In Northern Kenya, Kaltuma Hassan’s clan has studied the sky for generations, searching for any indication of rain or sign of water to quench the thirst of their dehydrated livestock. But the ancient techniques used by Hassan’s ancestors, the Samburu Tribe, have been rendered obsolete as periods of drought intensify and unpredictable weather patterns further degrade the already fragile lands.

The occurrence of famine is not rare in Kenya, or any of the other countries in the Horn of Africa: a region located in the northeast corner of Africa known for its horn-shaped geographical appearance, droughts, and high poverty levels. Periods of low rainfall befall the area annually, but in recent decades these droughts have become more frequent and severe. Dry seasons and warmer temperatures make it even harder for vegetation to grow in the already arid climate, causing food shortages as a result of dwindling yields. However, the perpetuation of food insecurity in the Horn of Africa extends beyond environmental factors. The region, plagued by political instability and conflict, provides little support or infrastructure for its citizens, and with a history of abysmal food provisions, political inaction exacerbates the detrimental impacts of droughts and limited food supplies.

Yemen and its citizens are no strangers to political uncertainty and its effects on food scarcity. The nation has been ravaged by upheaval since 2015 when President Abd Rabbu Mansur Hadi and his ministers lost control of the capital. Overthrown by Houthi rebels who captured the city, officials are seeking asylum in Saudi Arabia and trying to hold on to some control. However, with ruling powers residing in another state and government buildings destroyed little aid has been provided to citizens. Over 80 percent of the population or 24 million people are experiencing some form of starvation. Children are the most vulnerable demographic; millions of youth in the country are suffering from malnourishment. Child mortality rates have skyrocketed, and parents are forced to watch their children die of hunger in what has been dubbed the “worst humanitarian crisis of the 21st century ”.

The devastation of the conflict and the government’s lack of control means that federal powers provide barely any aid. Growing violence and conflict is destroying once farmable land, and millions are being displaced from farms that had been in their family for generations. Now, 90 percent of Yemen’s food is imported, but the population, with its growing unemployment rates, is struggling to purchase the imported goods. While millions drop below the poverty line the government is unable to provide social services, like food banks, subsidies for farmers, or other supports. Like Yemen, many of the regions in Africa have experienced, or are experiencing, some form of political instability, and as a result, food becomes harder to come by. When people do suffer the effects of malnourishment, illness, and disease as a result of food insecurity, there are little health services and qualified medical professionals to aid citizens, resulting in preventable and devastating deaths.

Though the troubles with food insecurity do not end with governments, as exponential population growth coupled with high poverty levels make it difficult to procure sufficient food supplies. The Horn of Africa has one of the fastest-growing populations in the world, the majority of states having a population growth percentage that hovers around 2.5%. For countries like Kenya, Uganda, and Somalia, populations have increased by more than 500 percent since 1960. In contrast, crop area has declined by 33 percent. In rural communities in the Horn of Africa, many families rely on subsistence farming. However, as the availability of fertile land and crop yields decrease due to climate change, it becomes harder for the farmers to support their families, being forced to purchase their food or starve. According to the World Bank, in Somalia income per capita is US$473. As it is not unusual for families with a single breadwinner to have seven or eight members, trying to provide enough food for everyone in the household becomes a near-impossible job.

Since the 1970s numerous initiatives have been launched to put an end to the devastating impacts that food insecurity has on the region. Interventions by the United Nations Food and Agriculture Organization, the World Food Program, and even the World Bank have been on the ground for decades, but given that tens of millions of people are still under and malnourished the international community is left questioning the efficacy of aid thus far. The main fault in the programs is that they fail to make long term commitments. The World Food Organization relies heavily on cash-based Food Assistance and Emergency relief which, while important, provides a short term solution to a long and complex problem. Little tangible progress can be attributed to minimal investments being made in improving the infrastructure of the region’s economy, which would allow for governments to implement food safety programs, contribute to healthcare and education services that would lead to better reproductive health and potentially lower fertility rates, and invest in more efficient and sustainable farming tools and techniques. For decades droughts and famines have killed millions, damaging the livelihood of populations and inhibiting prosperity. However, without comprehensive and specific long-term action by the community, this devastating issue will continue to harm generations to come.

