondary, 39

Source: Field enquiry, November 2012.

Internal migration, urban planning zones such as swamps is marked by and environment the irremediable proliferation of a - Internal migration and urban spontaneous unhealthy environment planning developed by migrants. This risky planning damages the ecological The lack of regular updating of urban balance in very sensitive areas. It planning is a determinant of the results in recurrent catastrophes, urbanization crisis in the surveyed such as flooding, and the emergence cities. As an example, the last urban of the phenomenon of sinking houses planning of Douala, the biggest city in swampy areas. of the country was dated 1983. The spatial-demographic expansion of the Overall, 31.8 per cent of surveyed studied cities operates faster than migrants are homeowners with an the capacity of renewing the tenure accompanying piece of land. However, of urban soils. The incidence of 75.4 per cent of these migrant migration flows is an important cause owners do not have legal land titles of overburdened management in the and 74.8 per cent still do not have cities. The very low prevalence of land building permission. The proportion titles within the surveyed migrant of migrant home and land owners population is a relevant indicator of in each of the surveyed cities varies land crisis in the four studied cities. (table 4). When settling, non-owner The occupation of undeveloped migrants agree to lodge in risky and 31 ACP Observatory on Migration precarious conditions. No migrant emptying of household rubbish into tenants have a legal lease contract. bins found in open areas or spaces like Just 27 per cent of migrants have an pavements, home gardens, streams informal lease contract co-signed by and drains. Finally, 8.8 per cent of the migrant and landlord. The State migrant households practise a mixed records show significant shortfalls in management system consisting of terms of tax charges for commercial the first two. Analysis of site research use of social housing. reveals the predominance of modern solid waste management of - Internal migration and urban household refuse in each of the four environment cities (figure 10). The urban environment is subject The opposite situation is observed to several dysfunctions in the concerning management of domestic surveyed cities. This study focuses waste water. It was found that 69 per on three environmental models: the cent of surveyed migrant households management of household rubbish, do not have modern sanitation. Just of waste water and land pressure. 19 per cent of surveyed migrant Regarding household refuse, households have a modern sanitation migrants are part of a context where system. Furthermore, 10.8 per cent all urban actors are responsible of migrant households practise a for insalubrity in the surveyed city. mixed management system which Modern solid household rubbish consists of combining the first two management is practiced by 59.8 modes of management. There is a per cent of migrant households predominance domestic waste water surveyed. It consists of collecting and being thrown away on the street. Site transmitting the rubbish to the dealer survey analysis showed the same in charge of hygiene and sanitation chaotic management in each of the using dust bins or trucks that collect surveyed cities (figure 11). waste. Inappropriate management is practised by 30 per cent of surveyed migrant households. This consists of

32 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Table 4: Assessment of housing ownership, possession of land titles and building permits of the surveyed migrant population (in %)

Right of Possession of Possession of ownership of a land title building permit house Douala 43.1 34.2 33.7 Yaoundé 23.7 19.6 23.7 Maroua 35.2 20.4 7.4 Ebolowa 14.0 10.0 16.0 Percentage in relation to the total number 31.8 24.6 25.2 of surveyed migrants Source: Field enquiry, November 2012.

Internal migration, urban economy have worked in this sector since and urban security their arrival in cities. These revenues also allow 32.8 per cent of surveyed - Internal migration and urban migrants to carry out social projects. economy The informal sector today is one Urban migration has created a new of the main income generators form of economy in Cameroonian of territorial self-governed cities. cities since the 1980s: the informal Migrants therefore contribute to economy which today is the largest local development in the cities. supplier of employment. Overall, Although not reported in the trade 76.4 per cent of interviewed migrants register, several informal activities work in the informal sector. Income also contribute to the bailout of State from informal activities precedes a funds and to the consumption of substantial improvement in living economic goods. conditions: 56 per cent of migrants

33 ACP Observatory on Migration

Figure 10: Varied modes of household Figure 11: Variation modes of rubbish management management of domestic within the investigated used water with in the migrant household investigated household population (in %) population (in %)

N N 7.4% 1.9% 9.3% WE WE 74.1% 16.7% S S 35.2% 0 100 200 Km 0 100 200 Km 55.6% Maroua Maroua

3.1% 1% 5.2% 1.5% 19.6% 2% 1.5% 11.9% 19.3% 16.3% 73.7%

37.6% 19.8% Yaoundé 58.2% Yaoundé 66.8% 12% 20% Douala 62.4% Douala 16%

38% 42% Ebolowa Ebolowa 72%

Disorder management Mixed management

Modern management No answer

Source: Field enquiry, November 2012.

- Internal migration and urban that migrants are a factor of urban security insecurity without having material evidence. No migrant aggressor The relationship between internal or thief has ever been identified migration and urban security exists directly or indirectly by denunciation. on three levels. The first relates However, interviewed migrants to the perception of migrants as a spoke of cases of aggression without factor of urban insecurity. Although revealing the aggressors’ identities. 23.4 per cent of interviewed migrant households house at least The second level relates to the one unemployed migrant (adult or perception of migrants as victims of adolescent), it is difficult to conclude urban insecurity. At this point, 132

