Millions of immigrants in the United States benefited from the program known as Obamacare, but Medicaid, for low-income people, reduced benefits only to migrants with legal status in the country. CREDIT: Telesur TV

By Edgardo Ayala
SAN SALVADOR, Aug 23 2022 (IPS)

Getting sick is one of the worst fears facing Jorge, a Salvadoran living in the United States, because without access to health insurance or public health programs, he knows he will not be able to afford the high cost of hospital care.

“It scares me to think about what would happen if I got sick, the medical services here are very expensive,” Jorge told IPS by video call. He preferred not to mention his last name for fear that, because he is undocumented, he could be traced and deported by U.S. immigration authorities.

Jorge, 56, left his native El Salvador, the smallest of the Central American countries, more than 10 years ago, where he worked as an English teacher. He went to the United States to forge a better future for himself."One night in a hospital, depending on the health problem, can generally cost 5,000 to 10,000 dollars." -- Emilio Amaya

“I came in search of the American dream, but that dream is now a kind of American nightmare,” he said, sitting on the side of his bed in the small room where he lives in the town of Silver Spring, in the southeastern U.S. state of Maryland.

Without the documents that would allow him to live legally in the U.S., Jorge is unable to find a better job, and must settle for working in a company that distributes vegetables, grains and other groceries to online buyers. He is paid 13 dollars an hour.

“I’m actually feeling a weird little pain here, in this part of my arm,” he added, and showed the area that has started to hurt.

According to him, the pain is probably due to the long hours he has to spend in a cold room, at a temperature of 4°C, because he is in charge of removing the products to be packaged and shipped.

Immigrants demand respect for their rights, including health care, during a demonstration in front of the State Capitol in Sacramento, California. CREDIT: Courtesy of the San Bernardino Community Service Center

Lacking health care in the world’s richest country

Like Jorge, many of the estimated 11 million undocumented immigrants living in the United States face the harsh reality of putting their lives at risk by not seeking hospital services, primarily for two reasons.

First, because they know that the costs of these medical services are exorbitantly high, even for citizens and legal residents, and even worse for undocumented immigrants, who do not have well-paying jobs and are generally ineligible to participate in state or federal health care programs.

And second, because they are afraid to go to hospitals because they believe, not without reason, that the immigration authorities will show up to detain and deport them.

“The fear is not unfounded, there have been documented cases of people who came for medical attention and the hospitals called the immigration office,” Emilio Amaya, executive director of the San Bernardino Community Service Centre, told IPS.

But Amaya added that “We cannot say that this is a generalized practice, there have been isolated cases, but it is common in towns on the border with Mexico.”

His organization, located in the San Bernardino Riverside area of California, has been helping undocumented migrants since 2001, added Amaya, a Mexican who has lived in the United States for some 40 years.

Regarding the high cost of hospital services, Amaya added: “In general terms, regardless of immigration status, access to medical care is difficult and expensive.”

And it gets more complicated, he said, in the case of undocumented immigrants, since they do not go to the hospital because they do not qualify for public medical assistance programs for low-income people, such as Medicaid, or because of the aforementioned fear of being detained by immigration authorities.

In doing so, they put their health at risk.

The possibility of receiving medical coverage, he said, as a result of state or federal programs, depends on the state or city where one lives, since there is no national standard that applies across-the-board throughout the country.

And while undocumented individuals generally have difficulty becoming eligible for some form of public health care, such as the national Medicaid program, in some states, such as California, there have been positive steps toward greater inclusion.

“For years we have been working on a campaign called Health for All, which has been allowing anyone, regardless of their immigration status, to have access to public health services,” Amaya said.

He said that a few years ago, young people up to the age of 26, regardless of their immigration status, qualified for Medicaid, and last year a law was passed that gives medical coverage to anyone over the age of 55, regardless of immigration status.

“Now we are trying to extend this to any person regardless of age,” he said.

But “this is not the case in other states, such as Texas, Alabama, Tennessee, the Carolinas, where access to health care for the undocumented community is nonexistent,” he said.

Americans and immigrants call for a public health system that guarantees universal access and want Medicaid to cover migrants without resources, regardless of their immigration status. CREDIT: Telesur TV

An arm and a leg

Most of the 11 million undocumented immigrants in the United States come from four countries: Mexico and the Central American countries of Guatemala, El Salvador and Honduras, which face acute problems of unemployment, insecurity, lack of education and housing.

In the United States, the richest and most powerful nation in the world, a healthcare system dominated by the profit motive, driven by one branch of the financial industry – the insurance industry – reigns supreme.

“This is unbridled capitalism, in all its glory,” said Jorge, talking to IPS at 7:00 p.m. while at the same time preparing his food and other things, to get up the next day at 4:00 a.m., and start his up to 14-hour workday an hour later.

If you do not have an employer that provides health insurance, or if you are not a beneficiary of programs such as Medicaid, which is designed with state or federal funds to cover people with little ability to pay, the cost of medical treatment must be borne by you alone, and it costs an arm and a leg.

“One night in a hospital, depending on the health problem, can generally cost 5,000 to 10,000 dollars,” Amaya said.

An operation can run around 50,000 to 100,000 dollars, “and someone with cancer ends up half a million dollars in debt,” he added.

Hospitals are required by law to provide medical services regardless of immigration status.

But with no private insurance policy and no medical coverage, and with a bill to pay of several thousand dollars, these hospitals give people the possibility of paying for the service in monthly installments.

According to the Cable News Network (CNN), which cited a report released in July 2021 by the Kaiser Family Foundation, 23 percent of immigrants in general and 46 percent of undocumented immigrants are uninsured, compared to just over nine percent of U.S. citizens.

Jorge told how a co-worker, an undocumented Guatemalan whose name he preferred not to give, suffered a hernia six months ago. He went to the hospital when he could no longer stand the pain, and the treatment cost him 12,000 dollars.

“Since then, he has that debt to the hospital, he hasn’t been able to pay a thing until now,” Jorge said.

The Guatemalan’s father-in-law, who he also did not identify, had an accident at work, falling from the roof of a house and suffering multiple fractures, said Jorge.

A metal plate to replace the broken bone, plus several therapy sessions, cost 400,000 dollars, he said.

Oscar, a Mexican immigrant who has obtained U.S. citizenship, told IPS that in 2004, having just arrived as a beneficiary of a legal temporary work program sponsored by a binational agreement, he sought help for stress.

An ambulance from one of the hospitals in Panama City Beach, the city in the state of Florida where he lived at the time, picked him up for medical assistance.

“They took an X-ray and an electrocardiogram, and I spent about two hours in the hospital, and for that they charged me 800 dollars,” said Oscar, 56, who works as a driver for the rideshare app Lyft and lives in Richmond, California.

The medical coverage included in Oscar’s contract only covered work-related accidents, he said, not other types of ailments outside the scope of work, although the stress was probably directly linked to the hotel work he performed.

Amaya, the director of the San Bernardino Community Service Centre, noted that despite the burden of having to pay debts for the hospital service received, the organization encourages undocumented individuals to seek health care.

“It is better to save your life by running up a debt you have to pay off in installments than to lose your life by not seeking the extremely expensive service,” he concluded.

Two Mexican teenage girls at their school. Investing in education for teenage girls in Latin America is regarded as the way forward for them to become future drivers of sustainable develpment in their societies. Credit: UNFPA LAC

By Estrella Gutiérrez
CARACAS, Jul 11 2016 (IPS)

Latin America’s teenage girls are a crucial force for change and for promoting sustainable development, if the region invests in their rights and the correction of unequal opportunities, according to Luiza Carvalho, the regional head of UN Women.

“An empowered adolescent will know her rights and will stand up for them; she has tools for success and is a driving froce for positive change in her community,” Carvalho told IPS in an interview from the regional headquarters of UN Women in Panama City.

Adolescent girls and boys will have a leading role in their societies when the Agenda 2030 for Sustainable Development has been completed, she said. One of the Sustainable Development Goals (SDG) is gender equality. Investing in today’s girls will have “a great transformative impact in future,” she said. “Investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as wellas for promoting gender equality” -- Luiza Carvalho.

The world today has a higher proportion of its population aged between 10 and 24 years old than ever before, with 1.8 billion young people out of a  total population of 7.3 billion. Roughly 20 percent of this age group live in LatinAmerica and the Caribbean, Carvalho said.

According to data given to IPS by the regional office of the United Nations Population Fund (UNFPA), 57million of the region’s 634 million people are girls aged between 10 and 19, living mainly in cities.

