In August, I arranged to meet with the President of Somalia’s transitional government, Sheikh Sharif Sheikh Ahmed. He flew to Nairobi to sit down with me at the U.S. Embassy. Sheikh Sharif was a strictly religious Islamic scholar who had fought an unsuccessful war to replace the government with a system of religious law courts (although he also won acclaim for negotiating the release of kidnapped children). After losing on the battlefield, he had won at the ballot box and, for the moment, appeared to be focused on protecting Somalia’s tenuous democracy and improving life for its people. Not that it would matter much if his government was defeated by Al Shabaab.
I found Sheikh Sharif, a young-looking forty-five-year-old, to be intelligent and forthright. He wore a white Islamic prayer hat and a blue business suit with a lapel pin depicting Somali and American flags. I thought that nicely captured the delicate balance he was trying to strike. In our conversation he was candid about the enormous challenges facing his country and fragile government. I told him that the United States would continue to send millions of dollars of military aid to his beleaguered forces and step up training and other support. But in return, his government would have to commit to making real progress toward establishing an inclusive democracy that brought together the country’s divided factions. Doing that would take substantial political will, especially from Sheikh Sharif himself.
As we talked, I wondered: Would he shake my hand? That was not a question I had to ask very often as the chief diplomat of the most powerful nation on earth, despite the sexism still rampant in many parts of the world. Even in the most conservative countries where women had little contact with men outside their families, I was nearly always received respectfully. But would this conservative Islamic scholar risk alienating his supporters by shaking the hand of a woman in public, even if it was the U.S. Secretary of State?
When we finished, we walked outside and held a joint press conference. I shared my belief that Sheikh Sharif’s government represented “the best hope we’ve had in quite some time” for the future of Somalia. (Privately I told Johnnie we were going to have to redouble our efforts to help the country get back on track.) As we parted, to my delight, Sheikh Sharif grabbed my hand and gave it an enthusiastic shake. A Somali journalist in the crowd shouted a question about whether such a gesture was against Islamic law. Sheikh Sharif just shrugged him off and kept smiling.
Throughout 2009 the Obama Administration increased support for the transitional government and allied African Union forces. Nearly $10 million in targeted aid began to turn the tide against Al Shabaab. Working together, the State Department and the Pentagon stepped up training of thousands of Somali troops in Uganda, sending them back into Mogadishu supplied with food, tents, gasoline, and other essentials. We also increased our training and assistance for the African peacekeepers fighting alongside the Somali troops. We flew in reinforcements directly from Uganda, Burundi, Djibouti, Kenya, and Sierra Leone.
To combat piracy, we set up a task force with the Department of Defense and other agencies and worked with allies and partners around the world to create an international naval force to patrol the most dangerous waters. Even China, usually reluctant to participate in such efforts, joined in. By 2011 pirate attacks off the Horn of Africa had declined by 75 percent.
To help bolster the still relatively weak transitional government, we embedded technical advisors to oversee the distribution of increased economic development assistance. Eventually the lights came back on in Mogadishu and the streets started being cleaned again. Our emergency humanitarian aid kept hungry Somalis alive and gave people the hope and strength needed to reject the extremist insurgency and begin rebuilding their country.
To provide a plan for the future, we launched a diplomatic offensive to bring together Somalia’s East African neighbors and the international community behind a single road map for political reconciliation and the establishment of a permanent democratic government that represented all of the country’s clans and regions. (The “transitional” government had been in place for years, with few signs of forward movement.)
In the years that followed, Somalia weathered several crises and made halting progress in strengthening democratic institutions and implementing the international road map. There were several times when the process seemed stalled and Al Shabaab rebounded and made tactical gains on the battlefield. The extremists continued to carry out terrorist attacks, including a suicide bombing in October 2011 in Mogadishu that killed more than seventy people, many of whom were young students waiting in line to receive test results. But in September 2011 key leaders from across Somalia’s fractured political spectrum pledged to implement the road map, finalize a new Constitution, and select a new government by mid-2012. There was a lot to get done in a short amount of time, but at least there was a plan and a commitment.