34 Internal migration in Cameroon: Constraint for or driver of urban and health development? physical aggressions were identified after migration in the current city of in the last two years within the sample residence. of surveyed migrant households. In general, 38.6 per cent of migrants are victims of aggression; 6.1 per cent Internal migration and epidemiologic has been victims four times, 6.1 per dynamics in urban centres cent has been victims five times. A Internal migration takes place total of 23 sexual attacks were also under conditions that do not always registered: Douala: 60.9 per cent, guarantee the health integrity Yaoundé: 34.7 per cent, Ebolowa: 4.3 of migrants and other urban per cent and none in Maroua. Despite populations. The development of a low turnout in the production of this spontaneous habitats and slums information, it appears that migrants by migrants is one of the principal are exposed and vulnerable. In other vectors of epidemiologic risk in the words, they are victims of urban researched cities. These urban sites insecurity. are epidemiological frameworks, The third level relates to the given the promiscuity and multiform perception of migrants as instigators environmental pollution. Migrant of urban insecurity. Here, field slums were the sites of vibrio cholera observation indicates that migrants and of all the cholera epidemics are active players in urban security. registered in Douala, Yaoundé, They participate in vigilance Maroua and Ebolowa. The risk of committees either physically or contamination is real because migrant through financial contributions. spontaneous slums suffer from a lack These contributions are particularly of drinkable water supply. It is also true important in view of the cosmopolitan that 63.8 per cent of the surveyed nature of agents and defence forces migrant households consumes in the surveyed cities. pipeline water as drinkable water. This migrants’ pipeline water is still exposed to the same contamination 5.3 Internal migration and associated with alternative sources urban health of supply for other uses. If pipeline This section analyses the influence of water is used as drinkable water, internal migration on the permanence well water, drill water, stream of epidemiological risk and on the water is used for cooking, washing, crisis of health care. It concludes bathing etc. Pipeline water is not with a comparative analysis of yet contamination/risk free. Meva’a migrant health state before and Abomo (2006a) indicates the presence 35 ACP Observatory on Migration of suspended solids in the pipeline management was highlighted by water of Douala, which is responsible 53.4 per cent of migrants who for its brownish colouration. These witnessed a substantial improvement hygiene conditions are favourable in their health since their arrival in to the development vector-borne the surveyed city. Secondly, public diseases. Malaria was contracted by health-care systems in urban areas 57.6 per cent of migrants interviewed fall victim to migration. after their relocation. Among others, Migration is a cause of urban 10.8 per cent of interviewed migrants overpopulation in Cameroon, contracted typhoid fever, 1.2 per cent resulting in a strong demand for tuberculosis, 1.6 per cent dermatitis health care without an adequate and 0.8 per cent a sexual transmitted system of care provision. This system disease. A Yaoundé migrant has thus operates at overload. The testified to contracting HIV after her emergence of an informal modern urban migration. health-care system, the development of the culture of auto-medication Internal migration and the system of and the emergence of traditional public health care medicine are all induced effects of insufficient quantitative and There is an inverse relationship qualitative public health care in between internal migration and the surveyed cities. Poor migrants urban health-care systems. Firstly, in general, therefore use different by its quality and capacities, the routes and different therapeutic availability of public health care mechanisms of health management. in urban areas is an element that In practice, 42.2 per cent of causes migratory dynamics. The interviewed migrants admitted using strong presence of health-care presumptive diagnosis. Conventional services, information, education medical diagnosis usually only occurs and communication, good hygiene, in complicated illnesses. Table 5 compliance with preventative below presents the occurrence of measures and finally the geographic each type of diagnosis in the different area and cost of accessibility to public cities. health institutions and medicines are described as elements that trigger migratory flows to urban health systems. Access to health-care

36 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Table 5: State of the prevalence of illness diagnosis types within the surveyed migrant households (in %)

Presumptive Legal medical diagnosis diagnosis Douala 39.1 57.9 Yaoundé 48.5 47.4 Maroua 38.9 42.6 Ebolowa 34.0 56.0 Percentage in relation to the total number who provided 42.2 52.0 information Source: Field enquiry, November 2012.

Table 6: Evaluation of requests for therapeutic treatment within the surveyed migrant households (in %)

Legal Informal Tradi- Self- Mixed No modern modern tional Religious medi- treat- answer medi- medi- medi- healing cation ment cines cines cine Douala 2.0 53.0 24.0 6.7 6.9 19.3 0.0 Yaoundé 2.6 45.8 28.9 7.7 10.8 8,8 0.0 Maroua 16.7 52.6 7.1 9.0 9.3 0.0 3.7 Ebolowa 12.0 45.4 12.0 5.4 8.0 4.0 0.0 Percentage in relation to the total number 4.8 49.2 18.0 7.2 8.8 11.6 0.4 who provided information

Source: Field enquiry, November 2012.

37 ACP Observatory on Migration

Six methods of managing migrants’ Predominance of an improvement of health problems were identified the health of migrants once in town (table 6). Modern legal medicines Despite the status of internal are used by 49.2 per cent of migrant migration as a lever of precariousness households. Informal modern in urban areas, a comparative study medicine is used via clandestine of the health status of migrants services, constituting 18 per cent of between their former and current surveyed migrant households. Just place of residence shows a substantial 8.8 per cent of surveyed migrant improvement. This improvement was households attested to using reported by 53.4 per cent of migrants traditional medicine, 0.4 per cent interviewed on average, 52.5 per cent requested religious healing in prayer of migrants in Douala, 45.3 per cent groups, and lastly 11.6 per cent of in Yaoundé, 74.1 per cent in Maroua migrant households used mixed and 66 per cent in Ebolowa. This medicine, that is, a combination of improvement is a response to the many methods. observation of certain preventative There is a wide variety of locations measures, for example, the use of that provide migrants with medicine. mosquito nets. In fact 70.2 per cent Four principal supply routes were of interviewed migrant households identified: public pharmacies, have at least one mosquito net and community pharmacies or 88.2 per cent of these mosquito nets pro-pharmacies in hospitals, road have been impregnated. This strong pharmacies owned by informal appearance of impregnated mosquito providers, and outlets for traditional nets is a solution provided by the products. However, five drug supply distribution of this preventative routes were identified. 47.8 per material to pregnant women and cent of migrants interviewed used children under five years in public public pharmacies, 16.6 per cent hospitals. Figure 12, on the contrary, pro-pharmacies, 28.2 per cent road presents the proportion of these pharmacies, 8.8 per cent in traditional households in different cities. medicine outlets and finally 11.6 per cent used a mix of supply routes.

38 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Figure 12: Variation of proportions of migrant households having at least one mosquito net (in %)

0 100 200 Km Maroua 50-59% 60-69% 70-79% 80-89%

90-99%

Yaoundé Douala

Ebolowa

Source: Field enquiry, November 2012.