The theme for this year’s World Population Day, celebrated July 11, is “Investing in Teenage Girls”, on the premise that transforming their present situation to guarantee their right to equality will not only eliminate barriers to their individual potential but will also be decisive for the sustainable development of their countries.

Women Deliver, an international organisation, has calculated the benefits of this investment in financial terms. For every additional 10 percent of girls in school, national GDP rises by an average of three percent; for every extra year of primary schooling a girl has completed, her expected salary as an adult grows by between 10 and 20 percent.

This is fundamental because, as Carvalho pointed out, “lack of economic empowerment, together with generalised gender discrimination and the reinforcemet of traditional stereotypes, negatively affects the capability of women in Latin America and the Caribbean to participate on an equal footing in all aspects of public and private life.”

Luiza Carvalho, regional director of UN Women for Latin America and the Caribbean. Credit: UN Women LAC

That is why “investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as well as for promoting gender equality,” she said.

Teenage women, she said, “are an especially vulnerable group who face special social, economic and political barriers.” Their empowerment in the region may come up against difficulties such as unwanted pregnancy, forced early marriage or union, gender violence and limited access to education and reproductive health services.”

As an example of these obstacles, the regional director of UN Women said that a Pan-American Health Organisation (PAHO) study of women aged 15-49 years in 12 countries of the region “reported that for a substantial proportion of these women, their first sexual encounter had been unwanted or coerced.”

Carvalho stressed that “early marriage or union imposed on girls is a major concern in the region, and it significantly affects the exercise of adolescent girls’ rights developing their full potential.”

“It is a form of violence that denies them their childhood, interrupts their education, limits their social development, curtails their opportunities, exposes them to the risk of premature pregnancy at too young an age, or unwanted pregnancy and its possible complications, and increases their risk of contracting sexually transmitted infections, including HIV (human immuno-deficiency virus),” she said.

It also increases the girls’ exposure to “becoming victims of violence and abuse,” Carvalho said.

In Carvalho’s view it is very positive that all the countries inthe region have established minimum ages for marriage in their laws, but on the other hand, the laws fix different minimum ages for boys and for girls, and in certain cases such as pregnancy or motherhood, girls may legally marry before they reach the minimum age.

In Latin America, far from diminishing, teenage pregnancies have increased in recent years, due to cultural acceptance of early sexual initiation. As a result, the region ranks second in the world for adolescent birth rates, with an average of 76 live births per 1,000 women aged 15-19 years, second only to sub-Saharan Africa.

Furthermore, 30 percent of Latin American teenage girls do not have access to the contraceptive care services they need, according to UNFPA. Sexual and reproductive health face especially high barriers in this region because of patriarchal,culture, the weight of conservative sectors and the dominance of the Roman Catholic Church.

In Latin America, indigenous teenage girls, together with their rural counterparts, are the group most discriminated against in terms of opportunities and access to education. Credit: Rajesh Krishnan/UN Women

In contrast, the region has a good record on education. Over 90 percent of its countries have policies to promote equal access by teenagers to education. Ninety percent of teenage girls have finished their primary school education, although only 78 percent go on to secondary school, according to UNFPA.

The greatest educational access barriers are faced by rural and indigenous teenage girls, who have difficulties for physical access to some education centres. In the case of indigenous and Afro-descendant girls, this is added to inappropriate curricula or the absence of educational materials in their native languages (mother tongues). 

Carvalho highlighted as a positive element that education laws, especially those that have been reformed recently, “have begun to recognise the importance of establishing legal provisions that promote and disseminate human rights, peaceful coexistence and sex education.”

However, she regretted that “direct connections with prevention of violence against women and girls are still incipient.”

In her view, the school curriculum plays an essential role. Including contents and materials “related to human rights and the rights of women and girls, non-violent conflict resolution, co-responsibility and basic education about sexual and reproductive health,” will potentiate more non-violent societies, inside and outside of the classroom, she said.

Carvalho quoted a 2015 study carried out in 13 Latin American countries by UN Women and the United Nations Children’s Fund (UNICEF), which concluded that education systems are failing to prevent violence against girls.

“This is something that must be improved, because it is in the first few years of early childhood that egalitarian role modelling between girls and boys can occur and lay the foundations of the prevention of violence, discrimination, and inequality in all its forms,” she emphasised.

Carvalho said changes should start with something as simple as it is frequently forgotten: “Girls, teenagers and women are rights-holders and entitled to their rights.”

If girls are given “equal access to education, health care, sexual and reproductive education, decent jobs, and representation in political and economic decision-making processes, sustainable economies would be promoted and societies, and humanity as a whole, would benefit,” she concluded. 

Edited by Verónica Firme. Translated by Valerie Dee.

By Emma Bonino
ROME, Jul 24 2015 (IPS)

“A serious political and social crisis will sweep through the euro countries if they do not decide to strengthen the integration of their economies. The euro zone crisis did not begin with the Greek crisis, but was manifested much earlier, when a monetary union was created without economic and fiscal union in the context of a financial sector drugged on debt and speculation.”

Emma Bonino

These words, which are completely relevant today, were written by a group of federalists, including Romano Prodi, Giuliano Amato, Jacques Attali, Daniel Cohn-Bendit and this author, in May 2012.

Those with a federalist vision are not surprised that the crisis in Greece has dragged on for so many years, because they know that a really integrated Europe with a truly central bank would have been able to solve it in a relatively short time and at much lower cost.

In this region of 500 million people, another example of the inability to solve European problems was the recent great challenge of distributing 60,000 refugees among the 28 member countries of the European Union. Leaders spent all night exchanging insults without reaching a solution.

Unless the federalist programme – namely, the gradual conversion of the present European Union into the United States of Europe – is adopted, the region will not really be able to solve crises like those of Greece and migration.

It can be stated that European federalism – which would complete Europe’s unity and integration – is now more necessary than ever because it is the appropriate vehicle for overcoming regional crises and starting a new phase of growth, without which Europe will be left behind and subordinated not only to the United States but also to the major emerging powers.“Unless the federalist programme – namely, the gradual conversion of the present European Union into the United States of Europe – is adopted, the region will not really be able to solve crises like those of Greece and migration”

Furthermore, its serious and growing social problems – such as poverty, inequality and high unemployment especially among young people – will not be solved.

Within the federalist framework there is, at present, only the euro, while all the other institutions or sectoral policies (like defence, foreign policy, and so on) are lacking.

Excluding such large items of public spending as health care and social security, there are however other government functions which, according to the theory of fiscal federalism (the principle of subsidiarity and common sense), should be allocated to a higher level, that of the European central government.

Among them are, in particular: defence and security, diplomacy and foreign policy (including development and humanitarian aid), border control, large research and development projects, and social and regional redistribution.

Defence and foreign policy are perhaps considered the ultimate bastions of state sovereignty and so are still taboo. However, the progressive loss of influence in international affairs among even the most important European countries is increasingly evident.

To take, for instance, the defence sector: as Nick Witney, former chief executive of the European Defence Agency, has noted: “most European armies are still geared towards all-out warfare on the inner-German border rather than keeping the peace in Chad or supporting security and development in Afghanistan.

“This failure to modernise means that much of the 200 billion euros that Europe spends on defence each year is simply wasted,” and “the EU’s individual Member States, even France and Britain, have lost and will never regain the ability to finance all the necessary new capabilities by themselves.”

It should be noted that precisely because the mission of European military forces has changed so radically, it is nowadays much easier, in principle, to create new armed forces from scratch (personnel, armaments, doctrines and all) instead of persisting in the futile attempt to reconvert existing forces to new missions, while at the same time seeking to improve cooperation between them.

Why should it be possible to create a new currency and a new central bank from scratch, and not a new army?

Common defence spending by the 28 European Union countries amounts to 1.55 percent of European GDP. Hence, a hypothetical E.U. defence budget of one percent of GDP appears relatively modest.

However, it translates into nearly 130 billion euros, which would automatically make the E.U. armed forces an effective military organisation, surpassed only by that of the United States, and with resources three to five times greater than those available to powers like Russia, China or Japan.

It would also mean saving an estimated 60 to 70 billion euros, or more than half a percentage point of European GDP, compared with the present situation.

Transferring certain government functions from national to European level should not give rise to a net increase in public spending in the whole of the European Union, and could well lead to a net decrease because of economies of scale.