In August 2012, just weeks before Somalia was supposed to hold elections and hand over power to new leaders, I once again met with Sheikh Sharif in Nairobi. We were joined by other leaders from Somalia’s various clans and factions. I praised them for the progress they had achieved but emphasized how important it was to proceed with the elections and a peaceful transfer of power. That would send a powerful message about Somalia’s trajectory toward peace and democracy.
In September, Somalis elected Hassan Sheikh Mohamud President of the new, permanent government. Sheikh Sharif finished a distant second and, admirably, bowed out gracefully.
Our diplomatic work to support Somalia and to coordinate a military campaign against Al Shabaab also had ancillary benefits in the region, helping us develop closer ties to East African partners and improving the capacity of the African Union to take the lead in providing African solutions to African problems.
In August 2012, I visited the Kasenyi Military Base, near Lake Victoria in Uganda, and talked with U.S. Special Operations troops helping train and support the African forces. They showed me some of the small Raven unmanned surveillance drones that were helping the African Union troops go after Al Shabaab. They looked like a child’s model airplane, and when I picked one up, it was surprisingly light. Yet it was loaded with sophisticated cameras, and the Ugandans were delighted to have them.
I was glad that American innovation was making a difference in this important fight, and I told the American and Ugandan soldiers that I hoped we could use this new technology also to speed the capture of the notorious warlord Joseph Kony. He and his murderous Lord’s Resistance Army (LRA) had been wreaking havoc across Central Africa for years. Kony kidnapped children from their homes, forcing girls into sexual slavery and boys into service in his rebel army. His murderous rampage displaced tens of thousands of Africans and forced countless more to live in perpetual fear. Kony’s atrocities became infamous in 2012 through a documentary that became a worldwide internet sensation. I had long been disgusted and outraged by what this monster was doing to children in Central Africa and was eager to see him brought to justice. I urged the White House to help coordinate diplomatic, military, and intelligence resources to track down Kony and the LRA.
President Obama decided to deploy a hundred U.S. Special Operations troops to support and train African forces hunting for Kony. To work with them, I sent State Department experts from our new Bureau of Conflict and Stabilization Operations, which I had created to increase the Department’s ability to work in crucial hotspots. Our civilian team arrived on the ground a few months before the troops and began building relationships in local communities. With their encouragement, village chiefs and other leaders started actively encouraging defections from the LRA, including through a new radio station we helped set up for them. It was a small mission, but I thought it showed the potential of what we could achieve when soldiers and diplomats lived in the same camps, ate the same MREs (Meals, Ready-to-Eat), and focused on the same goals. That’s smart power in action. Now, if we could use those drones I was inspecting to see through the thick jungle canopy, we might finally be able to locate Kony and end his atrocities
. In March 2014, President Obama announced that the United States would send additional Special Operations forces and aircraft to find him. The international community should not rest until he is found and defeated.
Meanwhile, in Somalia, Al Shabaab has lost most of the territory it once controlled. But the group remains a lethal threat, both to Somalia and the wider region. We saw this with tragic consequences in September 2013, when Al Shabaab terrorists attacked a shopping mall in Nairobi and killed more than seventy people. Among the dead was Elif Yavuz, a thirty-three-year-old Dutch nurse working for CHAI, the Clinton Health Access Initiative, which combats HIV/AIDS and other diseases. She was eight-and-a-half-months pregnant. Elif’s Australian partner, Ross Langdon, and their unborn child were also killed. My husband had met Elif on a trip to Tanzania just six weeks earlier and remembered her as beloved by her colleagues. “This beautiful woman comes up to me, very pregnant. She was so pregnant that I assured her that I had been a Lamaze father and could be pressed into service at any moment,” he recalled afterward. When Bill reached Elif’s grieving mother to offer our condolences, she told him the family had decided to name her unborn child and they were looking at the Swahili words for life and love. It was heartbreaking for all of us at the Foundation and a reminder that terrorism remains an urgent challenge for our country and the world.