5.4 Analysis of the results of the the qualitative data collection study technique (structured interviews) and dual analysis (qualitative and This section focuses on three points. quantitative). The use of this method It starts by an assessment of the via the multidisciplinary and systemic methodology used, continues with approach allowed the development of the results analysis and ends with categories, typologies and structures a presentation of the issues and for links that relate to the study’s challenges. objectives. These were derived from analysing popular discourse on the practised, experienced, perceived A methodological approach tested by and represented urban migration generalizing the study results patterns. Quantification of these The methodology applied in this study elements through a structured resulted in a better understanding qualitative analysis, followed by of the interaction between internal a fine-scale cartography of the migration, urbanization and health research sites, reflects the success in the cities studied: Douala, of the qualimetric method. However, Yaoundé, Maroua and Ebolowa. generalizing the results to represent The qualimetric method used Cameroon as a whole highlights the 39 ACP Observatory on Migration low statistical representativeness researched cities is not only a of the sample of cities studied (4) factor limiting their development, relative to the total urban population it also has an undeniable impact on in the country (312). A more national development because this significant sample in terms of the population represents a major flow number of researched cities (at least of economic products. It induces 5% of the total population of cities, a high consumption of goods and about 16) would have produced services that has a positive effect more applicable results for the entire on the national economy. Both national territory. capitals Douala and Yaoundé, totalling more than a quarter of the total population of the country, Revealing the predominance of the also have the highest rate of urban positive impact of internal migration consumption and labour provision on urban and national development in different forms. They are the The results of this study are generally lungs of the national economy. indicative of an ambivalent function of In terms of urban planning, it was migration in the four cities. On the one noted in the field that sub-standard hand, this phenomenon is a multiscale housing is not an exclusive challenge for urban development. It neighbourhood for migrants. is the main factor of rapid population Neighbourhoods of non-migrants growth, simultaneously uncontrolled are also characterized by and uncontrollable. It is the lever for uncontrolled land use and squatter the emergence of spontaneous and settlements. If the observed dirty slums. It is inseparable from the neighbourhoods of non-migrants causality matrix of the environmental are not spontaneous, they are crisis and health insecurity prevailing not always planned, neither in in the surveyed cities. These adverse part or in full. Several areas of effects are the result of a first paradigm non-migrants are much lower of urban migration: the migration of in quality and precarious than misfortune. It is practised by a certain the migrant neighbourhoods. group: the disadvantaged migrants Moreover, in-situ observations and the poor. reveal that migrants are proven developers of modern living, the On the other hand, internal migration best case being the resurgence is not an issue for urban development: of luxury buildings in residential In sociodemographic terms, areas of Douala (Bonapriso, Akwa, the demographic weight of the Bonamoussadi, Makepe), Yaoundé 40 Internal migration in Cameroon: Constraint for or driver of urban and health development?

(Bastos, Lake District, Mendong, services (HYSACAM) and even for Hippodrome, Odza), Maroua municipal officials in charge of (Djarengol, Domayo, Palar) and city maintenance. Already, field Ebolowa (Angale, Mekalat). It visits indicate that non-migrants is a way of living that follows pollute as much as migrants. Piles urbanization standards that of refuse in open areas, stagnant implicitly reconfigure the urban domestic waste water and morphology of the research cities. polluted streams were identified In total, the migrant is not only a in non-migrant quarters of Douala, promoter of slums. He is also an Yaoundé, Maroua and Ebolowa. engine of fast-growing residential The uncontrolled management areas in the studied regional of refuse and domestic waste capitals; an undeniable co-architect water are therefore not of modern and sustainable cities. exclusive to migrants’ quarters. This is a response to the migration Finally, migrants should not be of fortune, the second paradigm considered as the only agents of urban migration practised by of degradation and pollution of wealthy migrants. the urban environment. They are also active players in the quest On the environmental front, for regaining a sustainable urban migrants, regardless of their environment. Their dynamism is category, contribute to services also an undeniable development in the inhabited space through factor for sustainable development maintaining their living quarters. in Douala, Yaoundé, Maroua and In principle, their social integration Ebolowa. is promoted by their involvement in certain community-orientated In terms of health, in-situ activities. Several health and observations revealed that safety committees have also been migrants are not particularly identified in the researched areas. exposed or more vulnerable Migrants invest in sanitation, than non-migrants. Regarding release gutters, maintain roads the water hazard for example, and clear impassable roads in interdependence and their living space. This dynamism interpenetration of bodies of both is sometimes the only way of surface and underground water servicing the inhabited space in ensure the spread of germs and marginal urban areas (suburbs, contamination of all urban waters. marshy lowlands) that are difficult The entire urban population to access for health and safety (migrants and non-migrants) is 41 ACP Observatory on Migration

thereby exposed and vulnerable. drawbacks, the complementary The spread of germs in cities also role of this medicine is undeniable occurs due to stray animals, people in the context of a mismatch and contaminated objects. Public between supply and demand for places frequented by both migrants medical care services and of the and non-migrants are spaces of general dysfunction of the urban transmission of communicable health system. As underlined by diseases. The cholera epidemic of Meva’a Abomo (2011, 2012a), 2004 may be cited as an illustration. the weak and unequal health Starting from sub-standard wells coverage, the problem of financial (the main home of vibrio cholera) accessibility to treatment and in a migrant neighbourhood medication, the epidemiological in Douala (Bepanda TZF), the supervising crisis and the paralysis cholera first spread throughout of community health are indicative the city, and then seven of the actors of dysfunction in the ten regions in the country (Assako urban health system and justify Assako et al., 2005). Yaoundé, the emergence of an increasing Maroua and Ebolowa were hit integration of traditional medicine by the epidemics. Other field in researched cities. Despite these observations conducted during this shortcomings, the proximity study provide many informative of treatments offered in cities elements that tell more about the maintains a better sanitary epidemic dynamics. As mentioned situation for the surveyed migrant above, in principle, non-migrant population. It is an undeniable neighbourhoods are not always factor towards the improvement characterized by good health and of living conditions or human development of migrants. Hospital safety conditions. The permanent and clinics, public pharmacies, risk of unhealthy disease is medical laboratories, in short the confirmed, as is the epidemic entire private sector of public risk or spatial propagation. health, is mainly controlled by Ultimately, the health issue in the migrants in Douala, Yaoundé, researched cities is not exclusive to Maroua and Ebolowa. Most State spontaneous migrant slums nor is officials working in the public it inherent to migration. health sector are also migrants. Urban migration is accompanied Traditional medicine makes a by deportation in cities using significant contribution to wellness. sociocultural practices such as Similarly, the participation of traditional medicines. Despite its migrants in community activities 42 Internal migration in Cameroon: Constraint for or driver of urban and health development?