Taking the example of defence, for the same outlay a single organisation is certainly more efficient than 28 separate ones. Moreover, as demonstrated by experiences with the North Atlantic Treaty Organization (NATO) during the Cold War, efforts to coordinate independent military forces always produced disappointing results and parasitic reliance on the wealthier providers of this common good. (END/COLUMNIST SERVICE)

Translated by Valerie Dee/Edited by Phil Harris    

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

By Fredrik S. Heffermehl and Tomas Magnusson
OSLO, Apr 10 2015 (IPS)

The Nobel Peace Prize is about to bow out to critics. As of Jan. 1, the Oslo-based Norwegian Nobel Committee that selects the winners has a new secretary, Olav Njølstad, who announced that “changes loom” in a recent interview.

However, Njølstad added, the changes “will not be dramatic”, making it unlikely that they will satisfy the full makeover demanded by The Nobel Peace Prize Watch, a newly-formed advocacy group wishing to reverse and undo international militarism.

Fredrik S. Heffermehl

In a letter sent in February to the Nobel Prize awarders, the group pointed to the purpose Alfred Nobel actually had in mind and presented a selection of candidates among the 276 nominated for the 2015 prize who are actually qualified to win. The Nobel Prize awarders have promised to respond to the letter, which, along with the valid candidates, is posted on the group´s website.

The group has chosen to ignore the wishes of the Nobel Committee that has a policy of strict secrecy around candidates and the selection process. By publishing, for the first time, the full nominations of the 25 “valid candidates”, the group has made it possible for everyone to see what types of peace work Nobel actually intended the prize to promote and its “imperative urgency” in the current period.

For over one hundred years, the secrecy rule has shielded the awarders from being held responsible for its neglect of the true Nobel “champions of peace” and they have been able to get away with assertions that the winners Nobel had in mind no longer exist.

According to the group this is untrue. It says that the committee ignores the simple, indisputable – and never disputed – evidence showing that when he designated his prize to the “champions of peace”, Nobel “meant the movement and the persons who work for a demilitarised world, for law to replace power in international politics, and for all nations to commit to cooperating on the elimination of all weapons instead of competing for military superiority.”

Tomas Magnusson

To make the prize comply with its actual purpose will require a dramatic change of the award policy. The Nobel Peace Prize Watch therefore doubts that the impending changes, described as “undramatic”, will be sufficient to satisfy the legislation on wills and foundations and the decisions of two public agencies in Sweden tasked with overseeing that foundations spend their funds in accordance with the law.

Even if the nominations are secret, The Nobel Peace Prize Watch was able to identify 24 names properly nominated for the 2015 prize. The list of valid candidates for 2015 is dominated by Americans and by people involved is nuclear disarmament, with nominees like Japanese hibakusha (nuclear survivors) Samiteru Taniguchi and Setsuko Thurlow; U.S. lawyer Peter Weiss and the International Association of Lawyers against Nuclear Arms (IALANA), David Krieger and the Nuclear Age Peace Foundation.

Further candidates are David Swanson, the U.S. activist for full disarmament; whistleblowers Kathryn Bolkovac, Daniel Ellsberg, Chelsea Manning and Edward Snowden, all from the United States; veteran organisers of a law-based world order, such as lawyers Benjamin Ferencz and Richard Falk, also from the United States; and the Womens´ International League for Peace and Freedom, formed during the First World War.

It seems as if Norwegian politicians, imbued in Western militarism and loyalty to the North Atlantic Treaty Organisation (NATO), are unable to understand Nobel´s idea of peace: to liberate the nations of the world from weapons, warriors and war. The idea to be supported by his will was that all nations must cooperate on disarmament.

Laureates like U.S. President Barack Obama in 2009 and the European Union in 2012 both believe in military means and clearly are not the type of winners to whom Nobel dedicated his award.

If the world succeeded in realising the Nobel peace plan, this would release enormous funds to cater to human needs. It would cost only a tiny fraction of the world´s military expenditure to secure everyone access to food, clean water, housing, education, health care. It would become possible to secure decent circumstances for all people, all over the globe, poor and rich, East and West, North and South – and make them more secure in the bargain.

To a realist it must be obvious that a world filled with weapons and warriors, even nuclear weapons, is inherently an unsafe world.

In the letter requesting changes, The Nobel Peace Prize Watch refers to basic rules of law regarding wills and foundations and furthermore invokes decisions passed by two Swedish public agencies during the last few years.

The authorities expect the purpose of the Nobel testament to be respected and also that the Nobel Foundation in Stockholm will keep its Norwegian sub-committee for the peace prize under strict and effective supervision and also refrain from paying the prize amount to a winner outside the purpose Nobel actually had in mind.

The Norwegian Nobel Committee, elected by the Parliament of Norway, now has until Apr. 17 to decide whether it will serve the great mandate that Nobel entrusted to it, to illuminate and promote the vision of preventing future war by what Nobel in his will called “creating the brotherhood of nations”.

Governments and citizens all over the world should unite in demanding that Norwegian parliamentarians respect Nobel and help liberate us all from the very dangerous common enemy called militarism. (END/IPS COLUMNIST SERVICE)

Edited by Phil Harris    

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

* Fredrik S. Heffermehl is a Norwegian lawyer, former Vice President of the International Peace Bureau (IPB) and author of Peace is Possible and The Nobel Peace Prize: What Nobel Really Wanted. Tomas Magnusson is a Swedish civil servant in immigration and integration issues, and former president of the International Peace Bureau (IPB). The two are founding members of the Lay Down Your Arms Association and organisers of The Nobel Peace Prize Watch

Excerpt:

By Robert F. Kennedy Jr
WHITE PLAINS, New York, Dec 30 2014 (IPS)

Earlier this month, President Barack Obama announced the restoration of diplomatic relations with Cuba after more than five decades of a misguided policy which my uncle, John F. Kennedy, and my father, Robert F. Kennedy, had been responsible for enforcing after the U.S. embargo against the country was first implemented in October 1960 by the Eisenhower administration.

The move has raised hopes in many quarters – not only in the United States but around the world – that the embargo itself is now destined to disappear.

Robert F Kennedy Jr

This does not detract from the fact that Cuba is still a dictatorship. The Cuban government restricts basic freedoms like the freedoms of speech and assembly, and it owns the media.

Elections, as in most old-school Communist countries, offer limited options and, during periodic crackdowns, the Cuban government fills Cuban jails with political prisoners.

However, there are real tyrants in the world with whom the United States has become a close ally and many governments with much worse human rights records than Cuba – Azerbaijan, for example, whose president Ilham Aliyev boils his opponents in oil, Saudi Arabia, Jordan, China, Bahrain, Tajikistan, Uzbekistan and many others where torture, enforced disappearances, religious intolerance, suppression of speech and assembly, mediaeval oppression of women, sham elections and non-judicial executions are all government practices.

Despite its poverty, Cuba has managed some impressive accomplishments. Cuba’s government boasts the highest literacy rates for its population of any nation in the hemisphere. Cuba claims its citizens enjoy universal access to health care and more doctors per capita than any other nation in the Americas. Cuba’s doctors, reportedly, have high quality medical training.“It seems stupid to pursue a U.S. foreign policy by repeating a strategy that has proved a monumental failure for six decades. The definition of insanity is repeating the same action over and over, and expecting different results. In this sense, the [Cuba] embargo is insane”

Unlike other Caribbean islands where poverty means starvation, all Cubans receive a monthly food ration book that provides for their basic necessities.

Even Cuban government officials admit that the economy is smothered by the inefficiencies of Marxism, although they also argue that the principal cause of the island’s economic woes is the strangling impact of the 60-year-old trade embargo – and it is clear to everyone that the embargo first implemented during the Eisenhower administration in October 1960 unfairly punishes ordinary Cubans.

The embargo impedes economic development by making virtually every commodity and every species of equipment both astronomically expensive and difficult to obtain.

Worst of all, instead of punishing the regime for its human rights restrictions, the embargo has fortified the dictatorship by justifying oppression. It provides every Cuban with visible evidence of the bogeyman that every dictator requires – an outside enemy to justify an authoritarian national security state.

The embargo has also given Cuban leaders a plausible monster on which to blame Cuba’s poverty by lending credence to their argument that the United States, not Marxism, has caused the island’s economic distress.

The embargo has almost certainly helped keep the Castro brothers [Fidel and Raul] in power for the last five decades.

It has justified the Cuban government’s oppressive measures against political dissent in the same way that U.S. national security concerns have been used by some U.S. politicians to justify incursions against our bill of rights, including the constitutional rights to jury trial, habeas corpus, effective counsel and freedom from unwarranted search and seizure, eavesdropping, cruel and unusual punishment, torturing of prisoners, extraordinary renditions and the freedom to travel, to name just a few.

