Författare: Moina Spooner Assistant Editor

Every year breast cancer claims more than 650,000 lives worldwide.

Survival rates have been recorded to be as high as 90% in high income countries. In sub-Saharan Africa the rate is less than 40%.

A recent study found that the incidences of breast cancer in sub-Saharan Africa had increased by 247% from 1990 to 2019. The highest incidence was recorded in Nigeria.

For Breast Cancer Awareness Month we highlight four essential reads about the difficulties women in Africa must overcome to survive this cancer.

Catching it early

People living in low- and middle-income countries, such as Nigeria, are highly vulnerable to breast cancer. Surgeon and lecturer Olalekan Olasehinde explains that this is mainly because people in these countries seek medical help at a late stage when the disease is advanced. When breast cancer is at an advanced stage, it is harder to treat and people are more likely to die.

Olasehinde outlines the five things one can do to detect breast cancer early and reduce the risk of death. The signs to look for include lumps in the breast and changes in the size or shape of the breast.

Read more:
Breast cancer: five tips from an expert on catching it early and keeping safe

The demon disease

Black South African women are the least likely segment of the population to have breast cancer but the most likely to die from it.

Medical anthropologist Emily Mendenhall was part of a study seeking to understand why. The study interviewed black women living in Soweto who had undergone treatment for breast cancer.

She reveals that diagnoses tend to be too late for successful treatment. The cancer may have spread to other parts of the body. In low-income communities, detection is low.

The women interviewed in the study also described the treatment as toxic and stressful and chemotherapy as much worse than cancer itself.

The author says understanding how patients feel about cancer and treatment can improve the way they are cared for, and help them cope better after diagnosis.

Read more:
Demon disease, worse than HIV: Soweto women’s views on breast cancer

Mocked and laughed at

As if the cancer wasn’t bad enough, in a study of Nigerian women human development researcher Candi Nwakasi explains that they’re stigmatised for having it.

In interviews, one breast cancer survivor revealed: “I have been mocked … laughed at … embarrassed.” Another said she had not been given her job back after her cancer treatment was complete, and that her husband treated her unkindly after her mastectomy.

This stigma can result in social isolation, loss of livelihood and fear of seeking help.

The author says these qualities are particularly significant in Nigeria, where some people diagnosed with cancer may see it as a death sentence or refuse chemotherapy and surgery because they think those treatments can kill.

Read more:
Surviving breast cancer: Nigerian women share their stories

Treatment challenges

In low- and middle-income countries, such as South Africa, adherence to treatment is a challenge. For example, outcomes are dependent upon patients following the recommended chemotherapy protocols and getting the recommended drugs at the right time.

Breast cancer expert Jenny Edge unpacks the challenges women face when it comes to getting treated. These include access to transport, socioeconomic level and social support.

Read more:
Breast cancer patients in South Africa may find it hard to stick to treatment: here’s what they told us

Transport and access

Access and transport are a major barrier. Like many countries across the continent, few public health facilities in South Africa have the specialists and resources to treat breast cancer.

Jenny Edge explains that the majority of South Africa’s population – 80% – relies on the public health sector. And services, such as chemotherapy, are only available in tertiary hospitals which are located in urban centres.

She emphasises that the outcome from breast cancer should not depend on where a person resides.

Read more:
Breast cancer patients in South Africa are battling to maintain treatment because of high transport costs Läs mer…

The United Nations security council – the most powerful body of the UN – is the institution that is primarily responsible for maintaining international peace and security. But it’s facing a credibility crisis because of its failure to address the world’s biggest conflicts.

One arena in which it’s come under scrutiny is the way it represents Africa: poorly.

African countries number 54 of the 193 members of the UN and account for 17% of the world’s population. And in the last 30 years African issues took up nearly 50% of the security council’s meetings and 70% of its resolutions. But, as political scientist Sithembile Mbete points out, Africa is the only region without a permanent seat on the council.

Read more:
Africa on the UN security council: why the continent should have two permanent seats

As articles published by The Conversation Africa have illustrated, the global body’s peace and security apparatus has failed to bring peace to some of the continent’s worst conflict zones.

One area of the apparatus that stands out is peacekeeping. About half of the current UN peacekeeping operations are simple cease-fire monitoring missions, and the others are more complex state-building efforts in civil wars.

Why are these not working?

Researcher Alexandra Novosseloff argues that for three decades, UN peace operations have been falling into the same traps because stakeholders don’t want to tackle the fact that peacekeeping missions have to meet multidimensional mandates and minimise casualties while working with increasingly tight budgets.

Read more:
UN peacekeeping is stymied by serious contradictions. They need to be resolved

For his part, peace operations scholar Alexander Gilder argues that part of the problem lies with their “stabilisation” mission.

Several UN peace operations have had “stabilisation” included in their title. These include operations in Haiti, the Democratic Republic of Congo, Mali and the Central African Republic.

But it’s not clear what activities fall under stabilisation. Missions end up with one major similarity: they are instructed to support efforts that extend state authority.

Read more:
Why using UN troops to make countries more stable can be a risky business

Similarly, peace operations expert Jenna Russo argues that the issue lies in the peacekeeping approach. Stabilisation approaches to peacekeeping – which have been pursued in countries like the Congo, Mali and the Central African Republic – are characterised by efforts to neutralise non-state armed groups and extend state authority.

Such approaches have proven largely ineffective, in part because they fail to take into account local drivers of conflict.