of hygiene and sanitation in certain cases of aggression, urban migrant and mixed (migrants and migrants nonetheless contribute non-migrants) neighbourhoods to urban security. There is reflects the contribution of this therefore potential to improve the segment of the urban population neighbourhood. to the promotion of community On the socioeconomic level, it health. has already been underlined that In terms of urban insecurity, the urban migrants induce the informal study results show that migrants sector, a provider of employment are as much victims of urban (although precarious) and thus a insecurity as non-migrants. If the regulator of unemployment and its latter cannot be totally blamed as perverse effects. Despite its status the cause of insecurity, it does not as ‘informal’, the disadvantaged cause itself. Responsibility is rather migrants who are the principal shared between all urban actors. actors (motorbike taxi drivers, However, it has been established small traders) pay taxes to the that migrants are preventers of municipality and also to the State. urban insecurity through their From this perspective, internal participation in activities of migration contributes significantly vigilance committees created in the to the bailout of autonomous quarters since 1990. A substantial territorial communities and even reduction of crime and burglary in of State funds. It is a driver of houses has been registered since urban growth and also the national the introduction of this system of economy. Already the actors of monitoring and community safety the so-called ‘formal’ economy in the neighbourhoods. A system are mostly individuals from of self-financing was revealed other places (migrants and some by the vigilance committees. immigrants) in Douala, Maroua The inhabitants of the districts and Ebolowa where natives are participated or financially today minorities. supported the youths who patrolled The massive displacement of each night. In addition, several young people at the end of their thieves, bandits and aggressors are academic and professional training caught daily thanks to motorbike towards national university taxi drivers, the majority of whom megacities such as Douala, are migrants. Their intervention Yaoundé, Maroua and Ebolowa in the form of a swarm of bees is promotes the development of generally faster than the police. more qualified and diversified Though not exonerating them of human capital to fulfil the need for 43 ACP Observatory on Migration

higher professional qualifications partially or totally covered health for national socioeconomic care by their spouse, whatever development and the achievement the marital status. This allows of greater governmental ambitions them to save money and to make relative to the transformation of their migration profitable for their Cameroon as an emerging country family left behind. In total, urban by 2035. integration is generally easier and more harmonious for women than Analysis of the interaction between men. gender and migrant health reveals a gender variation in the exposure In addition to health issues, it and vulnerability of migrants. The was found that under the same urban activities practised by men conditions of the general non- sometimes expose them more qualification of migrants, women than women. Handling, motorbike integrate faster than men in the taxis and night security are some socioprofessional milieu. They activities causing different levels may undertake gainful activities of health risk exposure relating to and be self-employed. They could gender in the researched cities. equally benefit from support Men are subject to only one form from their partners to initiate an of health care: self-care where activity. Others are easily recruited they are the only guarantors of by companies through their their own health. Women, on spouses or another person who is the other hand, benefit from two sometimes more settled. The latter main opportunities: self-health analysis is indicative of a change care and health care provided in the migratory experience by their spouses. Having a regarding gender. However, this spouse becomes a secular and differentiation is linked to the preventative policy that justifies abusive exploitation of women the high birth rates registered in the urban setting. This reality in urban neighbourhoods highly therefore raises a double problem populated by migrants. It also on the dialectic of migration and causes the proliferation of sexually gender in Cameroon: the integrity of female migration on the one transmitted diseases in these hand, and the integration of urban urban neighbourhoods. However, migrants on the other hand. women have better financial access to health care because In short, at its best urban of the two above-mentioned migration contributes to income possibilities. 42.2 per cent of generation and quality of life, and interviewed migrants have to development intrinsically linked 44 Internal migration in Cameroon: Constraint for or driver of urban and health development? to urbanity. A positive impact of and especially urban migration have internal migration on urbanization hitherto been kept apart as marginal and health emerges despite some social facts, marginalized in the limitations, shortcomings and public governance sphere and during many adjustable exceptions. From economic and social development this perspective, urban migration planning. For this reason, internal becomes an opportunity to promote migration has produced devastating development. effects and contributed to a crisis in urban and even rural areas. Issues and challenges Regulating the negative impact and optimizing the fundamental The prevalence of migration’s development function of internal positive impact on urbanization and migration are emerging as the health as revealed by the present main challenges for governments, study refocuses economic, social, civil society, the population and political and even scientific debates researchers. In addition, the on the developmental issue of regulation of spontaneous and internal migration. This prevalence insalubrious slums, the promotion should not overshadow the more of decent social housing and negative effects of internal migration. sociocommunity infrastructures, Placing a special emphasis on the the quantitative and qualitative disadvantaged and mixed migrants’ improvement in the provision of neighbourhoods in the sample health care in urban areas marked has its strategic reason with the by the regulation of geographic aim of mobilizing and stimulating and financial access, are all specific corrective actions. At the same time, challenges in Cameroonian cities. the negative repercussions of the Rural development and the urban migration phenomenon that promotion of income-generating were noted remain at the basis of a activities in secondary cities or areas, fundamental problem. That is, it is a rural towns and in the countryside problem of control and management are another array of challenges that of this social fact in view of optimizing this study highlights to regulate urban economic, social, cultural and migration flows. environmental profitability. Internal

Internal migration in Cameroon: Constraint for or driver of urban and health development?