It is almost beyond irony that the very same politicians who argued that we should punish Castro for curtailing human rights and mistreating prisoners in Cuban jails elsewhere contend that the United States is justified in mistreating our own prisoners in Cuban jails.

Imagine a U.S. president faced, as Castro was, with over 400 assassination attempts, thousands of episodes of foreign-sponsored sabotage directed at our nation’s people, factories and bridges, a foreign-sponsored invasion and fifty years of economic warfare that has effectively deprived our citizens of basic necessities and strangled our economy.

The Cuban leadership has pointed to the embargo with abundant justification as the reason for economic deprivation in Cuba.

The embargo allows the regime to portray the United States as a bully and itself as the personification of courage, standing up to threats, intimidation and economic warfare by history’s greatest military superpower.

It perpetually reminds the proud Cuban people that our powerful nation, which has staged invasions of their island and plotted for decades to assassinate their leaders and sabotaged their industry, continues an aggressive campaign to ruin their economy.

Perhaps the best argument for lifting the embargo is that it does not work. Our 60-plus year embargo against Cuba is the longest in history and yet the Castro regime has remained in power during its entire duration.

Instead of lifting the embargo, different U.S. administrations, including the Kennedy administration, have strengthened it without result. It seems silly to pursue a U.S. foreign policy by repeating a strategy that has proved a monumental failure for six decades. The definition of insanity is repeating the same action over and over expecting different results. In this sense, the embargo is insane.

The embargo clearly discredits U.S. foreign policy, not only across Latin America, but also with Europe and other regions.

For more than 20 years, the U.N. General Assembly has called for lifting the embargo. Last year the vote was 188 in favour and two against (the United States and Israel). The Inter American Commission on Human Rights (the main human rights bodies of the Americas) has also called for lifting the embargo and the African Union likewise.

One reason that it diminishes our global prestige and moral authority is that the entire embargo enterprise only emphasises our distorted relationship with Cuba. That relationship is historically freighted with powerful ironies that make the United States look hypocritical to the rest of the world.

Most recently, while we fault Cuba for jailing and mistreating political prisoners, we have simultaneously been subjecting prisoners, many of them innocent by the Pentagon’s own admission, to torture – including waterboarding and illegal detention and imprisonment without trial in Cuban prison cells in Guantanamo Bay.

While we blame Cuba for not allowing its citizens to travel freely to the United States, we restrict our own citizens from traveling freely to Cuba. In that sense, the embargo seems particularly anti-American. Why does my passport say that I can’t visit Cuba? Why can’t I go where I want to go?

I have been a fortunate American. I have been able to visit Cuba and that was a wonderful education because it gave me the opportunity to see Communism with all its warts and faults up close. Why doesn’t our government trust Americans to see for themselves the ravages of dictatorship?

Had President Kennedy survived to a second administration, the embargo would have been lifted half a century ago.

President Kennedy told Castro, through intermediaries, that the United States would end the embargo when Cuba stopped exporting violent revolutionists to Latin America’s Alliance for Progress nations – a policy that mainly ended with Che Guevara’s death in 1967 and when Castro stopped allowing the Soviets to use the island as a base for the expansion of Soviet power in the hemisphere.

Well, the Soviets have been gone since 1991 – more than 20 years ago – but the U.S.-led embargo continues to choke Cuba’s economy. If the objective of our foreign policy in Cuba is to promote freedom for its subdued citizens, we should be opening ourselves up to them, not shutting them out.

We have so much to learn from Cuba – from its successes in some areas and failures in others.

As I walked through the streets of Havana, Model-Ts chugged by, Che’s soaring effigy hung in wrought iron above the street, and a bronze statue of Abraham Lincoln stood in a garden on a tree-lined avenue.

I could feel the weight of sixty years of Cuban history, a history so deeply intertwined with that of my own country. (END/IPS COLUMNIST SERVICE)

(Edited by Phil Harris)

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS – Inter Press Service. 

Excerpt:

Immigrants in Russia could face a wave of violence following thousands of arrests in a crackdown on illegal immigration which has been condemned not only for human rights breaches but for entrenching a virulent negative public perception of migrants.

More than 7,000 people were arrested across Moscow – and more than 800 already served with deportation orders – under Operation Migrant 2014 which ran between Oct. 23 and Nov. 2 in the Russian capital.

The scale of the operation and methods used by the authorities has left international and local rights organisations outraged.

They say police used violence during raids on thousands of locations, including work places, markets, lodgings, hotels and people’s homes. They said that some migrants were forcibly taken from their families with no information given to relatives of where they were being taken.“Operations like this [Operation Migration 2014] only reinforce negative images of migrants in Russia and increase violence towards them. Once Russians see images of the raids in the news they will rally to support the government's actions” – Tolekan Ismailova, Vice-President of the International Federation for Human Rights

Some were deported without proper procedures being observed, according to local lawyers while others claim many of an estimated up to 100,000 migrants detained had money confiscated by police before being released without their detention being recorded.

Tolekan Ismailova, vice-president of the International Federation for Human Rights (FIDH), said: “This is simply an institutionalised way of intimidating migrants and their families. The operation violates Russia’s international obligations to respect human dignity and ban the practice of arbitrary detentions.”

But beyond the rights abuses, the highly-publicised raids are, critics argue, also helping foment and entrench a xenophobic attitude to migrants in wider society that increases the risk of violence against them.

Ismailova told IPS: “Operations like this only reinforce negative images of migrants in Russia and increase violence towards them. Once Russians see images of the raids in the news they will rally to support the government’s actions.”

The warnings come amid hardening attitudes towards what some Russian MPs estimate to be as many as 10 million migrants across Russia.

Since the fall of the Soviet Union, Russia’s large cities have been a magnet for migrants, mainly from former neighbouring Soviet states. Wages on offer in cities like St Petersburg and Moscow are often enough for immigrants to support entire families back at home. In some Central Asian countries, remittances sent home from workers in Russia account for as much as one-third of national GDP.

But successful assimilation of those migrants has been limited for a number of reasons. Migrants, especially those from Central Asia, have tended to interact within their own communities while support from Russian authorities and representatives of their own states has often been weak.

Rights groups say local employers routinely exploit migrants, refusing to give  them proper contracts, leaving them with no rights, often working in poor conditions and for low wages. Many are de facto working and residing illegally, and unable to access health care and pension systems.

Their situation also forces many to live in bad conditions and fuels criminality and violence in migrant communities, leading to further arrests and a perpetuation of negative attitudes towards migrants in wider society.

Ismailova told IPS: “Central Asian migrants are harassed because there is a culture of racism in Russia that perpetuates the stereotype that they are ‘black’ and they do the ‘black’ work in Russia. Many Russians have prejudices against Central Asians.”

Attitudes to migrants hardened in the wake of the financial crisis in 2008 and have worsened considerably since Vladimir Putin’s return to the presidency in 2012.

Critics say that the Kremlin is pursuing a xenophobic and anti-migrant policy in an attempt to distract Russians from wider problems in society.

They point to Operation Migrant 2014 as just the latest in a string of recent highly-visible crackdowns seemingly aimed at reinforcing the public perception of illegal immigrants posing a threat.

Operation Illegal 2014, similar to Operation Migrant 2014, was conducted in St Petersburg from Sep. 22 to Oct. 10, resulting in charges being brought against 437 migrants. And just last month, draft legislation was heard in parliament which would increase the penalties for foreigners exceeding maximum stay periods in the country.

Rights campaigners also point to other methods being used to fuel distrust of migrants, including authorities’ encouragement of citizens to report migrants they suspect of working illegally to a special hotline which passes the information to the police.

According to Ismailova, “this is exactly the same strategy that was used by the KGB. It creates a sense of distrust among people and is a major obstacle against securing human rights for migrants.”

The raids, arrests, anti-immigrant legislation and rhetoric from public officials – last month Moscow’s mayor said that were it not for illegal immigrants Moscow would be the safest city in the world – are little more than a “PR exercise” designed to deflect attention from other issues.

Tanya Lokshina, senior researcher at Human Rights Watch (HRW) in Moscow, told IPS: “With the ruble suffering an alarming drop, the government is apparently trying to divert people’s attention from concerns over living standards by turning their discontent towards migrants and, at the same time, demonstrating its own ‘effectiveness’  by attacking that ‘enemy’.”

