The U.S. Brags About Health Aid to Africa While Bombing Some of Its Most Vulnerable Nations

Libya and Somalia, where U.S. forces have spent hundreds of millions on airstrikes, have fared especially poorly when it comes to direct U.S. health assistance.

A Somali woman carries wood to make a shelter in an internally displaced people (IDP) camp on December 18, 2018, as hundreds of people recently fled from southern Somalia US's airstrikes against al Shebab, in Baidoa, autonomous South West State of Somalia. - The US military said on December 17, 2018, it has killed 62 militants from the jihadist Shabaab movement in six air strikes in Somalia. The air attacks, in a coastal region south of Somalia's capital, Mogadishu, were the deadliest in the country since November last year when the US said it had killed 100 militants. (Photo by Mohamed ABDIWAHAB / AFP)        (Photo credit should read MOHAMED ABDIWAHAB/AFP via Getty Images)
A Somali woman carries wood to make a shelter in an internally displaced people camp on December 18, 2018. Hundreds of people fled from southern Somalia because of the US's airstrikes against al Shebab in Baidoa. Photo: Mohamed Abdiwahabafp/AFP/Getty Images

As Covid-19 began spreading across the African continent in late March, the U.S. State Department took to Twitter to boast about American health assistance there. A March 25 tweet from the department highlighted more than $100 million in U.S. medical assistance to foreign countries, including in Africa, as evidence of America’s emphasis on mitigating “endemic and emerging health threats” and its “long-term investment in the lives of Africans.”

When it comes to Africa, the messaging suggests, America’s focus is on saving lives, not ending them. But a wealth of evidence reveals that the opposite is true in the two African countries of greatest interest to the U.S. military: Libya and Somalia.

Since U.S. Africa Command became fully operational in 2008, American troops have seen combat in more than a dozen African countries and conducted more than 1,500 air attacks, commando raids, and other ground missions in Libya and Somalia alone. Yet these two countries, where U.S. forces have spent hundreds of millions on airstrikes, have fared especially poorly in terms of direct U.S. health assistance.

Libya and Somalia are also the only two African countries where the U.S. stands accused of killing civilians and failing to take responsibility for their deaths. “This sends an appalling message to the citizens of those countries — namely, that the U.S. cares more about propping up their governments than about helping people suffering on the ground there,” said Daphne Eviatar, director of the Security with Human Rights program at Amnesty International USA. “The irony is that message will only encourage ill will toward the United States and U.S. forces, and ultimately fuel support for the armed groups the U.S. is fighting.”

The U.S. military has sought to portray AFRICOM as something more akin to the Peace Corps than a geographic combatant command like Central Command, which oversees U.S. military operations and war-making across the Greater Middle East.

A parade of top generals and boosters have promoted the idea that AFRICOM would wield soft power through a “whole-of-government” approach, partnering with civilian agencies to “advance U.S. national interests” on the African continent. As a “hybrid” command, officials vowed, it would stand apart from its war-fighting brethren and approach its corner of the world differently.

It is, at its heart, a different kind of command with a different orientation,” said then-Defense Secretary Robert Gates at AFRICOM’s inauguration in 2008, stressing that it would forge “civilian-military partnerships.” Earlier this year, in testimony before members of the House Appropriations Committee, AFRICOM’s chief, Gen. Stephen Townsend, was still touting the command’s “whole-of-government” mindset. Problems like Covid-19 “don’t really have military solutions” and necessitate working with partners like the State Department and the U.S. Agency for International Development, Townsend said in March.

Two weeks later, the State Department’s Africa Media Hub tweeted about America’s focus on helping, rather than harming, Africans. The tweet was accompanied by a color-coded map showing which African countries have received the most direct “global health assistance” from the United States since 2001.

In April, the Africa Media Hub tweeted out an enhanced version of the map that included U.S.-funded national reference laboratories, whose core functions include supporting disease diagnosis and surveillance, as well as investigating outbreaks. The maps demonstrate that when it comes to the most militarily important countries on the continent, America’s synergistic whole-of-government approach to wielding soft power to achieve national security goals is more fantasy than reality.

AFRICOM engages in six “lines of effort” — primary objectives to be accomplished over years of sustained military operations. Most, such as “strengthen partner networks,” relate to general undertakings, but two target individual African nations: “Develop security in Somalia” and “Contain instability in Libya.” Of at least 13 African countries where U.S. forces have engaged in combat in the last decade, these nations have seen the U.S. military’s most intense (Libya) and sustained (Somalia) attacks.

The State Department maps also show that these two countries have received among the least U.S. health aid on the continent: less than $500,000 for Libya and between $500,000 and $99 million for Somalia.