6. Conclusion and recommendations

The present study raises questions The high population of the surveyed about the interaction between cities develop into genuine consumers internal migration, urbanization and of goods and services relevant to health in Cameroon. The qualimetric urban, and even national, economies. method was used. The structured Migrants are promoters of residential interview technique was used for and luxurious neighbourhoods data collection in the four sampled in the surveyed cities. They are cities through the combined effect consequently active players in the of several eligibility criteria. The development of modern cities. They collected data were analysed using actively participate in maintaining the qualitative, quantitative and spatial urban environment and community techniques. At the end of this study, health. They are also promoters of three principal affirmations could be the private sector of public health and formulated. constitute a majority within the public Firstly, urban migration is an sector and public health personnel. undeniable factor of the urbanization They are the creators of an informal crisis in general and the spontaneous economy sector which is a vital part and insalubrious urbanization model of the economy not only urban, but that prevails in the surveyed cities. It is a also and mostly national. Migration factor of overpopulation, emergence in the surveyed regional capitals is of slums and environmental crisis due a means of improving migrants’ life to the lack of control of the spatial- conditions regarding health-care, demographic growth of the surveyed jobs, education, and academic and cities. In addition, methods of land professional training. It is therefore use and urban practices of migrants a vector of the human development turn internal migration into a lever of the studied population. In total, for epidemiologic vulnerability in urban migration contributes to the cities in a context where the urban productive functioning of a better health system is overloaded due quality of life that is intrinsically to increasingly important and linked to urbanity. unmanaged migratory flows. Thirdly, comparing the negative and Secondly, internal migration is not positive impacts of urban migration only an issue and a constraint in urban generally leads to considering and health development. It is also an that internal migration has a more undeniable lever to the contribution contributory than restricting role for of migrants to urban functionality. urban and national development. A 47 ACP Observatory on Migration reconstruction of the difficult chain migration into an engine of balanced of causality of urban migration has national development and equitable been made. It appears that they do and sustainable human development. not result from any natural feature To achieve this goal, a fixed objective of the migratory phenomenon, is to reinforce institutional capacities but instead results from the crisis to improve the programmatic frames of planning and urban governance and strategic management of internal in the surveyed cities. One of the migration. In practice, seven pioneer great merits of migration is to recommendations were formulated compose and recompose urban for the implementation of the structures continually, to revitalize F-PGIM: urban functionality and to renew or regenerate indefinitely the productive 1. The creation of a national function of human development, institution for the proactive hitherto attributed to the city. governance of internal migration attached to the Ministry of Meanwhile, these merits produce Territorial Administration and the opposite effect if the process of Decentralization in cooperation urban migration is uncontrolled, such with several other government as in Douala, Yaoundé, Maroua and ministries; Ebolowa: urban disintegration and disconnection, dysfunction of urban 2. The development of a legislative units, poor development, and a lack of and regulatory framework for appreciation of the potential positive proactive governance of internal impact of migration on development. migration; The problem lies ultimately at the 3. The preparation of a national level of control and management geopolicy for the proactive of this social phenomenon, a governance of urban phenomenon which is experiencing migration implemented by the a management crisis. Faced with this aforementioned institution. reality, the present study prescribes This geopolitics is based on two a F-PGIM as an alternative. That paradigms: is, a tool for decision making and a programme for action directly usable a) Proactive geostrategy in rural to optimize the economic, social and areas: promotion of urban environmental benefits of urban development to stabilize the rural migration for developmental ends, population and to encourage both in urban and rural areas. migrants settled precariously in the city to return: The F-PGIM prescribed in this study has the goal of transforming internal 48 Internal migration in Cameroon: Constraint for or driver of urban and health development?

i) Creating sources of by the population before their employment in the primary arrival; sector on the basis of ii) Creating an urban migration opportunities in each locality; brigade in the neighbourhoods, ii) Intensifying the funding of municipal services and law income-generating projects for enforcement in the cities in youth in the rural milieu (SMSE, order to identify migratory CIG); flows, anticipate anarchic settlements and play the role iii) Constructing infrastructure of helpline and daily monitor and sociocommunity facilities for migrants; in rural areas (roads, primary, secondary and tertiary schools, iii) Identifying and individualizing primary health-care centres, standardization of informal hospitals, etc.); sector activities (motorbike taxis, urban agriculture, iv) Establishing and strengthening public phone booths, small the agricultural sector with a businesses, etc.) for a better focus on improving farming and more sustainable socio- techniques, access to subsidies professional integration of the and sales markets, facilitating migrants and for optimizing the flow of production and their contribution to economic optimizing the profitability of development; the agricultural service; iv) Initiating a programme to v) Creating training centres and decongest the cities based on vocational integration in rural the adopting and implementing areas (training in agriculture, incentives for assisted fisheries and handicraft voluntary return migration techniques and training in (AVRM); primary and paramedical health care, training in income- v) Promoting community health generating activities). (creation and capacity building of health and sanitation b) Proactive geopolitics in urban committees in urban areas: neighbourhoods, development i) Developing and implementing and dissemination of a strict urban decennial information, education and planning while overseeing the communication for health, new installation sites organized health training programmes 49 ACP Observatory on Migration

for city dwellers in techniques 6. Contextualized use of the Method of primary health care at the of Endogenous Potentialities and neighbourhood level, etc.); Opportunities/MEPO (Meva’a Abomo, 2013a) in the operation vi) Capacity building of technical phase. The MEPO is a procedure and vocational training of the for the effective and sustainable National Fund for Employment; resolution of local development vii) Extending health coverage issues. It recommends a five-step in cities by increasing health approach: geostrategic evaluation, centres in urban areas where geostrategic planning, feasibility it is lacking: in spontaneous, studies, impact assessment and insalubrious and peripheral validation of the geostrategic quarters; assessment (figure 13); viii)Establishing training centres 7. Collaboration and cooperation and professional integration by to promote the exchange of autonomous local authorities; experiences with States and ix) Promoting the development advanced institutions and of secondary cities considered organisms in the governance of bottlenecks in the regulation of internal migration. the rural exodus and interurban migration flows. 4. Integration of the internal migration phenomenon into the national strategy of poverty reduction and in any national development planning; 5. The creation of a National Centre for the integrated monitoring internal migration; a related structure of the National Institution of Proactive Governance of Internal Migration based on studies and scientific research in collaboration with universities;

50 Internal migration in Cameroon: Constraint for or driver of urban and health development?

Figure 13: Schematic overview on the Potentialities and Opportunities Method, adapted to the regulation of the internal migration issue (Meva’a Abomo, 2013a).

First stage: The geostrategic assessment of the urban migration issue in each urban site: ‐ Two levels of thematic scale: (the endocentric and exocentric diagnosis); ‐ Two levels of geographical scale: in‐situ scale (the town itself) and ex‐situ scale (the province or country where the said town is founded) ‐ Identification of potentialities and weaknesses, the specific opportunities and threats of each city.