Lokshina also said that “part of the problem with irregular migration is that employers don’t provide migrant workers with proper contracts. No one wants to work without a contract or permit – they do it because they have no other option. The government should ensure that migrant workers have contracts and relevant guarantees.”

Authorities have defended the need to tackle illegal immigration. They say that, among others,  illegal immigrants put a massive strain on state resources, particularly the health care system – migrants seeking medical help costs Moscow alone a reported 150 million dollars each year.

But rights campaigners say the government should be looking to strengthen migrants’ rights instead of enforcing repressive crackdowns.

They say authorities should give more notification to migrants to have residency and other documents in order before any raids are carried out and that a current three-month entry and exit visa regime for many migrants should be cancelled.

Even migration experts have openly questioned the policy of mass arrests.

Vyacheslav Postavnin, president of the Migration XXI Century foundation which cooperates with the Russian government working on migration policy, told Russian news agency TASS last week: “There are a lot of question marks around operations like this. I can see no quantitative value in them.

“Even if a thousand people were detained, there are thousands more that have not broken laws. The question is why were they arrested, taken away somewhere  and to some extent humiliated? What happens when it is found out that they are working legally?”

Others warn that the situation for immigrants is becoming increasingly fraught and there are serious concerns about the risk of violence against the immigrant community in the near future.

The Russian public holiday of Unity Day on Nov. 4 is often marked by massive nationalist and anti-migrant demonstrations in major cities and was last yearpreceded by violent riots in Moscow after an ethnic Azeri was alleged to have killed a Russian. Meanwhile, in St Petersburg, a migrant of Uzbek origin was killed during the national holiday.

When asked whether further violence against immigrants could be expected following the publicity around the arrests, Lokshina told IPS: “It’s certainly likely.”

(Edited by Phil Harris)

Irina was 21 when she first started using drugs. More than 30 years later, having lost her husband, her home and her business to drugs, she is still battling her addiction.

But, like almost all female drug addicts in this former Soviet state, she has faced a desperate struggle not only with her drug problem, but with accessing help in the face of institutionalised and systematic discrimination because of her gender.

“Georgia’s society is very male-dominated,” she told IPS. “And this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there.”

Women make up 10 per cent of the estimated 40,000 drug users in Georgia, according to research by local NGOs working with drug users.“Georgia’s society is very male-dominated and this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there” – Irina, now in her 50s, who has been taking drugs for 30 years

However, because of very strong gender stereotyping, women users have very low access to harm reduction services – only 4 percent of needle exchange programme clients are women and the figure is even less for methadone treatment.

Local activists say this startling discrepancy is down to the massive social stigma faced by women drug users.

Dasha Ocheret, Deputy Director for Advocacy at the Eurasian Harm Reduction Network (EHRN) told IPS: “In traditional societies, like Georgia’s, there is a much stronger negative attitude to women who use drugs than to men who use drugs. Women are supposed to be wives and mothers, not drug users.”

Many female addicts are scared to access needle exchanges or other harm reduction services because they fear their addiction will become known to their families or the police. Many have found themselves the victims of violence as their own families try to exert control over them once their drug use has been revealed. Others fear their drug use will be reported to the authorities by health workers.

Registered women drug users can have their children taken away while they routinely face violence – over 80 percent of women who use drugs in Georgia experience violence, according to the Georgian Harm Reduction Network– and extortion at the hands of police helping to enforce some of the world’s harshest drug laws. Possession of cannabis, for example, can result in an 11-year jail sentence.

Irina, who admits that she arranges anonymous attendance at an opioid substitution therapy (OST) programme so that as few people as possible can see her there, told IPS that she had herself been assaulted by a police officer and that police automatically viewed all female drug users as “criminals”.

But those who do want to access such services face further barriers because of their gender.

Free methadone substitution programmes in the country are extremely limited and because levels of financial autonomy among women in Georgia are low, other similar programmes are too expensive for many female addicts.

Discrimination is not uncommon among health service workers. Although some say that they have been treated by very sympathetic doctors, other female drug users have complained of abuse and denigration by medical staff and in some cases being denied health care because of their drug use.

Pregnant women are discouraged from accessing OST, despite it being shown to be safe in pregnancy and resulting in better health outcomes for both mother and child.

Eka Iakobishvili, EHRN’s Human Rights Programme Manager, told IPS: “Pregnant women don’t have access to certain services – they are strongly advised by doctors and health care workers to abort a baby rather than get methadone substitution treatment because they are told the treatment will harm the baby.”

While some may then undergo abortions, others will not, instead continuing dangerous drug use and the potential risk of contracting HIV/AIDS which could then be passed on to their child.

Meanwhile, those harm reduction services accessible by women are not gender-sensitive, according to campaigners, who say that female drug users need access to centres and programmes run and attended only by women.

Irina told IPS: “On some [harm reduction] programmes, the male drug users there will abuse the women drug users for taking drugs. This puts a lot of women off attending these programmes.”

She said that she had asked for a women-only service to be set up at the OST centre she attends but that it had been rejected on the grounds that only a few women were enrolled in it.

Together, these factors mean that many women are unable to access health services and continue dangerous drug-taking behaviour, sharing needles and injecting home-made drug cocktails made up of anything, including disinfectants and petrol mixed with over the counter medicines.

But there is hope that the situation may be about to change, at least to some degree, as local and international groups press to have the problem addressed.

At the end of July, CEDAW (UN Commission on Elimination of Discrimination against Women) released a set of recommendations for the Georgian government to ensure that women obtain proper access to harm reduction services after local NGOs submitted reports on the levels of discrimination they face.

These include, among others, specific calls for the government to carry out nationwide studies to establish the exact number of women who use drugs, including while pregnant, to help draw up a strategic plan to tackle the problem, and to provide gender-sensitive and evidence-based harm reduction services for women who use drugs.

The government has yet to react publicly to the recommendations but local campaigners have said they are speaking to government departments about them and are preparing to follow up with them on the recommendations.

Tea Kordzadze, Project Manager at the Georgian Harm Reduction Network in Tibilisi, told IPS: “We are hoping that at least some of the recommendations will be implemented.”

The Georgian government has been keen to show the country is ready to embrace Western values and bring its legislation and standards into line with European nations in recent years as it looks to create closer ties to the European Union. Rights activists say that this could come into play when the government considers the recommendations.

Iakobishvili said: “These are of course just recommendations and the government is not obliged at all to accept or implement any of them. But, having said that, Georgia does care what other countries and big international rights organisations like Amnesty International and so on say about the country.”

Irina told IPS that only outside pressure would bring any real change. “The European Union, the Council of Europe and other international bodies need to put pressure on the Georgian government to make sure that the recommendations don’t remain on paper only.”

But, she added, “in any case, the recommendations alone won’t be enough. The whole attitude in society to women drug users is very negative. It has to be changed.”

(Edited by Phil Harris)

New analysis suggests that developing countries are losing a trillion dollars or more each year to tax evasion and corruption facilitated by lax laws in Western countries, raising pressure on global leaders to agree to broad new reforms at an international summit later this year.

These massive losses could be leading to as many as 3.6 million deaths a year, according to the ONE Campaign, an advocacy group that focuses on poverty alleviation in Africa. Recovering just part of this money in Sub-Saharan Africa, the organisation says, could allow for the education of 10 million more children“Whenever corruption is allowed to thrive, it inhibits private investment, reduces economic growth, increases the cost of doing business, and can lead to political instability. But in developing countries, corruption is a killer” – ONE Campaign
 a year, or provide some 165 million additional vaccines.

“Whenever corruption is allowed to thrive, it inhibits private investment, reduces economic growth, increases the cost of doing business, and can lead to political instability. But in developing countries, corruption is a killer,” a report on the findings, released Wednesday, states.

“When governments are deprived of their own resources to invest in health care, food security or essential infrastructure, it costs lives, and the biggest toll is on children.”

The new analysis focuses on a spectrum of money laundering, bribery and tax evasion by criminals as well as government officials. The lost money is not development aid but rather undeclared or siphoned-off business earnings – immense tax avoidance resulting in a decreased base from which governments can fund essential services.

International trade offers a key point of manipulation, the report says, with the extractive industries particularly vulnerable. In Africa alone, exports of natural resources grew by a factor of five in the decade leading up to 2012, offering clear prospects for growth alongside lucrative opportunities for corruption on a mass scale.

“Between 2002 and 2011 we saw an exponential increase in illicit financial flows across the globe,” Joseph Kraus, a transparency expert at the ONE Campaign, told IPS.

