Aside from guarantees on paper, fundamental freedoms receive little or no protection in Djibouti, which has had the same head of state for almost 20 years. Already difficult conditions for civil society were made worse in the lead up to April 2016 elections, as the government intensified its repression of independent voices and civil society. According to local rights groups, the results of the elections reflected an unprecedented retreat from basic respect for freedoms. Opponents of the government, human rights activists, journalists and even ordinary citizens bore the brunt of this latest crackdown. A low point was reached on 21 December 2015 when people taking part in a religious and cultural ceremony were shot dead by police using live ammunition. Estimates of the death toll varied between 19 and 37 people killed. This decline in respect for basic rights has coincided with the increasing military presence of several foreign powers in Djibouti, a presence which has however not brought vocal condemnation of rights abuses in the country.