Works Cited

1. Burgess, S. (2009). Stabilization, Peacebuilding, and Sustainability in the Horn of Africa. Strategic Studies Quarterly,3(1), 81-118. http://www.jstor.org/stable/26268919

2. Food and Agricultural Organization of the United Nations. (2018). Pastoralism in Africa’s Drylands: Reducing Risks, Addressing Vulnerability, and Enhancing Resilience, Food and Agricultural Organization, http://www.fao.org/3/CA1312EN/ca1312en.pdf

3. Keller, E. (1992) Drought, War, and the Politics of Famine in Ethiopia and Eritrea, The Journal of Modern African Studies, 30(4) 609-624. http://www.jstor.org/stable/161267.

4. Khalidi, Lamya “The Destruction of Yemen and its Cultural Heritage” International Journal of Middle Eastern S tudies, Cambridge Press, 735-738. 16 November 2017, https://doi.org/10.1017/ S0020743817000691

5. OxFam “Crisis in Yemen” Oxfam Canada, 2019, https://www.oxfam.ca/emergency/crisis-in-yemen/

6. United Nations Environmental Program (2011). Food Security in the Horn of Africa: The Implications of a Drier, Hotter and More Crowded Future, United Nations Environment Program, www.unep.org/GEAS/

7. United Nations Human Rights Committee (UNHRC) “Yemen Crisis” United N ations, November 2018, https://www.unrefugees.org/emergencies/yemen/

8. World Bank, The. (2019) Overview of the World Bank in Ethiopia, The World Bank, https://www.worldbank.org/en/country/ethiopia/overview#1

9. World Food Organization, The (2019) “Our Work in the Horn of Africa” World Food Organization https://www.wfp.org/crisis/horn-of-africa

Introduction

To strive to live long, healthy lives to our fullest is a commonly accepted value in Canadian society. Likewise, fully funded healthcare is a matter of national pride; we expect as a matter of course that we will be able to have medicine for our children, care for elderly parents, and top-notch hospital service for ourselves should we need it. We shake our heads ruefully at our neighbours to the south and their backwards ways, and we feel secure in our state-of-the-art and free healthcare system. However, the fact of the matter is that that ideal—part of our Canadian identity—is far from the reality faced by Ontario hospitals today.

In Canada, healthcare is a provincial responsibility. Here in Ontario, that is represented by OHIP, or the Ontario Health Insurance Plan. OHIP ensures that every Ontario citizen has access to free hospital care, free visits to their family doctor, and covers most essential vaccinations including hepatitis B, tetanus, and measles. Even so, it is apparent that while OHIP promises much, it only partially delivers.

‘Hallway healthcare’ is the term that has been coined to discuss the issue of overcrowding plaguing our healthcare system. As the name suggests, Ontario’s hospitals are packed to the point of bursting, with patients receiving critical care in hospital hallways, patient lounges, and waiting rooms.

This issue is one that affects nearly every aspect of our lives. The good health of a population has been clearly linked with its economic success, and the advent of hallway medicine threatens to limit this. Socially, the ramifications are obvious—the strain on our healthcare resources can both physically and mentally scar those directly affected, and ultimately undermines the foundation of trust Ontarians have in our hospital system. And finally, with the recent COVID-19 pandemic, it’s evident that if the COVID-19 situation escalates to a point similar to that of China, Italy, or the United States, Ontario’s hospital system is at serious risk of being overwhelmed.

Analysis

Hallway healthcare is the product of a growing and aging population coupled with a government whose healthcare expenditure simply cannot keep up.

Hospital administrators aim for a patient occupancy level of about 85%, balancing efficiency with the ability to accommodate sudden surges in patient numbers. Yet between January and May of 2017, occupancy in University Health Network hospitals never fell below 97 percent (Ontario Hospitals Association, 2017). In Mississauga and Etobicoke, a similar pattern was observed: hospitals recorded record occupancy levels of 109 and 122 percent at their highest—and never fell below 100 percent patient occupancy. In January 2018, the issue reached its climax: Scarborough and Rouge Hospital reached 147 percent occupancy (Motluk, 2018). This is the epitome of hallway healthcare—patients wait hours to be seen, and when they finally are, it’s in a repurposed lounge filled with many other patients and their families.

While horrific in many ways, for many hospital workers, this comes as no surprise. Canada has very few total acute care beds, especially compared to other developed countries. In Canada, there are 2 for every 1,000 people; France has 4.1, Germany 6.1, and Japan 7.8. Furthermore, Ontario’s gross number of beds has actually declined and not increased in recent years, despite a both growing and aging population. Ontario in 1990 had 33,403 acute care beds. In 2014, we had only 18,588. In 2019, provincial ER waiting times set a record of longest in history. For patients forced to be privy to this, the experience can be degrading due to its lack of privacy. In some cases it can even be fatal—if hospital occupancy rises higher than 85% for a prolonged period, the risk of hospital-acquired infections rises steeply (Dwyer, 2018). For our most vulnerable, including children at Sick Kids Hospital, many of whom must share rooms with up to five others while waiting for critical surgeries, or the elderly, this is too high a price to pay (Slaughter, 2017).