“Yet while we’re all familiar with corruption in developing countries, it takes two to tango – that money often ends up in the financial centres of the Global North. Those banks, lawyers and accountants are all essentially facilitators of that corruption, so in order to get at the root of this issue we need to go after the problems there.”

Real opportunity

Advocates including the ONE Campaign are currently stepping up pressure on industrialised countries to institute a series of across-the-board transparency measures. Some are aimed at corruption in developing countries, such as strengthening disclosure laws impacting on the extractives industry and bolstering “open data” standards to allow citizens increased oversight over their governments’ dealings.

Several other reforms would need to be carried out by developed countries, particularly those housing major financial centres such as the United States and United Kingdom. These would include new standards requiring governments to automatically exchange tax information, to mandate the publication of full information on corporate ownership, and to force multinational corporations to report on their earnings on a country-by-country basis.

In certain circles, such demands have been percolating for years. But current circumstances could offer unusual opportunity for such changes.

“In the last two years we’ve seen an acceleration of this agenda,” Kraus says. “Eighteen months ago, no one was talking about phantom firms or anonymous shell companies. But these issues have gained a lot of momentum in a short period of time, and there is real opportunity coming up.”

This new energy has been motivated particularly by concerns in advanced economies over shrinking government budgets in the aftermath of the global economic downturn. Yet developing countries arguably stand to benefit the most from substantive reforms, provided they’re structured accordingly.

Advocates of such changes are now looking ahead to a summit, on Nov 15 and 16 in Australia, of the members of the Group of 20 (G20) world’s largest advanced and emerging economies as well as two major meetings of finance ministers in the run-up to that event.

The G20 represent about two-thirds of the world’s population, 85 percent of global gross domestic product and over 75 percent of global trade.

The members of the G20 are Argentina, Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Italy, Japan, Republic of Korea, Mexico, Russia, Saudi Arabia, South Africa, Turkey, the United Kingdom, the United States and the European Union.

The G20 has taken on a primary role in issues of global financial stability and, more recently, in pushing the automatic exchange of tax information between governments. A new global standard on such exchange could be approved by the G20 ministers in November, among other actions.

“For too long, G20 countries have turned a blind eye to massive financial outflows from developing countries which are channelled through offshore bank accounts and secret companies,” according to John Githongo, an anti-corruption campaigner in Kenya.

“Introducing smart policies could help end this trillion dollar scandal and reap massive benefits for our people at virtually no cost. The G20 should make those changes now.”

Coordinated response

In fact, many G20 countries have instituted some of these reforms on their own. The U.K. government, for instance, has taken unilateral action on publicising information on corporate ownership, while the United States was the first to pass strong transparency requirements for multinational extractives companies.

While such piecemeal national legislation can spur other countries to action, many feel only a comprehensive approach would have a chance at having a substantial impact. Further, many governments have pledged to act on these issues, but have yet to actually follow through.

“Illicit financial flows are a perfect example of a transnational problem, in that you have two legal regimes in which loopholes are being exploited,” Josh Simmons, a policy counsel at Global Financial Integrity, a Washington watchdog group that supplied data for the new ONE Campaign report, told IPS.

“So when an international cooperative body is able to identify these loopholes, they can get member countries to move in sync to address the situation. But if only one country tries to do so, businesses would probably just move elsewhere.”

Others are looking even more broadly than the G20. A paper released last month by researchers with the Center for Global Development, a think tank here, calls for the inclusion of anti-tax-evasion aims in the new global development goals currently being negotiated under the United Nations.

Indeed, even while there could be real movement at the G20 on several of these issues this year, the work on the other end of this equation – in developing countries – remains onerous.

“We need to get developing countries’ tax systems up to speed, strengthen their financial intelligence units and get their anti-laundering laws up to code. And that is proceeding, but much more under the radar given its complexity,” Simmons says.

“Still, that’s where people are actually bearing the brunt of this problem. Tax avoidance in the United States contributes to the national debt, but in developing countries it’s literally causing people to go hungry.”

Edited by Ronald Joshua

Doctors are warning of a worsening tuberculosis epidemic in Eastern Ukraine as the continuing conflict there begins to take a heavy toll on public health.

With thousands of people fleeing the region every day, medical supplies severely disrupted and those left behind under growing physical stress and increasingly unable to access medical services, conditions are ripe for a rise in new TB cases.

Dr Masoud Dara, Tuberculosis Programme Manager at the World Health Organisation (WHO) Europe, told IPS: “The situation with TB was not good before the conflict, but we can say that the conflict has certainly made it worse.”Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure

Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure.

Not only have hospitals been forced to deal with treating of casualties of the fighting, they have also had to cope with patients being moved in and out of hospitals and abandoning or interrupting treatment as the security status of individual towns and cities changes.

It has also become increasingly difficult to obtain supplies of vital medicines, and terrified staff – up to 70 percent of medical staff are estimated to have fled Donetsk and Luhansk, according to U.N. officials – have left hospitals and clinics.

The problems have been particularly acute with regard to TB. Ukraine has one of the worst TB problems in Europe, second only to Russia in terms of infection numbers.

According to official data, there are 48,000 people registered with the disease and it claimed the lives of just over 6,000 people in 2013. However, one in four people with TB are not officially registered, according to WHO.

The country also has a particular problem with multidrug-resistant tuberculosis (MDR-TB) which is much harder to successfully treat than normal TB.

WHO reports that Ukraine is one of “27 high multidrug-resistant tuberculosis (MDR-TB) burden countries in the world,” adding that “despite the adoption of the Stop TB Strategy by the National TB Programme (NTP), its components have not been sufficiently implemented.”

Organisations working in the region say they fear the disease will claim lives as the fighting is making it impossible to identify cases, monitor or guarantee timely treatment for those who need it.

Dr Dara told IPS: “There are indications that incidence of TB may increase. TB sufferers need to have medicines provided to them in a timely fashion and if that cannot be done and TB sufferers’ treatment is interrupted and they cannot access treatment elsewhere, there is a risk that the disease could then be spread and that people may die.

“We do not have detailed information at the moment on how exactly the conflict has affected the TB situation in Eastern Ukraine, but we do know that it has, at least, affected TB control efforts. It is hard to thoroughly implement checks on all people with TB in the conflict zone.”

Doctors in Donetsk, a city of one million and regional stronghold for pro-Russian separatists, have told humanitarian organisations working in the region of their fears over the fate of patients needing treatment.

Ole Solvang of Human Rights Watch, who carried out detailed research in Eastern Ukraine on the effects of the current conflict on the region’s health care, told IPS: “One hospital administrator in the main hospital in Donetsk told us that his hospital had a capacity for 1,200 patients but that because of the war they had only 450 at the moment.”

Solvang said that “the explanations put forward for this are that because people were afraid of travelling they were not coming to the hospital, that they were saving money and did not want to pay to get to hospital or that so many people have left the region because of the conflict.”

But his fear was that people with medical problems not connected to the conflict, such as serious diseases, are now not getting the treatment that they need.

Other doctors have warned that problems with medicine supplies because of the conflict could turn out to be an even bigger problem than the interruption of TB treatment.

One who spoke to IPS said that if a TB patient was given only a few drugs instead of the full range of medicines needed as part of treatment, it could lead to developing the much more dangerous drug-resistant TB.

The true scale of the problem with TB in the region is impossible to ascertain clearly because of the rapidly changing conditions in the conflict zone, while many under-pressure medical staff working directly in the conflict zone have been reluctant to speak in detail to anyone other than colleagues.

Regional officials also declined to comment when approached by IPS.

One doctor from Donetsk who spoke to IPS said that TB patients in regional hospitals, as well as hundreds being treated on an out-patient basis, were receiving the treatment they needed.

According to Dr Yuriy Semionovich, “there are 550 tuberculosis patients in Donetsk and Slavyansk hospitals at the moment. They are getting all the medicines and treatment they need. There are 200 patients treated on an out-patient basis and they too are receiving what medicines they need. We have the situation under control.”

However, some others are far more pessimistic in their assessment of the TB threat to the region.

Natalia Chursina, deputy head of the Donetsk Regional Tuberculosis Hospital, told local media earlier this month that “we will definitely have an outbreak in prevalence of all forms of TB after all this ends”.

Despite claims from some Ukrainian officials that the separatists will soon be dealt with and that fighting could be over in a matter of weeks, many experts say a quick end to the conflict is unlikely. And even if that were to happen, it is unclear how quickly medical service provision would return to normal, nor how many TB patients may have abandoned or interrupted treatment.