Read more:
Protests against UN in eastern Congo highlight peace mission’s crisis of legitimacy

Researcher Delphin Ntanyoma also shares this position. He argues that UN experts reduce the very complex causes of violence in the eastern part of the DRC to inter-communal violence. This widely disregards armed groups’ motivations to resort to violence.

Read more:
DRC violence has many causes – the UN’s narrow focus on ethnicity won’t help end conflict

The world’s costliest and deadliest peacekeeping mission, in Mali, drew to a close in December 2023.

The United Nations Multidimensional Integrated Stabilisation Mission in Mali (Minusma) was set up in 2013 when the Malian state was on the verge of collapse after assaults by terrorist groups and Tuareg rebels.

Conflict researchers Moda Dieng and Amadou Ghouenzen Mfondi point out that the end of Minusma will have many negative implications. For instance, though Minusma was not very effective in protecting civilians – 2020 was the bloodiest year for civilians in Mali – it had a human rights division that played an important role in supervising and investigating violations of human rights and international humanitarian law.

Read more:
UN troops to withdraw from Mali: what will change in terms of security

What needs to change

But there is hope.

As war and peace scholar Lise M. Howard emphasises, UN peacekeeping remains an important instrument of peace.

Read more:
UN peacekeeping in Africa is working better than you might think

Adam Day, an expert in peace operations, explains that, to improve peacekeeping operations, we can learn from what has worked in the past and refocus the UN on the more limited – but achievable – tasks that peacekeeping can deliver.

Read more:
Realism should guide the next generation of UN peacekeeping

Alexandra Novosseloff argues for a more nimble approach: missions with less ambitious and more achievable objectives, which would place more responsibility on other actors (national, regional, parallel forces) to shore up basic security in trying to find a path to peace.

Read more:
How the UN’s more nimble approach can contribute to peace and security Läs mer…

Africa is already being heavily affected by climate change. Between 1991 and 2023, the African continent warmed at a rate of 0.3°C per decade, a rate slightly faster than the global average. This has brought more frequent and severe weather extremes.

The cost of adapting to these changes and events is also immense. This was emphasised in a recent report by the World Meteorological Organization. The UN agency found that, on average, African countries were losing 2%-5% of their GDP – a measure of economic output – annually and many were diverting up to 9% of their budgets in response to climate extremes.

The report estimates that the cost of adaptation in sub-Saharan Africa ranges from US$30 billion to US$50 billion annually over the next decade.

The Conversation Africa has been tracking the impact of climate change on the African continent. Our authors have written articles that shed light on where some of these biggest climate impacts are already being felt. They also offer insights into how this can be mitigated.

Here’s a selection of reads.

Heat stressed animals

Livestock are vital to the livelihoods of millions of people across Africa. But it’s a sector that’s going to be hard hit by climate change. Unless massive adaptation measures are put in place, the number of extreme heat events driven by climate change – especially in the continent’s tropics – is set to rise.

Livestock experts Polly Ericksen and Laura Cramer explain that poultry and pigs already face major heat stress challenges in many regions of the tropics where they are currently raised. The same is true for all five major domesticated species in large swathes of west Africa, where heat stress is likely to make it nearly impossible for livestock to be kept outdoors.

They argue that, even under relatively mild but realistic climate scenarios, it will be necessary to reconfigure and relocate agricultural systems.

They set out various ways in which the International Livestock Research Institute is trying to mitigate the impact. They include index based livestock insurance programmes, community land management programmes and working with farmers to help them to adapt.

Read more:
Climate change is already hitting Africa’s livestock – here’s how to address the risks

Transport infrastructure – such as roads and railways – is another sector that’s already being threatened by climate change.

For instance, a report on Tanzania found that long stretches of road and rail networks are exposed to extreme flooding events, and exposure will grow in the future.

Damage to these networks can disrupt the flow of goods and people – which will have a negative impact on the country’s economy. The report estimated that worst-case disruptions to Tanzania’s transport networks could cause losses of up to US$1.4 million per day.

Environmental engineers Amani George Rweyendela and William John Mwegoha put forward a solution which already exists within the planning machinery of governments: environmental impact assessments.

In their work, which investigated Tanzania’s US$14.2 billion standard gauge railway project, they showed how environmental impact assessment can be used to identify climate risks and ensure that they are minimised during the project design.

They did this by carrying out climate projections along the railway’s proposed route and outlined adaptation measures for the projected risks. Recommendations included using heat-resistant asphalt, installing flood defence walls and using reinforced steel.

Their study demonstrates the huge potential of environmental impact assessments to foster adaptation in transport projects.

Read more:
Climate change is a threat to Africa’s transport systems: what must be done

Health impacts

As the world gets warmer, this will bring significant implications for our health. Public health expert Lenore Manderson unpacks some of them:

High temperatures cause heat stroke, heat exhaustion, heart attacks, strokes and other cardiovascular disease.
Drought will affect food and water systems. Millions of people will be left without proper nutrition and water shortages will heighten the risk of organ failure and death.
Viral and bacterial infectious diseases, especially prevalent in Africa, are set to rise. For instance, there is growing evidence of mosquito migration to higher altitudes, infecting people who have not been exposed to mosquito-borne diseases before.

Read more:
From heart attacks to malaria – the devastating health effects of global warming in Africa

Changing weather patterns are also having an impact on Africa’s mountains. Physical geographer Jasper Knight explains that it’s affecting their climate, weathering and erosion processes, soils, ecosystems and water resources.

This will have a knock-on effect on geological hazards, regional economies and cultural practices.

Read more:
African mountains are feeling the heat of climate change Läs mer…