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Like so many development workers, Elif Yavuz dedicated her life to helping overcome the scourge of HIV/AIDS and other diseases, including malaria. For Africa, this is a pivotal challenge, with implications for long-term development, prosperity, and peace. In 2003, President George W. Bush launched the ambitious President’s Emergency Plan for AIDS Relief (PEPFAR). There are more than 35 million people living with HIV around the world, more than 70 percent of them in sub-Saharan Africa.
When I became Secretary, I was determined to support and expand PEPFAR. I began by convincing Dr. Eric Goosby to head the program as our Global AIDS Coordinator. As a physician in San Francisco in the early 1980s, he had started treating patients with a mysterious disease that would one day be recognized as AIDS. He later joined the Clinton Administration and ran the program named for Ryan White, a young American who contracted the disease from a blood transfusion.
In August 2009, Eric and I traveled to a PEPFAR clinic outside Johannesburg, South Africa. Inside we met with the new South African Minister of Health, Dr. Aaron Motsoaledi. With Motsoaledi’s appointment that May, South African President Jacob Zuma signaled a shift away from his predecessor’s denial of South Africa’s enormous HIV/AIDS problem and toward an aggressive new effort to combat and treat the disease. In that first meeting Motsoaledi told me that South Africa would not have enough money to buy the drugs to treat patients in all nine provinces and asked for our help.
This was a problem I was familiar with. Starting in 2002, Bill and a team at CHAI led by Ira Magaziner worked with pharmaceutical makers to reduce the cost of HIV/AIDS drugs and help millions of people afford the medicine they needed. By 2014 more than 8 million patients around the world have access to HIV/AIDS medicine at much lower cost in no small part because of CHAI’s efforts. And not just a little cheaper—up to 90 percent cheaper.
Yet by 2009, even though South Africa was a large manufacturer of generics, the government was still buying large quantities of brand-name antiretroviral drugs. PEPFAR, CHAI, and the Gates Foundation worked with them to complete a shift to generics, which now constitute a vast majority of their purchases. The Obama Administration invested $120 million in 2009 and 2010 to help South Africa buy the less costly medicine. As a result more than double the number of people have been treated. By the end of my tenure, many more people were on antiretroviral drugs in South Africa, and the government had saved hundreds of millions of dollars in the process, all of which it put back into improving health care. When I returned to South Africa in August 2012, the government was preparing to take over management of all the HIV/AIDS programs in the country and to oversee a large-scale expansion of treatment with a goal of treating 80 percent of those in need by 2016.
I knew that we had to build on PEPFAR’s success with fewer resources in an age of shrinking aid budgets. Through the use of generic antiretroviral drugs, consolidation of clinics, and more efficient administration and distribution, PEPFAR was able to save hundreds of millions of dollars, which allowed us to expand the program without asking Congress for additional funding. The number of patients treated with antiretroviral drugs paid for by PEPFAR together with country investments and support from the Global Fund rose from 1.7 million in 2008 to nearly 6.7 million in 2013.
The results were above and beyond what I had hoped for. According to the United Nations, since 2000 the rate of new HIV infections has dropped by more than half in many parts of sub-Saharan Africa. People are living longer and accessing more and better treatments. HIV/AIDS, a disease that used to kill 100 percent of patients, is no longer a death sentence.
Because of these successes and the advances of science, I declared an ambitious new goal on World AIDS Day in 2011: an AIDS-free generation. That means a generation in which no child is born with the virus, young people are at far lower risk of being infected throughout their lives, and those who do contract HIV have access to treatment that will prevent them from developing AIDS and from passing the virus on to others. HIV may be with us well into the future, but AIDS need not be.
