The US is wary of China’s military ambitions in Africa

China has officially launched its support and logistics base in the Djibouti. More than 300 people attended the opening ceremony on Tuesday
China officially launched its first overseas military base in the Djibouti in August 2017.

  • The top US commander in Africa recently said China’s new naval pier in Djibouti could support an aircraft carrier.
  • China’s peacekeeping deployments in Africa are seen as a potential excuse to build up its military presence on the continent.
  • See more stories on Insider’s business page.

With a population of under 1 million, Djibouti on the Horn of Africa is one of the smallest countries on the continent.

But what it lacks in size, it makes up for with its strategic location, overlooking the Bab el-Mandeb Strait, a choke point between the Red Sea and the Gulf of Aden.

It is that location that has made it a hub for foreign militaries. Before 2017, the United States, France, Japan and Italy had established bases for their armed forces in the country. Then China arrived, setting up what it described as a logistics facility for resupplying Chinese vessels on peacekeeping and humanitarian missions.

That facility houses between 1,000 and 2,000 Chinese navy personnel, according to various reports. About 12 km away, the US’s Camp Lemonnier military base houses 3,400 personnel.

Analysts say that while the US has always welcomed China’s support for UN peacekeeping operations and anti-piracy efforts in Africa, it is concerned China plans to expand its rights to set up bases, using them to extend its military reach and grow arms sales to African countries.

china africa
Children hold Chinese flags before the arrival of Chinese President Hu Jintao in Monrovia, Liberia, February 1, 2007.

Luke Patey, a senior researcher at the Danish Institute for International Studies, said whether in Africa or the Arctic, the US did not want to see a challenger upset its dominant global military presence.

“Chinese participating in peacekeeping missions may not turn too many heads at the Pentagon, but China’s Djibouti base has military capabilities that extend far beyond the logistical needs of any peace or humanitarian mission,” Patey said.

US Army Gen. Stephen Townsend, leader of US Africa Command, told the US Senate Armed Services Committee on April 20 that China “continues to expand their base in Djibouti into a platform to project power across the continent and its waters – completing a large naval pier this year.”

He said the recently completed pier at the Chinese naval base in Djibouti was large enough to support an aircraft carrier.

Townsend said Beijing sought to open more bases, tying their commercial seaport investments in East, West and Southern Africa closely with involvement by Chinese military forces to further their geostrategic interests.

Reflecting those concerns, US Sen. Robert Menendez has sponsored a bill proposing to deny help to governments that allow China’s People’s Liberation Army to host a military installation.

China has not responded to Washington’s latest claims. But last year, when the US Department of Defence alleged in its annual report to Congress that Beijing was planning to set up more military bases in Africa, China’s foreign ministry denied the reports and urged the US to “abandon the outdated Cold War mentality and zero-sum game mindset, stop issuing irresponsible reports year after year.”

China's President Xi Jinping speaks during a Forum on China-Africa Cooperation in Sandton, Johannesburg, December 4, 2015. REUTERS/Siphiwe Sibeko
Chinese President Xi Jinping at a Forum on China-Africa Cooperation in South Africa, December 4, 2015.

Jeffrey Becker, director of the Indo-Pacific Security Affairs Programme at the Centre for Naval Analyses, said that for China establishing a second African base was certainly a possibility as China’s interests in Africa and the surrounding regions continued to grow.

“Places such as Kenya and Tanzania on Africa’s east coast, or Namibia along the Atlantic, have been mentioned as possible locations,” Becker said.

“A second base in Africa would improve China’s ability to conduct a range of operations, including evacuating Chinese citizens in times of crisis and protecting China’s access to key maritime chokepoints in the region, which are critical to China’s trade and energy imports.”

Even if China were to open bases in those countries, Patey said “these plans may still pale in comparison to the hundreds of bases operated by the United States, but if enacted they would still extend China’s military reach far from its mainland and near waters.”

But US concern about China’s security presence in Africa was not especially grounded in national security rationale, according to Samuel Ramani, a tutor in politics and international relations at the University of Oxford in Britain.

Ramani said China and the US broadly supported a stable continental order and neither saw insurgencies or terrorism to their advantage. But Townsend’s comments reflected the US geopolitical rivalry with China and concerns about losing influence to China, Ramani said.

“It is about losing access to oil and mining resources, further erosion of US leverage in the UNGA [United Nations General Assembly] and China gaining more influence, perhaps in concert with Russia, on Indian Ocean security,” Ramani said.