What is clear though is that without a change in current conditions, the situation with TB in the region is unlikely to improve any time soon.

“If conditions improve with regard to the supply of treatment, medicines and provision of health care services then we can foresee some improvement with the TB situation,” Dr Dara told IPS. “But without a change in those, then there is little hope that TB treatment can improve.”

(Edited by Phil Harris)

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

When Veronika Sintsova was diagnosed with tuberculosis in 2009, she spent six months in hospital before being discharged and allowed to continue treatment as an outpatient.

Today clear of the disease, the 35-year-old former drug user from Kaliningrad says the fact that she beat tuberculosis (TB) is not because of, but rather in spite of, the way many people with tuberculosis are treated in Russia.

“I think it would be fair to say that Russian authorities don’t take the problem of tuberculosis seriously,” she told IPS.

Tuberculosis is a major health threat in Russia, where it is the leading infectious disease killer.The country has the highest rates of multi-drug resistant (MDR) and extremely drug resistant (XDR) tuberculosis in Europe and the third highest in the world. And those rates are climbing.Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

It also has the 11th highest burden of all TB in the world, according to the World Health Organisation (WHO), which just last week said that parts of the country were “disaster areas” for the disease.

Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

But, say NGOs in Russia and international groups working to combat the disease, the continued use of outdated and inefficient approaches to the disease are still fuelling its spread.

Long stays in health facilities filled with people with TB were a cornerstone of the Soviet health care system’s approach to the disease, and have remained, even though they were abandoned years ago in the West because they were seen as contributing to the spread of the disease.

But it is not just in health care facilities where people with TB are being failed. The disease is rife in Russian jails. Overcrowding, poor conditions and bad nutrition all contribute to high infection rates with one in seven prisoners having active TB, according to the Russian Federal Penitentiary Service.

The way prisoners with TB are treated typifies the general approach to the disease by authorities. Sintsova said that although she was treated well by doctors, it was during a sixth month spell in prison for a drug offence that she had what she says was “the worst experience” of all the time she had the disease because fellow inmates and wardens took no pity on her when she left her cell.

“They would shout out ‘tuberculosis sufferer on a walk’ as I went along. That really hurt me. It was probably the worst thing I experienced in all the time I had tuberculosis,” she told IPS.

And this abuse is typical, she said, of the way many people with the disease are viewed in Russia. TB is common among those at the margins of society – drug users, alcoholics, people with HIV and those in dire poverty. “In our society, a drug user is not a person and their death from tuberculosis is seen as something they deserve,” Sintsova, who herself has HIV, told IPS.

Third sector groups working with TB sufferers say approaches towards such people need to be changed. Anya Sarang, president of the Andrei Rylkov Foundation for Health and Social Justice, has previously told local media that the “unjustified imprisonment of Russian people, especially drug users, leads to prison overcrowding” which in turn fuels continued TB infection.

Others point to the need to provide integrated care for people with co-infections, such as HIV and hepatitis C. Oksana Ponomarenko, Russia country director for the U.S. organisation Partners in Health (PIH) which works with TB patients in Russia, said on the group’s website: “The biggest problem lies in the fact that each health system in Russia is vertical and operates separately –TB, drug addiction services, HIV care, psychiatric services, among other health programs.

“At federal level and in individual regions these programs are not connected. Often, clinicians in one programme will not have complete information on other nearby services and programmes.”

PIH and other local organisations have started programmes to try and provide integrated treatment to people with TB in some cities, including a mobile clinic.

Some success has been reported in a scheme in the city of Tomsk where prisoners with TB are all housed in one facility. If released before their treatment has finished, they are placed straight into hospital to prevent infecting others when they return to wider society.

PIH says that its methods have been adopted as official state policy on TB and legislation was recently brought in to emphasise the importance of ambulatory, rather than institutional, care in TB treatment. The government has also increased spending on TB in recent years, modernised diagnostic equipment and overhauled research institutes specialising in TB.

But what worries many working with TB patients is the Kremlin’s approach to some of the biggest international funders of TB projects. It recently decided to reject money from the Global Fund for Aids/TB and Malaria, justifying the move by saying that Russia is now a donor to the Global Fund and that it would be wrong for it to continue to take money from it.

Some see the move as entirely political and part of attempts by the Kremlin to crack down on foreign NGOs operating in Russia. Another major funder of groups working on TB programmes, USAID, was expelled from the country in 2012 and forced to stop operating, on the grounds that it was interfering in Russian politics.

Some projects, including a few run by PIH, have already been affected.

Intellectual property provisions proposed by the United States would extend monopoly powers derived from patents to pharmaceutical companies that sell their medicines abroad. Credit: Bigstock

By Jared Metzker
WASHINGTON, Jul 16 2013 (IPS)

As a new round of talks behind a major proposed free trade area, the Trans-Pacific Partnership (TPP), get underway this week, the United States is pushing several developing countries to accept provisions that critics say would make it more difficult for their citizens to access medicine.

“The concern about access to medicine, and that the TPP deal will lead to high health-care costs, is huge,” Arthur Stamoulis, executive director of Citizens Trade Campaign, a fair trade advocacy group based here, told IPS.“TPP is certainly not being written in the interest of small business owners or working people.” -- Arthur Stamoulis of the Citizens Trade Campaign

On Monday, as negotiations for the TPP enter their 18th round, Medecins Sans Frontieres (MSF), a humanitarian organisation, reflected this concern, urged negotiating countries “to remove terms that could block people from accessing affordable medicines, choke off production of generic medicines, and constrain the ability of governments to pass laws in the interest of public health.”

Negotiations for the TPP, which officially started in 2010, are currently being held in Malaysia, and the countries participating include the United States, Australia, New Zealand, Chile, Peru, Brunei, Singapore, Malaysia, Vietnam, Canada and Mexico.

Japan is expected to join at the end of this round, while others have expressed interest in signing on, as well.

The Office of the United States Trade Representative has explained that the purpose of the deal is to “enhance trade and investment among the TPP partner countries, promote innovation, economic growth and development, and support the creation and retention of jobs.”

Yet critics have long warned that the United States appeared to be setting onerous conditions for any agreement, while complaining that the talks have been held in near secrecy, lacking oversight even from the U.S. Congress.

While intellectual property provisions proposed by the United States may be intended to promote innovation, MSF notes that they would extend monopoly powers derived from patents to pharmaceutical companies that sell their medicines abroad.

This means that it would take longer for cheaper generic drugs to come to market in low-income countries, where citizens often struggle to afford basic necessities.

Further, by hamstringing Asian suppliers of generic drugs, the effect of TTP’s restrictive intellectual property provisions could ultimately reverberate beyond the countries involved in the agreement.

“The critically important role that many Asian countries have in supplying both generic medicines and the active pharmaceutical ingredients needed to produce drugs is in jeopardy because of new restrictions proposed in the TPP,” says Judit Rius Sanjuan, U.S. manager of MSF’s Access Campaign.

“The TPP threatens to put a stranglehold on the world’s supply of affordable treatments, with dire consequences for patients, treatment providers, and pharmaceutical producers in developing countries.”

The proposed agreement could facilitate “evergreening” by patent-holding pharmaceutical companies, a term that refers to legal manoeuvres that, when successful, lead to monopoly powers being maintained longer than the 20 years typically allotted by patents.

Imposing these types of new restrictions would run counter to previous international agreements and national legislation under which Washington has pledged to expand access to generic medicines.

Any restriction in access to such medicines would also affect the United States’ own global health goals. Generics are said to make up some 98 percent of the medicines used by PEPFAR, the United States’ flagship anti-HIV/AIDS programme and the world’s largest.

MSF calls the practice of evergreening “abusive”. Further, under a free trade agreement all adhering countries would conform their laws, and the standard promoted by the United States would, the group is warning, do so in a way that would make evergreening more feasible abroad.

Sense of urgency

For the administration of President Barack Obama, there has been a sense of urgency to finish the TPP negotiations by the fall. Some observers have suggested that this could lead countries that would otherwise reject the clauses affecting access to medicine to allow them to remain.

“We are hearing from other negotiating teams that the pressure to finalise this agreement by October is rising,” Sanjuan told IPS during a previous round of negotiations, “and they fear that if there is not more time for substantive discussion, this chapter could stand.”

She also notes that negotiations are being carried out in secret and without input from civil society. Her office became aware of the clauses related to intellectual property and access to medicine only after text of a chapter was leaked to them.