To achieve this goal, we have to focus on targeting key populations, identifying people at risk, and getting them the prevention and care they need as quickly as possible. If we continue to drive down the number of new infections and drive up the number of people on treatment, eventually we will be able to treat more people than become infected every year. That will be the tipping point. It’s treatment as prevention.
In August 2012, I visited the Reach Out Mbuya Health Center in Kampala, Uganda, where I met a patient named John Robert Engole. Eight years earlier, having contracted AIDS, John Robert was near death, having dropped ninety-nine pounds and developed tuberculosis. He became the first person in the world to receive life-saving medication through PEPFAR. Miraculously he was still alive and thriving—a living and breathing example of the promise that American support can bring to the people of the world. And he proudly introduced me to two of his children.
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Nobody symbolizes the pain of Africa’s past or the promise of its future more than Nelson Mandela. Mandela is rightly hailed as a larger-than-life hero. But he was, in fact, deeply human and full of complexity: a freedom fighter and also a champion of peace; a prisoner and a President; a man of anger and forgiveness. Madiba, as his clan, family, and friends called him, spent all those years in prison learning to reconcile these contradictions and become the leader he knew his country needed.
I first went to South Africa in 1994 for Mandela’s inauguration. For those of us who witnessed the ceremony, it was an unforgettable moment. Here was a man who had spent twenty-seven years as a political prisoner now being sworn in as President. And his journey represented something even larger: a long but steady march toward freedom for all South Africa’s people. His moral example helped a system born out of violence and division end in truth and reconciliation. It was the ultimate guns-or-growth decision.
That day I had breakfast with outgoing President F. W. de Klerk at his official residence and then returned for lunch with the new President. In the course of a few hours the entire history of a nation had changed. At the lunch President Mandela stood to greet the many high-level delegates from around the world. Then he said something that has stayed with me always (I’m paraphrasing here): “The three most important people to me, here in this vast assembly, are three men who were my jailers on Robben Island. I want them to stand up.” Mandela called them by name and three middle-aged white men stood up. He explained that in the midst of the terrible conditions in which he was held for so many years, each of those men saw him as a human being. They treat
ed him with dignity and respect. They talked to him; they listened.
In 1997, I returned to South Africa, this time with Chelsea, and Mandela took us to Robben Island. As we retraced his steps through the cells, he said that when he was finally released, he knew he had a choice to make. He could carry the bitterness and hatred of what had been done to him in his heart forever, and he would still be in prison. Or he could begin to reconcile the feelings inside himself. The fact that he chose reconciliation is the great legacy of Nelson Mandela.
Before that visit my head was preoccupied with all the political battles and hostility in Washington, but listening to Madiba talk, I felt those troubles falling back into perspective. I also loved watching Chelsea’s face light up around him. They developed a special bond that lasted for the rest of his life. Whenever he and Bill talked on the phone, Madiba would ask to talk to Chelsea, and he stayed in touch with her as she went off to Stanford and Oxford and then moved to New York.
On my first visit to South Africa as Secretary, in August 2009, I paid a call on Madiba at his office in a suburb of Johannesburg. At ninety-one he was frailer than I remembered, but his smile still lit up the room. I pulled my chair close and held his hand, and we talked for half an hour. I also was delighted to see Madiba’s remarkable wife, my friend Graça Machel. Before marrying Mandela, she was a political activist and a Minister in Mozambique’s government, married to Samora Machel, the President of Mozambique, who helped guide that war-torn country toward peace. He died in a suspicious plane crash in 1986.
Together Graça and I walked through the Nelson Mandela Foundation Centre of Memory and Dialogue, where I examined some of Madiba’s prison diaries and letters, early photographs, and even his Methodist Church membership card from 1929. As a fellow Methodist, I was struck by his commitment to self-improvement, a topic he mentioned often, and his unshakable discipline.
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