He said Beijing had been cautious about its next moves concerning naval bases in Africa.

“Sao Tome and Principe was rumoured as a naval base in 2018 and there are persistent rumours about Namibia being the site of an army base. Overall though, I see China treading cautiously and not proceeding to establish a base in the near future,” Ramani said.

china africa
A Sudanese woman walks past a Chinese flag on a street in Khartoum, February 1, 2007

David Shinn, a former US diplomat and a professor at George Washington University’s Elliott School of International Affairs, said the US had always been concerned about the global expansion of the PLA Navy, including its base in Djibouti.

“Over the short and medium term, I expect China will pursue dual-use port facilities in African waters rather than new military bases,” Shinn said. “That is one reason why China is pursuing so many equity investments in African ports.”

John Calabrese, director of the Middle East-Asia Project, said the US had been encouraging China’s participation in peacekeeping as a means of showing that it was indeed a “responsible stakeholder.” But he said potential concerns included the proliferation of weapons and the possible acquisition of basing rights.

Calabrese said China’s sudden need to evacuate thousands of expatriate workers from Libya during the Arab spring drove home the need for China to develop the capacity to protect its far-flung overseas interests and assets.

Further, Calabrese said the implementation of the Belt and Road Initiative extended and deepened Chinese commercial activities in the zone around the Gulf of Aden and Horn of Africa domain in East Africa, justifying the need for a military presence in and around critical waterways and choke points at the Western extremity of the Maritime Silk Road.

Besides making baby steps as a blue-water navy, China is a key player in the UN-led peacekeeping missions in Africa, known as the blue helmets. The number of Chinese peacekeepers in Africa peaked at 2,620 in 2015 and then declined to about 2,100.

Richard Gowan, UN director of the International Crisis Group, said “there is a longer-term worry that Beijing could use its peacekeeping deployments as an excuse for building up military bases in Africa, ostensibly to support the blue helmets.”

However, he said Western fears about China’s peacekeeping ambitions were overstated and that “China has adopted a fairly cautious approach to UN deployments since 2017 when it suffered fatalities in Mali and South Sudan.”

“China’s single biggest UN deployment is in South Sudan, where it has an infantry battalion. This is, of course, in part linked to China’s energy interests there,” Gowan said.

Read the original article on Business Insider

We’ve been wrong about how insulin has to be stored, and a new approach could revolutionize diabetes treatment for millions of people

Mohamed test
Mohamed Hussein Bule, 27, who teaches science at a refugee camp in Kenya.

  • For people living with diabetes in the developing world, a lack of electricity can hamper access to insulin. 

  • But a project in Kenya has shown that insulin can be maintained in hot climates without refrigeration.
  • Researchers, calling it a breakthrough, are urging the World Health Organization to amend its guidelines. 
  • Visit the Business section of Insider for more stories.

For people living with diabetes in the developing world, getting daily life-sustaining doses of insulin has gone hand in hand with access to electricity.

Once a vial is opened, manufacturers recommend storing it in a refrigerator until it expires, which is usually after four weeks. But an estimated 470 million people around the world who don’t have access to electricity and fridges for food and medicine, making it difficult to store insulin at home.

But now, a new program could help revolutionize treatments around the world. 

It started at the Dadaab refugee camp in northern Kenya, where temperatures can reach up to 99 degrees Fahrenheit and many have no access to refrigeration. As a consequence, patients’ lives have practically revolved around going to and from the hospital to receive insulin. Having diabetes could mean missing school, work, especially since the camp’s curfew restricts when it’s possible to make the trek.

When doctors working in the camp noticed more and more patients coming to the hospital with complications from their diabetes, they reached out to researchers at the University of Geneva and decided to monitor at-home insulin storage at the camp, which experienced much warmer temperatures than label recommendations. 

Researchers replicated the camp’s daily temperature, which ranged from 77 to 99 degrees Fahrenheit, in the lab, and tested the insulin’s effectiveness. They also studied leftover insulin from vials that patients had used after storing them in their homes.

They discovered that even without refrigeration, insulin kept at the camp’s tropical temperatures was safe to use for four weeks – a revelation that could be life-changing for diabetes patients around the world. 

Following their investigation, the team adjusted the advice they were giving patients, teaching them how to self-inject, check their own blood sugar, and what danger symptoms to look out for. Most exciting of all, they showed patients how to store the insulin at home using a plastic container with a wet towel around it.  

