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Eritrea Chapter 1 CHAPTER 1 INTRODUCTION 1.1 Geography, History and Economy Geography Eritrea, shaped like a hatchet, lies north of the equator and just north of the Horn of Africa. It is bounded in the northwest by the Sudan, in the south by Ethiopia, and in the southeast by Djibouti. Its longest border, the "handle" of the hatchet, is in the east on the Red Sea. The country has a coastline of more than 1,000 kilometers (625 miles) and its territory includes more than 350 islands. Eritrea's proximity to the Red Sea together with its physical features account for its varied climate and rainfall. The highlands have a cool temperate climate while the lowlands are characterized by a hot and humid climate, especially along the coast. Eritrea is in the Saharan rainfall zone and receives its heaviest rains from the southwest monsoons. In normal years, rainfall varies from an annual average of 400 mm to 650 mm in the highlands and from 200 mm to 300 mm in the lowlands. History On 1 January 1890, Italy set the boundaries of Eritrea and ruled it as a colony until 1941 when the British defeated the Italians in the African theater and took over the administration of Eritrea. During World War II, the British made Eritrea into an important center for British and American operations in the region. With Italy's defeat in the Second World War, the question of the disposal of its colonies was raised in the United Nations (UN). The UN sent several multinationalinvestigative teams to Eritrea to conduct local surveys on the wishes of the people. Different teams came up with different solutions, including dividing Eritrea into various portions and awarding them to Britain, France and Ethiopia; maintaining the protectorate for 10 years and then conducting a referendum; and granting full independence. After some years of deliberation, the UN adopted a resolution federating Eritrea with Ethiopia, but guaranteeing Eritreans some democratic rights and autonomy. However, during the federation with Ethiopia, Emperor Halle Selassie's government systematically violated the rights granted by the UN. In 1961, an armed struggle for independence began after years of peaceful protest against Ethiopian infringements on Eritrean democratic rights and autonomy produced no improvement in a deteriorating situation. The Emperor's transgressions culminated in the unilateral dissolution of the Eritrean parliament and annexation of Eritrea as Ethiopia's fourteenth province in 1962. In May 1991, 30 years after the struggle for independence began, the Eritrean People's Liberation Front (EPLF) liberated the entire country and established the Provisional Government of Eritrea (PGE). At the same time, the Ethiopian People's Revolutionary Democratic Front overthrew the Dergue, the Ethiopian Military junta, and instituted a Transitional Govemment in Ethiopia (TGE). In July 1991, at a national conference in Addis Ababa held to deliberate on the future of the country, the TGE endorsed the EPLF's decision to settle the Eritrean question in a referendum to be held two years hence, in which only Eritreans would participate. In April 1993, the PGE conducted an internationally supervised referendum in which 98.5 percent of the population participated; 99.8 percent voted for independence. The head of the UN observer mission said the referendum was "free and fair at every stage." Other observer groups confirmed this. After Eritreans celebrated their official independence on 24 May 1993, the Government was enlarged and reorganized, and a timetable of four years was set to accomplish the drafting of a constitution, development of political pluralism, and the establishment of an elected government (Ministry of Foreign Affairs, 1995). Economy Economically, the thirty-year war of liberation caused decades of lost development as well as the destruction of economic and social infrastructures. In 1995, Eritrea was a low-income developing country with a per capita income of less than US $200 per year. Over 70 percent of Eritrea's people depend for their livelihood on traditional subsistence agriculture including crop farming, livestock raising and fishing, although commercial agriculture and fishing have recently been revived. Eritrea's industrial base is extremely backward and narrow as it is made up of small- and medium-scale consumer-goods producing industries (food, beverages, leather goods, textiles, etc.) whose technology is largely out of date as a result of neglect of investment during the long war. Eritrea has, however, ample natural resources including over 2 million hectares of potentially arable land and the vast Red Sea continental shelf. The Red Sea fishing grounds are estimated to be capable of sustaining a production level of around 70,000 tons of fish per annum, while the current production level is less than 5,000 tons per year. As far as mineral resources are concerned, studies indicate the existence of base metals (gold, copper, zinc, lead, silver etc.) in several parts of the country but the commercial viability of the deposits has yet to be established. In fact, several companies have recently applied and received licenses to undertake exploration and prospecting work for base metals in the promising areas of the country. The potential for extracting petroleum from the Red Sea is also considered to be good and one company has already been granted an exploration license. Government development efforts since independence have concentrated on rehabilitating and rebuilding the war-damaged and destroyed economic and social infra- structures, creating and strengthening the institutions of a new state, and laying down the policy and legisla- tive groundwork for development. In November 1994, the government issued a Macro-Policy statement which spells out the broad goals and strategies of development for the next twenty years. According to the Macro-Policy, "The creation of a modem technologicallyadvanced and internationallycompetitive economy within the next two decades is an overriding national development objective." The key strategies envisaged in realizing this objective are "... human capital formation with education and health as key inputs, export oriented development both in industry and agriculture, infrastructure development to remove critical bottlenecks, environmental restoration and protection, and the promotion of the private sector." 1.2 Population Since there has not been any survey or census conducted in the country before or after independence, the population size is not known with any degree of precision. Some rough professional estimates put the country' s population in the range of 2.5 to 3.5 million. Estimates of the number of Eritreans living abroad range between 700,000 and 1,000,000. The population is culturally and linguisticallydiverse, consisting of nine ethnic groups, namely: Tigre, Tigrigna, Saho, Hedarib, Bilen, Kunama, Nara, Afar and Rashaida. 1.3 Historical Health Settings and Problems At the end of the 19th century the Italians introduced a medical service into Eritrea, initially designed purely to protect the settlers from the tropical diseases they encountered. They established a hospital at Asmara, and set up clinics in the areas of Italian settlement. Later, the post-war Labor government during the British occupation opened a network of dispensaries, and although some facilities, such as the hospital at Zula, were dismantled when the British left, Eritrea had a relatively advanced health service by the beginning of the federal period. This health system initially prospered under the Eritrean Administration. Mother and Child Health clinics were established and hospitals renovated (Firebrace and Holland, 1987). But since colonization, little had been done to teach the rural population about the causes and spread of disease. Sanitation and hygiene were rudimentary. In the late 1950s Halle Selassie's regime began to cut Eritrea's health budget, which by 1965 had fallen to a third of its 1955 level (Firebrace and Holland, 1987). As the Eritrean liberation movement become more active, the Ethiopians began to close and destroy clinics. In the rural areas, where the limited health services provided by successive colonial authorities had minimal impact, traditional healers were still consulted and commanded respect. The Eritrean Peoples Liberation Front (EPLF) set up clinics in the settled areas and served the nomadic zones and the contested areas with mobile teams. The EPLF health service started in 1970 with a single mobile clinic only competent to treat malaria and give basic first aid. Training of the first group of 25 "barefoot doctors" began in 1972, but it was not until the period 1975-78 that the health service really became effective. During these years hundreds of skilled Eritreans, including doctors, nurses and paramedical staff, fled the towns and joined the EPLF. Health services were rendered to both combatants and civilians (Firebrace and Holland, 1987). The major health problems in Eritrea are communicable and nutritional deficiency diseases. Among the communicable diseases are diarrhea, acute respiratory infections, tuberculosis, malaria, HIV/AIDS, and parasitic infections. Vaccine preventable diseases are still common among children. 1.4 Health Policy Goals, Priorities and Programs The national health policy is based on the concept and principles of primary health care (PHC), and is designed and developed in such a way that it serves the interest of the majority of the population (Ministry of Health, 1993). The key element of the concept is to
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