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August 4, 1993

Africa on the PrecipiceAn Ominous but Not Yet Hopeless Future

JAMA. 1993;270(5):629-631. doi:10.1001/jama.1993.03510050095036

FOR SUB-SAHARAN Africa, the past 20 years have been disastrous. The region has been beset by famines, droughts, civil wars, political corruption, AIDS, a rapidly increasing population, decreased food production, environmental degradation, a fall in the value of exports, an increase in the costs of imports, and massive government indebtedness. In addition, Africa now faces increasingly intense competition from other regions for scarce international aid, most notably from Eastern Europe. Aid experts are unanimous in their prediction that further economic decline, poverty, and suffering are inevitable, at least in the short term.1-8 Despite ominous economic and demographic trends, there are indications that genuine political and economic reform may be about to take place. The opportunities for Western countries and institutions to contribute to the long-term humanitarian progress of the continent may be greater now than at at any time since the end of the colonial era.1-3 However, if