What followed was a dramatic drop in the number of diabetic patients coming to hospital with acute complications. They were able to go to work and school and “not spend all day seeking out healthcare to stay alive,” said Philippa Boulle, from the Médecins Sans Frontières (MSF, also known as Doctors Without Borders).

Even though insulin can be damaged when it’s stored at high temperatures, the researchers found that cooler temperatures overnight could keep the insulin safe.

Dadaab
Somali refugees attend market in the sprawling Dadaab refugee camp in northern Kenya.

“Every protein goes towards degradation when it’s heated, but there are proteins that can go back when you cool them down again, and insulin seems to be one of them,” Leonardo Scapozza, a professor at the University of Geneva’s School of Pharmaceutical Sciences and one of the researchers who worked with doctors in the Dagahaley camp, told Insider. 

At the moment, guidance says patients can store their insulin at an “‘ambient temperature’,” but Scapozza said “and hot settings” should be added for clarification. There only needs to be three words added to that: ‘and hot settings’, Scapozza says.  

He said the findings could also be applied to high-income countries such as the US, for example, when natural disasters and storms that cut off power supplies.

The researchers have done further studies to test insulin in different climates, and are helping supporting refugees in their South Sudan setting to take insulin home, too.  

Now, MSF is calling on pharmaceutical corporations to amend guidelines, and for the World Health Organization to endorse their findings.

While there have been many studies testing how stable insulin is at different temperatures, the oscillating temperature factor in this study is a “new twist,” says Gojka Roglic, a medical officer at the WHO responsible for activities on diabetes management, told Insider.

WHO won’t be making any recommendations based on this study alone, but Roglic  said it will be included in a review of all research later this year.  

Ali Bishar, who is in charge of MSF’s insulin management program at the Dadaab refugee camp in Kenya, said education on diabetes and insulin is “paramount” to the program working.

“After they’re trained, the patients have to pass a competency test. Then they’re given their insulin and care is provided on and outside the wards,” Bashar said, adding that the program, which started in 2015, has grown from 35 to 45 patients in the last six years.

However, insulin storage is only the start of  managing diabetes in low-resource settings. Another major concern is how a poor diet can contribute to patients’ symptoms. 

“You have to have food when you inject insulin. In some settings, patients are fearful of the injection if they haven’t had a meal that day,” Boulle says.

Rahmo, who was in the first cohort of patients to start the MSF programme in 2015, told Insider that she has challenges with getting enough food and having a good diet., But regardless of her diet, Rahmo said  her health has improved. 

“Before this, I was confused about how to continue my life and if I’d survive,” she  told Insider through an interpreter.  “Today, I’m very happy to control my diabetes at home.” 

Mohamed Hussein Bule, 27, a refugee from Somalia who works as a teacher at a primary school in Dagahaley, enrolled in the MSF program in 2015. 

He was diagnosed with diabetes in 2014 after his weight plummeted from 150 pounds to 82 pounds, but since joining the program his weight is back up to about 143 pounds.

“I was supposed to pick up insulin at the hospital early in the morning to take home, then go to work. I was missing a lot of classes. Now, I take a vial in the morning and record my glucose, and continue with the program as my day continues,” he said. 

“I don’t even feel like a patient with diabetes now. I’m very glad to be on the program.”

Read the original article on Business Insider

A new approach for handling insulin could revolutionize diabetes treatment for millions of people

Mohamed test
Mohamed Hussein Bule, 27, who teaches science at a refugee camp in Kenya.

  • For people living with diabetes in the developing world, a lack of electricity can hamper access to insulin. 

  • But a project in Kenya has shown that insulin can be maintained in hot climates without refrigeration.
  • Researchers, calling it a breakthrough, are urging the World Health Organization to amend its guidelines. 
  • Visit the Business section of Insider for more stories.

For people living with diabetes in the developing world, getting daily life-sustaining doses of insulin has gone hand in hand with access to electricity.

Once a vial is opened, manufacturers recommend storing it in a refrigerator until it expires, which is usually after four weeks. But an estimated 470 million people around the world who don’t have access to electricity and fridges for food and medicine, making it difficult to store insulin at home.

But now, a new program could help revolutionize treatments around the world. 