Doctors, nurses, and administrators feel the strain as acutely as their patients. Administrators are engaged in a constant battle with occupancy levels, and struggle to fit as many people as possible into as compact an area as possible. Meanwhile, nurses bear the brunt of this issue; many have to take on up to six patients when they are accustomed to a maximum of four. For this reason, many feel spread thin and burned out (Motluk, 2018).

Recent studies on Ontario’s preparedness for COVID-19 found that, as a result of our experiences with SARS and H1N1, Ontario is actually slightly better prepared for a pandemic than the rest of developed countries around the globe. Nationally, Canada has a National Emergency Strategic Stockpile with equipment including ventilators, medicine and other supplies, that has been used to respond to emergencies like H1N1 and the Fort McMurray wildfires of 2016 (Keller and Stone, 2020). Overall, Ontario has done a good job preparing, by putting elective (non-essential) surgeries on hold. That said, medical professionals caution that the system could quickly be overwhelmed due to the relatively few beds available, and worry about a sudden surge in patients. Again, this may potentially exacerbate the issue of hospital-staff burnout, putting even more patients at risk.

So the system needs more money, more beds, and more personnel—the question is where to draw it from. Healthcare is already Ontario’s single largest budgetary expenditure (Dwyer, 2018), but this number needs to increase, not be on the decline.

In the lead up to the June 2018 provincial election, the New Democrats and Conservatives became increasingly critical of healthcare under the Liberal government in power. In this way, medicine became a political issue in Ontario, as the Liberals responded with a $822-million investment into hospitals prior to the election (Ferguson, 2018). As part of their platform, the Conservatives promised to find ‘efficiencies’ in the budget, but it is unclear how that has impacted the healthcare system in the time since they came into power.

The current Ontario budget promised to increase spending to support hospitals with service demands related to population growth and aging. Beds were also a topic of funding, with funding outlined for new adult critical care beds, and more hospital beds including new medical and surgical beds, mental health beds and beds for long‐term ventilated patients. There are also 40 new hospitals currently in construction across Ontario, enough to seriously improve the current situation (Sousa, 2018). In light of the COVID-19 pandemic, $100 million was also committed by the Ontario government to improve hospital capacity, although it’s uncertain how quickly this will be mobilized (Reuters, 2020). Even though these investments appear promising, it will only aid the situation, not fix many of the underlying issues.

Recommendations

Ontario needs to take action to end hospital overcrowding, and fast. In the next 25 years, the population of Ontario is expected to increase by 30 percent. A critical first step, legislatively, for Ontario, should be to implement legislation allowing the government to transfer patients requiring long-term care to other facilities, legislation that exists in many of Canada’s other provinces. This would free up precious space in hospitals for patients requiring acute care—which, of course, is a hospital’s primary mandate. With other provinces having already laid down the groundwork, Ontario needs only to imitate.

Many Ontarians do not have a designated family doctor. While the figure was previously quite low, it has increased to as high as 10 percent of the population. This results in a disproportionate number of people visiting the ER for minor issues that can be easily resolved by a family clinician. If all citizens were required to have a family doctor, this problem would likely be limited.

More alternative care options are also in order. Ontario purportedly has not built a single long-term care facility since 2003, and in light of our rapidly aging population, we need more beds allocated towards long-term care facilities. Other types of alternative care such as mental health facilities and rehabilitation centres need to be more accessible and well funded as well; diverting patients to more specific, well-equipped facilities is better for their care, and eases the strain on hospitals as well (Motluk, 2018).

With this in mind, we need to look at our budget. Healthcare spending needs to match if not exceed the rate of inflation so we can continue to provide services at a rate matching the previous year’s spending. That has not been the case of late, but is a crucial step for Ontario to restore its reputation as the healthcare haven that we market it as—the healthcare haven that we hope exists already as we tackle COVID-19. Let us confront hallway medicine head-on, and finally move forward as the thriving province we want to be. In doing so, let us secure a happy, healthy future not only for ourselves, but for the generations to come.

Works Cited