Second stage: The geostrategic planning of developing migration in a specific manner in each urban site: ‐ The formalization of a theoretical diagram of optimal valorization of each endogenous opportunity previously diagnosed; ‐ Elaboration of a tactical plan of intervention for each theoretical diagram; ‐ The formalization of one mode.

Method of Endogenous Third stage: Study of feasibility Potentialities and Assessment of possibilities for implementation on technical, economical, Opportunities (MEPO) sociocultural, political and environmental plans.

Fourth stage: Study of impact Assessment of the social, cultural, economic, political and environmental impacts on the implementation of the tool.

Fifth stage: The validation of the tool Consensus between all local actors and leads to the production of a realistic intervention and directly exploitable model.

In spite of the negligible effect of Cameroonian cities” has been verified the methodological shortcomings in the researched cities. The second linked to a reduced sample of studied hypothesis which stipulated that “the cities, the main objective of the strategically planned governance study was “to achieve a structured and the proactive vocation of analysis of the dialectic of internal internal migration as an engine migration, the urbanization crisis of transformation of this societal and health precariousness in urban phenomenon from a constraint into areas, identifying the tangible an opportunity of urban development opportunities that it offers to make in Cameroon” has also been verified it an engine of sustainable human in the researched cities. Despite development” has been achieved. the reduced sample of researched According to the results, the first sites, it is still possible to identify hypothesis which stipulated that the overall problem of interaction “internal migration is a determinant between internal migration, of the crisis of urbanization and urbanization and health due to the the health precariousness in high qualitative representation of

51 ACP Observatory on Migration the four cities observed (Douala, thus been reached. At this stage of Yaoundé, Maroua, and Ebolowa) in the survey, a fundamental question relation to the study’s objectives. emerges in relation to the feasibility The results of this study allowed of the F-PGIM: if internal migration the development of the F-PGIM, a is an opportunity for both urban and politically expedient managerial tool human development at the national that is socially needed, economically level, shouldn’t the mobilization of feasible and culturally integrated. resources to carry out the F-PGIM The aim of the study that was be considered as a worthy public “to contribute to improving the investment from the Cameroonian institutional, programmatic and State? strategic management frameworks of internal migration in Cameroon” has

52 Internal migration in Cameroon: Constraint for or driver of urban and health development?

7. References

Aktouf, O. 1992 Méthodologie des sciences sociales et approche qualitative des organisations. Une introduction à la démarche classique et une critique. Les Presses de l’Université du Québec, Montréal. Alawadi Z. 2006 Problématique de la cohabitation inter- communautaire au Nord du Cameroun. L’expérience des communautés migrantes, Revue internationale des Sciences Humaines et Sociales, 1(1) : 319-349. Amou’ou Jam, J.P., A. Melingui and A. Tchepannou 1985 Géographie, le Cameroun, Armand Colin, Paris, 128p. Assako Assako, R.J., D. Meva’a Abomo and L.B. Tchuikoa 2005 Etude géographique de l’épidémie de choléra à Douala ou la qualité de vie à l’épreuve des pratiques urbaines. Espaces, qualité de vie et bien être. Presses Universitaires d’Angers, Angers. Ba’ana Etoundi, M.L. 1996 Dynamique et fragilité des pôles secondaires au Cameroun : le cas de Kribi. Thèse de Doctorat de Géographie. Université Paris IV- Sorbonne. Bekolo Engoudou, B.D. 2008 La relation thérapeutique dans les interférences entre médecine conventionnelle et traditionnelle. Une lecture anthropologique à l’hôpital Laquintinie et à l’African clinic de Douala (Cameroun). Mémoire de DEA d’Anthropologie de la Santé. Université de Douala. Corvevin, M. 1993 Archéologie africaine. Maisonneuve et Larose, Paris. Cheru, F. 2007 Mondialisation et urbanisation inégale en Afrique. Alternatives Sud : Explosion urbaine et mondialisation – Points de vue du Sud. De Bruijin, M., R.Van Dijk and D. Foeken 2001 Mobile Africa. Changing Patterns of Movement in Africa and Beyond, Leiden, Brill. Dongmo, J.L. 1980 Polarisation de l’espace camerounais : les champs migratoires des villes. Revue de géographie du Cameroun, I (2) : 145-160.

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Dong Mougnol, G.M. 2006 Migrations internes et problèmes fonciers au Cameroun. Les cas de Makenene et Mbangasina dans la région du Mbam, de 1926 à nos jours. Thèse de Doctorat/Ph. D en Histoire. Université de Yaoundé 1. Eboussi Boulaga, F. 2012 Préface. In Le Cameroun septentrional en transition. Perspectives pluridisciplinaires (Alawadi Zelao and Bouba Hamman, eds). L’Harmattan, Paris : 7-9. Evina, R.C. 2009 Migration au Cameroun, Profil national. Organisation Internationale pour les Migrations (OIM), Genève. Fadibo, P. 2012 Femmes et santé au Nord-Cameroun (1902 à nos jours) : des consultations par personnes interposées aux visites médicales féminines directes. In Le Cameroun septentrional en transition. Perspectives pluridisciplinaires (Alawadi Zelao and Bouba Hamman, eds.). L’Harmattan, Paris : 231-353. Gubry, P. 1996 Le retour au village est-il une solution ? Le cas du Cameroun, in Crise et population en Afrique (Cousy, J. et al., eds.). Cahiers du CEPED. Institut National de la Statistique (INS) 2011 Deuxième Enquête sur l’Emploi et le Secteur Informel au Cameroun (EESI 2) ; Phase 1 : Enquête sur l’emploi, Rapport principal. International Organization for Migration (IOM) 2007 Glossaire de la migration No. 9. OIM, Genève. . Kalenge Nguvulu, C. 2010 Vue d’ensemble sur les migrations Sud-Sud, tendances du développement et besoins en termes de recherche au Cameroun. . Lututala Mumpasi, B. 2007 Les migrations en Afrique centrale : Caractéristiques, enjeux et rôles dans l’intégration et le développement des pays de la région. Papier présenté à l’Atelier sur les migrations africaines, du 18 au 21 septembre, Accra.

