South Africa: Maré and the Cape Flats - Where Violence Becomes a Public Health Crisis

The bustling neighborhood of Maré in Rio de Janeiro appeared ordinary at first glance. Children played in the streets, residents sat outside chatting, shops bustled, and motorcycles navigated the narrow lanes. However, beneath this facade of normalcy lay a community grappling with decades of poverty, territorial disputes between armed groups, and heavily militarized policing.

Visiting Maré during the 26th International AIDS Conference, journalists realized that the tour offered more than just insight into the community. It underscored the well-established perspective among public health experts that HIV, health, and human rights are inextricably linked to the daily realities of residents, encompassing poverty, violence, housing, education, and access to essential services.

Redes da Maré, a renowned civil society organization, emerged in 1997 as a grassroots movement advocating for better education, healthcare, sanitation, public safety, and other necessities. Founded by residents and former residents, it has expanded its mission over time to encompass various aspects of community well-being.

Carolina Dias, the Coordinator of the Right to Health Axis programme at Redes da Maré, emphasized that defining a favela extends beyond labeling it as an informal settlement. Instead, it is characterized by informality, vulnerabilities, and a lack of access to rights. As they toured the area, Dias highlighted the invisible boundaries separating different armed groups, some of which stood memorializing residents lost to violence.

Despite being home to approximately 140,000 people, Maré faces significant challenges. The community comprises 49 schools, but access to education diminishes as students advance. Only three high schools serve the entire population, leaving younger children relatively better off in terms of educational access. The scarcity of higher education opportunities exacerbates the community's struggles, as many young people find themselves unable to pursue university-level studies.

For Redes da Maré, these inequalities are intrinsically tied to health. The organization views health through a broader lens, recognizing that without safety, education, housing, and other fundamental rights, individuals cannot attain good health.

Redes da Maré's work incorporates a multifaceted approach, addressing various facets of community life. From preparing young people for university to supporting women facing violence and providing services to those experiencing homelessness or seeking harm reduction, the organization's philosophy is clear: without public safety, education, and housing, the pursuit of health remains elusive.

Police operations in Maré are not solely quantified by the number of fatalities but also by the disruption of daily life. Raids often commence before dawn, sometimes as early as 4:30 a.m., and can persist for over 12 hours. Such disruptions result in missed school days, cancelled clinic appointments, and interrupted vaccination schedules, particularly affecting children.

The repercussions of these operations extend beyond immediate losses, affecting childhood vaccination rates—sometimes plummeting by up to 90% during raids—and education, with nearly 20,000 learners attending schools in Maré experiencing school closures frequently. These closures rob students of valuable learning time and often deprive them of a consistent meal, further straining already impoverished families.