Since 9/11, the U.S. has carried out more attacks in Libya, targeting militants associated with Al Qaeda and the Islamic State, than anywhere but the war zones of the Greater Middle East. The United States has conducted no fewer than 776 airstrikes — and likely far more — in the North African nation from 2011 to the present, according to figures provided to The Intercept by retired Air Force squadron commander Lt. Col. Gary Peppers and by Airwars, a U.K.-based airstrike monitoring group.

The bulk of those attacks occurred during the Obama administration, which launched the first large spate of strikes in 2011 to support the rebels who ultimately ousted then-Libyan leader Muammar Gaddafi. That war shattered the Libyan state and turned the country into a haven for Islamist militants, leading to another surge in U.S. strikes in 2016.

That summer, the fledgling post-Gaddafi regime — the Libyan Government of National Accord — asked for American help in dislodging ISIS fighters from Sirte. The Obama administration designated the city an “area of active hostilities,” loosening guidelines designed to prevent civilian casualties and allowing the U.S. military a freer hand in carrying out airstrikes. Between August and December 2016, according to a statement from AFRICOM, the U.S. carried out “495 precision airstrikes” in the city.

In 2011, President Barack Obama pledged that the United States would “work with the international community to provide assistance to the people of Libya, who need food for the hungry and medical care for the wounded.” Almost a decade later, medical care remains a challenge for Libyans because, according to USAID, “a substantial proportion of health facilities [are] only partially operational or closed.”

The State Department’s recently tweeted maps highlight one of the reasons: almost nonexistent U.S. support. Libya is one of only two countries to receive so little in direct American health assistance, according to government figures. (The other is Tunisia, where U.S. troops have also been involved in combat in recent years, but whose relative stability sets it apart from its neighbor Libya.)

While the U.S. military has carried out more airstrikes in Libya, Somalia is the site of America’s longest-running air campaign outside the CENTCOM area of operations — and that war is escalating at an exponential rate under the Trump administration. The United States has carried out more than 220 attacks in Somalia since 2007, primarily aimed at the terrorist group al-Shabab. There have already been more U.S. airstrikes in Somalia in 2020 than there were declared attacks by AFRICOM during the entire Obama presidency. Add ground operations, and the number of total U.S. attacks in Somalia would be even higher, according to retired Brig. Gen. Donald Bolduc, who served as commander of Special Operations Command Africa from April 2015 to June 2017, and Air Force files obtained by The Intercept via the Freedom of Information Act.

There has been much speculation about U.S. troop drawdowns in Africa, and Covid-19 has paused or curtailed U.S. military deployments around the globe. But the number of troops deployed in Somalia has hovered between 650 and 800 American personnel since last year, Manley said.

SABRATHA, LIBYA - FEBRUARY 19: People gather around a damaged area after U.S. warplanes carried out air strikes against Daesh training camp in western Libya on February 19, 2016.  (Photo by Hazem Turkia/Anadolu Agency/Getty Images)

People gather around a damaged area after U.S. warplanes carried out air strikes against Daesh training camp in western Libya on February 19, 2016.

Photo: Hazem Turkia/Anadolu Agency/Getty Images

To house those forces and support hundreds of ground missions over the years, the U.S. military has built an archipelago of outposts and bases across the country. But experts say that what Somalia really needs are hospitals and clinics. According to the United Nations Office for the Coordination of Humanitarian Affairs, Somalia’s “healthcare system is overburdened, fragmented, under-resourced and ill-equipped to provide lifesaving or preventive services.”

“Somalia’s health indicators are among the worst in the world,” the World Bank recently observed, “and Covid-19 cases threaten to stretch a fragile healthcare system.”

“I urge our donors … to invest in the future of Somalia through the health of its people,” Dr. Ahmed Al-Mandhari, the World Health Organization regional director for the eastern Mediterranean, said during a late 2019 visit to the country, where 3 million people are in need of health assistance.


U.S. Airstrikes Hit All-Time High as Coronavirus Spreads in Somalia

Yet the United States has only invested $30 million in health assistance to Somalia over the last 19 years — less than it has given to 33 other countries on the continent, including Botswana ($1.1 billion); Eswatini ($490 million); Guinea ($365.5 million); Namibia ($970.5 million); and Zambia ($3.9 billion). Those countries have received far less attention from the U.S. military — and no airstrikes.

U.S. attacks in Somalia have killed as many as 142 civilians since 2007 and up to 82 in Libya since late 2011, according to Airwars. Yet AFRICOM has admitted to killing only four civilians on the continent, two each in airstrikes in Somalia in 2018 and 2019.

Despite its whole-of-government rhetoric, AFRICOM’s failure to coordinate with the State Department and USAID was likely a key reason that Somali civilians have never received assistance, reparations, or compensation for deaths and injuries caused by U.S. airstrikes, Eviatar noted. “AFRICOM’s minimal presence on the ground in Somalia is also the reason they give for being unable to adequately investigate claims of civilian casualties, and they’ve made no effort to coordinate with State or USAID to do so,” she told The Intercept.

