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On October 14, Rwandan President Paul Kagame joined a team from a Silicon Valley start-up on a hillside 28 miles outside of Kigali and launched the world’s first national drone delivery service. Now, a fleet of 15 small, red-and-white drones created by the robotics company Zipline are aiming to transport blood for transfusions and other emergency medical supplies across the country. “Nobody else in the world is doing anything close to what Rwanda is doing, period," Zipline’s Justin Hamilton told MTV News, “and definitely not at this scale.”

At a time when it is virtually illegal under federal law to deliver goods via drone in the United States, and when other African governments are often openly hostile to drones in their airspace, Rwanda is becoming a powerhouse of drone-based delivery systems.

If everything goes to plan, Zipline will operate 150 flights a day from central warehouses where blood products and medical supplies are stored, and deliver them to 21 clinics across the country. The drones, programmed via GPS, can fly as far as 93 miles before they need to land, and they’re fast too, traveling at about 43 miles per hour. The drone network is designed so that when health care workers need a certain blood type, they can send a text to Zipline’s distribution center. From there, packages of blood are loaded onto the drone, which is then shot into the air from a launcher. “It’s very similar to how jets take off and land on an aircraft carrier,” Hamilton said. When the drone is approaching the clinic, the health care worker who placed the order gets a text asking them to go outside. From 300 feet above the ground, the drone then drops its package by parachute.

Shaking It Up

While Rwanda is forging ahead with building a national drone network, many other African countries have come to entirely different conclusions about remotely piloted aircraft — viewing them not as a development opportunity, but a security risk.

In Ghana, flying an unregistered drone could lead to a 30-year jail sentence. Kenya recently created its own regulations for commercial drone use, but security concerns mean that if Kenyans want to buy or use a drone, they have to ask the Ministry of Defense first. And Uganda requires drone users to be licensed, have a security clearance, and submit a map of where the drone will be flying and a document explaining the drone’s purpose. In Nigeria, a drone permit costs $4,000 and requires navigating a labyrinth of regulations. As Nigerian tech blogger David Adeleke wrote in May, “We don’t even know which is more difficult: for a camel to pass through the eye of a needle, for a rich man to enter into the kingdom of God, or to get a [drone permit] from the Nigerian Civil Aviation Authority.”

The anxieties that have informed these restrictions are predictable. It’s difficult to even say the word “drone” without thinking of their lethal reputation — clandestine military weapons with names like Predator. And those more traditional drones are still very much active in African countries, taking off from dusty runways in places like Djibouti and Niger, where the U.S. military has a low-key but notable presence with multiple drone bases.

No conversation about remotely piloted aircraft, even ones that only deliver medical supplies, is complete without acknowledging that these small delivery drones are going to be an inherently provocative technology as long as they are associated with those larger, more familiar drones carrying out lethal strikes on the militant group Al-Shabaab in Somalia and flying over the Lake Chad Basin to gather surveillance on Boko Haram.

The partnership between Zipline and Rwanda’s government is determined to renegotiate our relationship with drones, to reconsider our ideas of what they can do and where they belong. Hamilton is quick to emphasize that “every flight [Zipline] makes will be to save someone’s life.” It’s hard to argue with that. Yet it’s still important to acknowledge the complexities involved in integrating U.S.-made drones into everyday life in Rwanda. Whether they are spilling blood or delivering it, drones — no matter how adorable they look — should not be immune from questions about their limitations, nor about how they fit into the political and social contexts they operate in.

Rwanda’s Tech-driven (And Controversial) Approach to Development

At the Zipline launch, President Kagame said, “Rwanda has chosen to place information and communication technologies at the core of our development strategy because we recognize its power to change lives.” A national drone-delivery network certainly fits in with that vision. As Kim Yi Dionne, a professor of political science at Smith College who has written extensively on the politics of global health interventions, told MTV News, “There has been an embrace of technology by the government of Rwanda, more so than in many places. Development means something exceptional there.” This is clearly on display with drones, but it’s visible in many other ways, too.

Rwanda is “one of the only countries in Africa, and probably the world, that has nationwide 3G coverage,” Hamilton said. “At my hotel, I’d have to turn off the Wi-Fi on my phone because it was slower than the nationwide 3G. There’s a whole series of innovations like that that the national government has adopted and pushed forward that are pretty amazing.”

Yet critics have pointed to the many blind spots of Rwanda’s development style. A journalist might have access to free public Wi-Fi everywhere they go, but uploading a story that’s critical of the government’s development efforts will likely result in heavy surveillance — or even arrest. Kigali has streets clean enough to make New Yorkers jealous, but you can be arrested for using a plastic bag to carry your groceries home. The world’s first commercial drone network is operating in an impressive technology hub — with a tense political landscape.

Aerial Band-Aid or Game Changer?

Another central consideration is that Zipline drones are only part of the puzzle when it comes to improving health care outcomes in Rwanda. It might be possible for a drone to drop off blood or vaccines to a clinic now, but it’s still human workers who diagnose patients and perform transfusions. In Rwanda, the doctor-to-patient ratio is around one to 12,000. That means that for thousands of Rwandans, getting access to a health care worker who can perform needed care is far more difficult than getting the blood needed in the first place.

The challenges also go beyond the clinic. Part of Zipline’s advertising copy reads “no roads, no problem,” but drones can’t transport patients in need of emergency medical services. Those people will still have to travel roads that are often unpaved and sometimes treacherous to navigate. “During the rainy season, the roads are washed out or are nonexistent,” said Hamilton. “And even when it’s not the rainy season, if you’re driving uphill and you get behind the wrong petrol truck, you’re going to be there for a long time.” So it’s important to ask: What if the blood a patient needs can get to the clinic in time, but the patient can’t? “I imagine whoever came up with that tagline has not spent a lot of time in a place with no roads,” Dionne said.

Both Rwanda’s government and Zipline want to change the way drones fit into global health, and to illustrate the role they could play in delivery networks worldwide. But sitting on the sidelines of these ambitions are very real people who might find themselves, or someone they care about, relying on drones for their health or even survival. Without also acknowledging the realities of health care institutions, road infrastructure, and the use of armed U.S. drones in other African countries — not to mention the complex politics of Rwanda itself — medical delivery drones will risk papering over more challenges than they address. It’s clear that whether drones are taking lives, saving lives, or just delivering a pizza, it’s time for more complex conversations about them.