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Mbarkoutou Mahamat, H. 2012 Le banditisme urbain au Nord-Cameroun : entre archaïsme et professionnalisme, in Le Cameroun septentrional en transition. Perspectives pluridisciplinaires (Alawadi Zelao and Bouba Hamman, eds.). L’Harmattan, Paris : 151-168. Meka’a, C.B. 2007 Capital humain, migration interne et revenus au Cameroun. Thèse de Doctorat nouveau régime en économie. Université de Yaoundé 2. Meva’a Abomo, D. 2006a Etude géographique de l’endémicité du paludisme dans l’interface Environnement et santé à Kribi. Mémoire de DEA de Géographie. Université de Douala. 2006b De l’abondance des ressources en eau a la rareté de l’eau potable, un indicateur pertinent de la crise managériale des villes littorales du sud: l’exemple de Douala au Cameroun. Communication scientifique 7ème Conférence Internationale Conférence « Gestion démocratique des bien collectifs / Ville Management », CIDEGEF, A.U.F., C.U.D., University of Douala, 22-24 November 2006, Douala. . 2006c Logiques d’aménagement des marches urbains ou construction du risque environnemental dans les villes du Tiers-monde : l’exemple du marché Mboppi à Douala (Cameroun). Communication in the 7th International Conference: « Gestion démocratique des bien collectifs / Ville Management », CIDEGEF, A.U.F., C.U.D., University of Douala, 22-24 November 2006, Douala. . 2011 Etude des facteurs d’endémicité du paludisme urbain à Douala (Cameroun). Thèse de Doctorat / Ph. D de Géographie, Aménagement, Développement Durable. Université de Douala. 2012a Dysfunctions study of epidemiological surveillance system of urban malaria in Douala (Cameroon). African Journal of Social Sciences - AJOSS. 2012b Géographie de la santé appliquée à l’étude des disparités spatio- sanitaires dans la plantation d’Hévécam au Sud – Cameroun, MUTUBE. Annales de la Faculté des Lettres et Sciences Humaines (FLSH). Université de Douala (sous presse). 2013a La crise de l’eau potable dans les villes côtières du sud : résultats d’une étude menée à Kribi (Cameroun). Revue Internationale des Lettres et des Sciences Sociales « ABA ,» N° 2. Editions Dianoïa, Chennevières/Marne.

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2013b Migration, environnement et changement climatique en Afrique Centrale (pays membres de la CEEAC). Communication à Atelier régional de planification de politique stratégique en matière de migration et développement, du 23-24 janvier 2013, Libreville, Gabon, 17p. Meva’a Abomo, D., M. Fouda, B. Nguehan, G. Pola and A.A. Ebana 2011 Répercussions du développement de l’agriculture urbaine sur la transition démographique des villes du sud : le cas du bassin versant du Mbanya à Douala (Cameroun). Laboratory of Research, Planning and Sustainable Development, Department of Geography, University of Douala (not published). Meva’a Abomo, D., M. Fouda, B. Chofor Zoum and M. Kamwo 2010 Analyse spatiale du risque d’inondation dans le bassin versant du Mbanya à Douala, capitale économique du Cameroun. NOVATECH International Conférence, Lyon, 27th June – 1st July 2010. . Meva’a Abomo, D. and D. Piih 2007 Précarité de l’emploi et insécurité socioprofessionnelle des femmes dans les villes du Tiers-monde : bilan d’une étude expérimentale menée à Douala, capitale économique du Cameroun. Communication à la Conférence Internationale de l’Association Internationale sur le Sécurité Sociale (AISS), Warsaw (Poland), March. . Mimche, H. and F. Fomekong 2008 Dynamiques urbaines et enjeux socio-démographiques en Afrique noire : Comprendre le présent pour prévoir l’avenir. Revue Internationale des Sciences Humaines et Sociales. L’Afrique subsaharienne à l’épreuve des mutations, 2(2). L’Harmattan : 241- 264. Ndione, B. and J.P. Pabanel 2007 Définition d’un profil migratoire pour la région Afrique Centrale. Rapport provisoire, Fonds européen du Développement - Afrique Centrale. Ndjanteng, M.C. 2005 Logiques des acteurs et gestion de l’espace périurbain : le cas de la zone Nylon et de Douala – Nord. Mémoire de DEA de Géographie. Université de Yaoundé 1.

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Sali, H. 2012 Habitat, urbanisation et problèmes fonciers dans la ville de Maroua : mutations et constances, de 1985 à nos jours. In Le Cameroun septentrional en transition. Perspectives pluridisciplinaires (Alawadi Zelao et Bouba Hamman, eds.). L’Harmattan, Paris : 327-348. Seignobos, C. 2002 Les services de santé : des structures sous perfusion internationale. In Eléments d’une stratégie de développement rural pour le Grand nord du Cameroun, II-Notes thématiques. Ministère de l’Agriculture du Cameroun, SCAC Cameroun. Tabapssi, F.T. 1999 Le modèle migratoire bamiléké (Cameroun) et sa crise actuelle : perspective économique et culturelle. Université de Leiden, Leiden. Tendron, G. 2002 Les problèmes environnementaux de l’eau et sa gestion à Douala (Cameroun), Mémoire de DEA Professionnel, Université de Caen- Basse Normandie. United Nations Organization 2008 Principes et recommandations concernant les recensements de la population et de l’habitat. . Van Santen, J.C.M. 2012 The Mafa Dispersed: Migration, Citizenship and Access to land in Cameroon. In Le Cameroun septentrional en transition. Perspectives pluridisciplinaires, (Alawadi Zelao & Bouba Hamman, eds.), L’Harmattan, Paris : 255-288. Watang Zieba, F. 2011 Muskuwaari, immigration et mutations spatio-agricoles en pays guiziga (Extrême-Nord Cameroun). Thèse de Doctorat en Géographie. Université de Ngaoundéré. Watang Zieba, F. and B. Gonne 2009 Le pays guiziga : de l’émigration à l’immigration ou « l’effet miroir » des migrations vers la vallée de la Bénoué. In Kaliao, Revue de l’Université de Maroua, Séries Lettres et Sciences humaines, 2. Watang Zieba, F. and M. Lieugomg 2009 Mobilités et mutations agricoles dans la plaine du Diamaré : le cas des terroirs de Foulou et Mobono / carrière. In Les migrations et mobilités spatiales dans le bassin du Lac Tchad (Tourneux, H. and Woin, N., eds). IRD, Marseille : 443-459.

