By Yalda Hakim (for BBC News),
ERITREA is considered one of the most repressive and secretive states on earth. The UN says forced labour and detention without trial are common.
There have been no elections in the country since independence in 1993 and President Isaias Afewerki has been in power for almost 22 years. Political opponents and journalists have been imprisoned for voicing dissent.
BBC News hasn’t been allowed to film in the country for around a decade. But now, my team and I have been allowed in to look at improvements in Eritrea’s healthcare.
It may be one of the poorest countries on earth but the nation of roughly six million people is on track to meet three of its Millennium Development Goals – targets set by the United Nations in 2000 to tackle poverty.
Under-five mortality has dropped by two-thirds, deaths in childbirth have decreased to a quarter of what they were 30 years ago and levels of HIV/Aids and malaria have plummeted.
Getting into Eritrea wasn’t easy. It took months of negotiation with the central government. After a 10-hour flight, via Turkey and Saudi Arabia, we arrived in the capital, Asmara at 04:00 bleary-eyed.
A government official was there to meet us and cheerfully told us to be ready in four hours because they had prepared a busy schedule for us.
It is difficult to ignore the beauty of Eritrea’s capital city, with its leafy boulevards and Modernist buildings, a reminder of its Italian colonial past. But beneath the elegance, lies something more sinister.
Eritrea is still recovering from 30 years of war with its far larger southern neighbour, Ethiopia. The fighting ended in 1991 and it became an independent nation two years later.
But that peace didn’t last and, after another war, the two countries are in a state of “no war, no peace“. There is a strong sense that the struggle needs to continue and all Eritreans need to do what it takes not only to protect their country but also to rebuild it.
Accompanying us on our journey was a government minder. He was with us everywhere we went, listening and taking notes during all our interviews. About a half-hour drive outside the capital is the Embaderho health clinic.
Social workers from here go into villages and people’s homes to train and advise pregnant women and new mothers on what’s best for them and their babies’ health.
Our minder watched over us as one health worker told me: “Mothers were dying from unsafe delivery helped by local neighbours but now mothers are giving birth in hospitals.
“Because of the raised awareness, children have started to receive vaccinations on time and that is saving them from dying of chickenpox and other diseases. Really, we have seen a big change.”
‘Value for money’
They told me that this investment, at grassroots level, is one of the reasons they are succeeding in reducing maternal and infant mortality.
We were taken to clinic after clinic to hear about the success stories and were shown the best of the country’s healthcare.
— BBC Our World (@BBCOurWorld) March 13, 2015
Maternal mortality rate (per 100,000)
Eritrea: 670 in 2000; 380 in 2013
Ethiopia: 990 in 2000; 420 in 2013
Under-five mortality rate (per 1,000 live births)
Eritrea: 89 in 2000; 50 in 2013
Ethiopia: 146 in 2000; 64 in 2013
Yemane Ghebreab, friend and political adviser to the president, says it is all about priorities, telling me that “as a small country with limited resources, we can only thrive and compete if we can build our human resources”.
Though the UN has criticised Eritrea’s human rights record, it has commended its health achievements.
Christine Umutoni, the Eritrean representative for the UN Development Programme, says the lack of corruption around healthcare has helped the country reach its development targets.
“We’ve seen value for money and accountability. You know, you invest a little and you get a lot,” she says.
We were taken to hospitals where we were introduced to women needing surgery who, we were told, were allowed to stay for as long as they needed – weeks or even months – at no cost.
But the question always on our minds was: If things are so good, why does the UN estimate up to 4,000 people leave Eritrea every month?
The full documentary Inside Eritrea will be broadcast on the BBC World News “Our World” programme on Friday 13 March at 20:30 GMT, Saturday 11:30 GMT Sunday 17:30 GMT and 22:30 GMT.