It started at the Dadaab refugee camp in northern Kenya, where temperatures can reach up to 99 degrees Fahrenheit and many have no access to refrigeration. As a consequence, patients’ lives have practically revolved around going to and from the hospital to receive insulin. Having diabetes could mean missing school, work, especially since the camp’s curfew restricts when it’s possible to make the trek.

When doctors working in the camp noticed more and more patients coming to the hospital with complications from their diabetes, they reached out to researchers at the University of Geneva and decided to monitor at-home insulin storage at the camp, which experienced much warmer temperatures than label recommendations. 

Researchers replicated the camp’s daily temperature, which ranged from 77 to 99 degrees Fahrenheit, in the lab, and tested the insulin’s effectiveness. They also studied leftover insulin from vials that patients had used after storing them in their homes.

They discovered that even without refrigeration, insulin kept at the camp’s tropical temperatures was safe to use for four weeks – a revelation that could be life-changing for diabetes patients around the world. 

Following their investigation, the team adjusted the advice they were giving patients, teaching them how to self-inject, check their own blood sugar, and what danger symptoms to look out for. Most exciting of all, they showed patients how to store the insulin at home using a plastic container with a wet towel around it.  

What followed was a dramatic drop in the number of diabetic patients coming to hospital with acute complications. They were able to go to work and school and “not spend all day seeking out healthcare to stay alive,” said Philippa Boulle, from the Médecins Sans Frontières (MSF, also known as Doctors Without Borders).

Even though insulin can be damaged when it’s stored at high temperatures, the researchers found that cooler temperatures overnight could keep the insulin safe.

Dadaab
Somali refugees attend market in the sprawling Dadaab refugee camp in northern Kenya.

“Every protein goes towards degradation when it’s heated, but there are proteins that can go back when you cool them down again, and insulin seems to be one of them,” Leonardo Scapozza, a professor at the University of Geneva’s School of Pharmaceutical Sciences and one of the researchers who worked with doctors in the Dagahaley camp, told Insider. 

At the moment, guidance says patients can store their insulin at an “‘ambient temperature’,” but Scapozza said “and hot settings” should be added for clarification. There only needs to be three words added to that: ‘and hot settings’, Scapozza says.  

He said the findings could also be applied to high-income countries such as the US, for example, when natural disasters and storms that cut off power supplies.

The researchers have done further studies to test insulin in different climates, and are helping supporting refugees in their South Sudan setting to take insulin home, too.  

Now, MSF is calling on pharmaceutical corporations to amend guidelines, and for the World Health Organization to endorse their findings.

While there have been many studies testing how stable insulin is at different temperatures, the oscillating temperature factor in this study is a “new twist,” says Gojka Roglic, a medical officer at the WHO responsible for activities on diabetes management, told Insider.

WHO won’t be making any recommendations based on this study alone, but Roglic  said it will be included in a review of all research later this year.  

Ali Bishar, who is in charge of MSF’s insulin management program at the Dadaab refugee camp in Kenya, said education on diabetes and insulin is “paramount” to the program working.

“After they’re trained, the patients have to pass a competency test. Then they’re given their insulin and care is provided on and outside the wards,” Bashar said, adding that the program, which started in 2015, has grown from 35 to 45 patients in the last six years.

However, insulin storage is only the start of  managing diabetes in low-resource settings. Another major concern is how a poor diet can contribute to patients’ symptoms. 

“You have to have food when you inject insulin. In some settings, patients are fearful of the injection if they haven’t had a meal that day,” Boulle says.

Rahmo, who was in the first cohort of patients to start the MSF programme in 2015, told Insider that she has challenges with getting enough food and having a good diet., But regardless of her diet, Rahmo said  her health has improved. 

“Before this, I was confused about how to continue my life and if I’d survive,” she  told Insider through an interpreter.  “Today, I’m very happy to control my diabetes at home.” 

Mohamed Hussein Bule, 27, a refugee from Somalia who works as a teacher at a primary school in Dagahaley, enrolled in the MSF program in 2015. 

He was diagnosed with diabetes in 2014 after his weight plummeted from 150 pounds to 82 pounds, but since joining the program his weight is back up to about 143 pounds.

“I was supposed to pick up insulin at the hospital early in the morning to take home, then go to work. I was missing a lot of classes. Now, I take a vial in the morning and record my glucose, and continue with the program as my day continues,” he said. 

“I don’t even feel like a patient with diabetes now. I’m very glad to be on the program.”

Read the original article on Business Insider