Internal migration in Cameroon: Constraint for or driver of urban and health development?

8. Annex: Direct interview guide

Remarks for the researcher: Persons to be interviewed: all qualified individuals in migrant households, Target persons: exclusive migrant population of households Good morning Mrs. /Mr., my name is……………………………,Researcher-lecturer at the University of Douala. Within our research, your neighbourhood was chosen for a study on the problem of urbanization and health in relation to internal migration. The African, Caribbean and Pacific State Observatory on Migration sponsored this study in collaboration with the Pan-African Agency of Builders. It will formulate concrete solutions to several problems found here in these neighbourhoods. So, with your permission, I wish to interview with you for a few minutes. You are not obliged to take part. Nevertheless, given the value of the information you can provide us, I ask you to participate with sincerity, and rest assured of the confidentiality of your information. Can we begin our interview?

THEME 1: CHARACTERIZATION OF MIGRATION Thematic axis 1: Information on the migrants 1. What is your region of origin? 2. Can you tell us when you arrived in this city? 3. How long have you been gone from your primary area of residence? 4. What made you migrate or leave your initial residence to come here: Principal causes? Other causes? 5. Do you wish to return and live in your primary area of residence? 6. Are there preliminary conditions to fulfil for you to be motivated to return to your initial area of residence? 7. If yes, which? Thematic axis 2: Information concerning the other migrants in the household 8. Are there other individuals in your household who are not natives? 9. If yes, how many are there? 10. Where do they come from? 11. Can you reconstitute the migratory itinerary of each person? 12. How long have they each been here in the house? 13. What made each one of them migrate or leave their primary area of residence to come here: principal causes? Other causes? 14. Do you think each one of them wishes to return to their primary area of residence? 15. If yes, how many?

59 ACP Observatory on Migration

16. Are there conditions that are necessary for a return to their place of origin? 17. If yes, according to you, which conditions do they require in order to be able to go back?

THEME 2: SOCIODEMOGRAPHIC CHARACTERISTICS Thematic axis 1: Household structure 18. What is your marital status (single or cohabiting, married, divorced, widow/ widower)? 19. What is your marital regime? (to be asked only to the married interviewees) 20. Do you have children? If yes, how many? Thematic axis 2: Household population 21. What is the total number of migrants in your household? 22. Which is the number of migrants in your household in terms of age and sex group (0-5 years; 6-10 years; 11-20 years; 21-30 years; 31-40 years; 41-50 years; 51-60 years)? 23. What is the total number of your household members who are not migrants? 24. What is your level of education? 25. What is the highest level of education in your household?

THEME 3: INTERNAL MIGRATION/URBANIZATION Thematic axis 1: Internal migration, urban planning and environment 26. Do you own this accommodation? 27. If yes, do you have a land title/deed? 28. What did you do to get this piece of land? 29. Do you have a construction permit? 30. Where do you pour your domestic waste water? 31. Do you have a modern shower system? 32. Where do you put your refuse? Thematic axis 2: Economy (informal sector) and urban insecurity 33. What is your main activity? 34. Do you have secondary activities? If yes, what? 35. What are the main activities of the other migrant workers in your household? 36. What is your monthly income? 37. Can you estimate the monthly average income of the other migrant workers in the household? 38. Does this income allow you to carry out your social projects?

60 Internal migration in Cameroon: Constraint for or driver of urban and health development?

39. Do you feel better here than in your original place of residence? 40. Are there adolescent(s) or adult(s) migrants who do not have a particular occupation or is/are unemployed(s)? 41. Are there migrants who work at night in your household? 42. Have you or a migrant of your household ever suffered from physical aggression here in the city? 43. Have you or a migrant of your household ever suffered from sexual aggression here in the city?

THEME 4: INTERNAL MIGRATION AND URBAN HEALTH Thematic axis 1: Exposure and epidemiology risk 44. Which water do you drink (tap, well, natural source, stream)? 45. Which water do you use for cooking (tap, well, natural source, stream)? 46. Which water do you use for bathing (tap, well, natural source, stream)? 47. Do you sleep under a mosquito net? 48. How many migrants sleep under a mosquito net? 49. Are the nets treated? Thematic axis 2: Health treatment/disease management 50. Since your stay in the city, have you ever been ill? 51. What diseases have you suffered from? 52. How did you diagnose these disease(s) here in the city? 53. How was the illness treated? 54. Did you suffer from the illness before your arrival in the city? 55. If yes, which illness precisely? 56. Can you name some of the illnesses that migrants in your household have suffered? 57. Where do you and other migrants in your household get medication for your treatment? 58. Are there young migrants of school age who are mothers in your household?

Internal migration is often considered a major determinant of unplanned urbanization and urban health precariousness in Cameroon. However, internal migration contributes at the same time to improving the living conditions of migrants and to the emergence of an informal sector that provides jobs and is predominant in the national economy. This study emphasizes that internal migration constitutes an undeniable opportunity for development which unfortunately is hampered by a crisis of governance. The study aims at contributing to the management of internal migration and its transformation into an engine of balanced and sustainable national development. EastAfrica

Central database Africa

Caribbean

Senegal

health

labour

Haiti

Nigeria diasporas environment

Southern integration Africa training Timor-Leste

South-South Kenya

return development internal Democratic

migration Republic ObservatoryAngola of the Congo rights Cameroon

displacement trafficking Pacific Tanzania Lesotho statistics gender West Africa remittances urbanization Trinidad and Tobago Papua irregular New Guinea

ACP Observatory on Migration An Initiative of the ACP Secretariat, Funded by the European Union 20, rue Belliardstraat (7th floor) 1040 Brussels - Belgium Implemented by IOM and with the Financial Support of Switzerland, IOM, the IOM Development Fund and UNFPA Tel.: +32 (0)2 894 92 30 - Fax: +32 (0)2 894 92 49

[email protected] - www.acpmigration-obs.org International Organization for Migration (IOM) Organisation internationale pour les migrations (OIM) Organização Internacional para as Migrações (OIM)