“We are proud to stand by our partners as we battle this deadly virus in Africa and around the globe,” U.S. Air Force Lt. Gen. James Vechery, AFRICOM’s deputy chief, said recently as the command drew attention to training and equipment provided to four African nations to enable them to set up and operate mobile hospitals. “The effort highlights a whole-of-government approach, aimed at ensuring African partners are educated, resourced, and supported to contain the spread of the virus,” reads a recent AFRICOM news release.

But neither Somalia nor Libya, nor any of the other 11 nations where the U.S. has been engaged in combat in recent years, received any of that assistance.

In this photo taken Wednesday, May, 13, 2020, medical workers in protective suits carry the body of Ibrahim Hassan, 56, before he is buried in Mogadishu, Somalia. His brother said he died of the coronavirus at the Martini Hospital. At the hospital, the main facility treating COVID-19 patients in Mogadishu, health care workers have received little training, and they have raised concerns about their personal safety. (AP Photo/Farah Abdi Warsameh)

Medical workers in protective suits carry a body before it’s buried in Mogadishu, Somalia on May 13, 2020. At the hospital, the main facility treating COVID-19 patients in Mogadishu, health care workers have received little training, and they have raised concerns about their personal safety.

Photo: Farah Abdi Warsameh/AP

The second version of the State Department’s Global Health Assistance map was accompanied by the claims that that the United States is “leading the world’s humanitarian & health assistance response to the COVID-19 pandemic” and that U.S. investment in Africa “increases local access to and delivery of health services.”

This map, too, spotlights the neglect for the “delivery of health services” in countries that have borne the brunt of American attacks. Of the 29 national reference laboratories supported by PEPFAR, the President’s Emergency Plan for AIDS Relief, not one is located in either Libya or Somalia. In fact, only five of the 29 labs can be found in countries where the United States has been engaged in combat in recent years: two in Kenya and one each in Cameroon, the Democratic Republic of Congo, and South Sudan.

In March, USAID announced an initial commitment of $37 million from its Emergency Reserve Fund for Contagious Infectious Diseases for 25 “high-priority countries.” Only seven of them were in Africa, and they did not include Libya or Somalia. Only one — Kenya — was the site of recent U.S. combat.

Last month, the State Department and USAID announced nearly $508 million in emergency health, humanitarian, and economic assistance to “support critical activities to control the spread” of the coronavirus. Together, Libya and Somalia are receiving 3.6 percent of the total Covid-19 response funds, or $18.6 million. By comparison, Italy — which has a far more robust health care system than either nation and hasn’t borne U.S. attacks since the 1940s — will receive $50 million. Other contemporary U.S. battlegrounds include Afghanistan (more than $18 million); Iraq (more than $25.6 million); and Syria (almost $18 million). All of those countries outpaced Libya ($6 million) and Somalia (nearly $12.5 million). The U.S. has since announced an additional $4 million in Covid-19 assistance for Somalia, but seemingly none for Libya.

AFRICOM has acknowledged conducting 39 airstrikes in Somalia this year. Even if each strike involved just one missile, that’s roughly $4.7 million spent on munitions alone. Add in a second $120,000 Hellfire missile, a portion of the cost of a $16 million MQ-9 Reaper drone, fuel, salaries for the pilot, sensor operator, and ground crew, and the costs of additional intelligence and surveillance assets for each strike, and the tab jumps exponentially.

Add the 188 prior attacks since 2007 by U.S. drones, AC-130 gunships, and attack helicopters, as well as naval bombardments and cruise missile strikes, and the costs skyrocket. Tally the price of supporting Ethiopian, Kenyan, Somali, and Ugandan troops in hundreds of ground missions — including construction and operating costs of bases, provisions, and other materiel, contractor-flown helicopters, and the like — and expenses mount ever higher. Then add a minimum of 776 airstrikes in Libya at just $120,000 each, and you’ve increased the tally by another $93 million.

“It’s astonishing that while the U.S. has been willing to conduct bombing campaigns in both Libya and Somalia, they’re willing to leave local populations behind in their response to a deadly pandemic and leave them even more vulnerable to the reach of extremist groups who gain traction by offering services,” said Priyanka Motaparthy of the Columbia Law School’s Human Rights Institute.

The State Department and USAID did not respond to questions about the allocation of U.S. resources. When The Intercept asked Dr. Meredith McMorrow, a medical officer in the U.S. Centers for Disease Control and Prevention’s influenza division based in South Africa, if money poured into U.S. counterterrorism activity in Africa would have been better spent on public health assistance, she sidestepped the question and noted that the U.S. has provided African nations with “significant support in the past.”

Eviatar sees it another way: “This just highlights the perverse nature of the United States’s so-called security assistance to Somalia and to Libya, which has consisted of killing people there, including untold numbers of civilians, while providing only minimal assistance to improve the health and well-being of those countries’ populations.”

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