In fact, concerned groups and the media have had extremely limited opportunities to speak with negotiators. Much of the communication has occurred at so-called “stakeholder meetings”, wherein groups are allowed to make brief presentations to certain negotiators and given controlled access to speak face-to-face with them.

IPS recently attended a stakeholder meeting related to another major proposed U.S.-led free trade agreement and was told by multiple delegates that the information they could divulge was very limited.

That lack of transparency is being interpreted by some as a clear indication that the TPP agreement is not being negotiated in the interest of the general public. Indeed, the vast majority of those who have had access to the TPP talks have been representatives of major corporations.

“TPP is certainly not being written in the interest of small business owners or working people,” the Citizens Trade Campaign’s Stamoulis says. Instead, he suggests it will serve the interest of “a small handful of very powerful corporations”.

Stamoulis, too, notes mounting pressure on negotiators to finish the deal by the end of the year.

“They’re definitely going full steam ahead to get this thing done as fast as possible, there’s no doubt about that,” he says.

For her part, Sanjuan recommends that the urgency of those looking to push the agreement through be met by urgency on the part of those who want to avoid restricting medicinal access to poor people.

“The time for negotiators to fix the TPP is now, in this round of talks, before political pressure escalates and a deal that is bad for public health is sealed in the interest of time.”

Medical services are increasingly difficult to provide in Syria. Above, a field hospital. Credit: FreedomHouse/CC by 2.0

By Mutawalli Abou Nasser
DAMASCUS, Jun 5 2013 (IPS)

It was nine in the morning when the shell landed in front of nine-year-old Hella al-Abtah’s house in the Yarmouk Palestinian refugee camp in Damascus. Hella survived the initial blast but was critically wounded in the head, and her father rushed her to the Palestine Hospital, blood pouring from the laceration.

Doctors at the hospital managed to stabilise Hella, but the relief was short-lived. Because of a chronic shortage of critical medical supplies and frequent power cuts, they could not complete even routine procedures. Hella passed away, hers one of many needless deaths due to collapsing medical services in the besieged Yarmouk camp.

Before the Syrian uprising began in March 2011, Yarmouk, which, with a population of 125,000, was the largest Palestinian refugee camp in Syria, was a bustling hub in Damascus and home to one of the busiest markets in the city.

Now Yarmouk has become a violent battlefield subject to daily bombardment. Until 2012, Palestinian camps had mainly stayed out of the Syrian conflict, but many are now fully engaged in the fighting.

Since opposition fighters established a permanent presence in Yarmouk, the Syrian army’s siege on the camp has resulted in a complete ban on any medicine or medical supplies entering the camp."It is simply impossible for us to deliver sometimes even the most basic services."
-- Abdullah Hariri

The collective punishment enforced on the community, as well as the direct targeting of individuals or groups offering humanitarian support, has severely weakened medical services available to the camp’s embattled residents.

Losing services

The only place where Yarmouk’s residents can still receive medical treatment is the Red Crescent-run Palestine Hospital. The other two main hospitals were shelled and destroyed by fighter jets and artillery, and many medical staff have fled the camp over the past four months.

Meanwhile, the United Nations Works and Relief Agency (UNWRA), the main body that offers social services such as education and health care to the Palestinians, has withdrawn its entire staff from Yarmouk camp due to the deteriorating security situation. With their evacuation, the community lost many essential health services.

And while doctors, nurses and medical students continue to treat patients in the Palestine Hospital in spite of the risks, the siege on the camp has rendered much of their work impossible, creating shortages in supplies from blood to electricity to the most basic medicines.

“It is simply impossible for us to deliver sometimes even the most basic services, because we have been starved of the essential supplies,” said Abdullah Hariri, a doctor at the Palestine Hospital.

Doctors, nurses or activists who have attempted to smuggle medical supplies into the camp have been targeted as well, with some killed and scores in prison, and hospitals in areas under rebel control, such as Palestine Hospital, are regularly shelled.

Staff have been threatened and intimidated on multiple occasions by security service personnel to abandon their humanitarian mission.

Violations from both sides

Elements of the armed opposition are no less innocent, having abused, threatened and extorted medical professionals in the camp, stolen resources and fuel from the hospital and even opened fire within the building.

“Once, some fighters came and demanded we hand over one of our staff, saying she was a collaborator,” said a doctor at the hospital, who asked to be called by his nickname, Abu Hakam. “This is such a loathsome accusation when you consider [that] she, like us, has chosen to stay, serving the people of the community.”

When hospital staff protested and barred the entrance to the hospital, fighters threatened the staff with guns, forced their way through and kidnapped the nurse. Although she was eventually released after extensive interrogations, such incidents increase the vulnerability of medics who remain active in Yarmouk.

Power shortages and electricity cuts are also hobbling efforts to offer even the most basic medical services.

“Because of the cuts in power supply to the camp, we have to use the electrical generators,” described Hussam al-Hariri, a doctor at Palestine Hospital. “This requires fuel, and as everyone knows, the regime blocks the entrance of fuel to the camp.”

“We have to buy fuel at exorbitant prices, even though we said from the outset that we don’t have any political stance,” Hariri added.

On top of all these challenges, Yarmouk camp has become refuge of sorts to many civilian refugees and opposition fighters from the suburbs and countryside south of Damascus. What remains of the camp’s debilitated medical services has to serve these communities as well as the Palestinians who refused to leave.

Despite having been reduced to a most basic level of operations by both the government’s siege on Yarmouk and aggression from members of the armed opposition, for the residents and refugees in Yarmouk, the camp’s medical infrastructure nevertheless remains critical, for they have little else.

Syrian refugee children learn to survive at a camp in north Lebanon. Credit: Zak Brophy/IPS.

By Katelyn Fossett
WASHINGTON, May 14 2013 (IPS)

Humanitarian assistance groups in Washington are warning that the health care system has become a deliberate target in the increasingly brutal civil war in Syria, presenting major challenges to addressing the humanitarian and refugee crises spurred by the conflict.

In a meeting with U.S. President Barack Obama on Monday, UK Prime Minister David Cameron stressed the centrality of the unfolding health crisis, emphasising the need in Syria to “care for trauma injuries, help torture victims to recover, [and get] Syrian families clean drinking water”.

Health aid is meeting significant obstacles, though, as the public health system in Syria reportedly has been largely dismantled after being targeted by Bashar al-Assad’s regime, which has wiped out a third of the hospitals in the country.

“The systematisation of the attacks [in Syria]…certainly served its purpose,” Stephen Cornish, executive director at Médecins Sans Frontières (MSF) in Canada, said recently at a panel discussion in Washington. “It created a flight of many medical personnel and destroyed large numbers of hospitals and interrupted public healthcare in a significant way.”

According to the Violations Documentation Centre, a Syrian human rights organisation based in Damascus, 469 health workers are currently imprisoned in Syria. Tom Bollyky, a senior fellow at the Council on Foreign Relations, a Washington think tank, estimates that around 15,000 doctors have been driven out of the country.

Bollyky noted that these attacks are one conflict’s manifestation of a disturbing global trend in which medical facilities and personnel become more frequent combat targets in conflict zones. In a March report, the Independent International Commission of Inquiry on the Syrian Arab Republic accused the Assad regime and opposition groups of strategically targeting medical facilities and personnel."Attacking medical personnel is a way of depriving a population of the humanitarian support they need."
-- Tom Bollyky

“Attacking medical personnel is a way of terrorising a population and depriving them of the humanitarian support they need,” Bollyky told IPS.

He pointed to similar instances in the Middle East and Asia, particularly coordinated attacks by the Taliban on polio immunisation volunteers in Afghanistan and Pakistan. On Monday, the Taliban announced it was halting its years-long effort to sabotage the campaign to eradicate polio among children in these two countries.

Such attacks are specifically outlawed in the Geneva Conventions, which entitle hospitals and medical staff to protection from hostile fire.

“Medical personnel are absolutely protected under international law,” Bollyky noted. “There is no circumstance where it is okay to attack medical personnel or facilities, and it is certainly happening on both sides.”

Silent casualties

The targeting of the Syrian health care system has not only left those wounded by combat without urgently needed care but has also exacerbated a public health crisis brought on by the poor living conditions of refugee camps outside of Syria.

Refugees from the conflict currently number more than one million, and the United Nations is warning that figure could swell to 1.5 million by the end of this year. That number is dwarfed by the more than 4.2 million Syrians who are displaced within Syria.

In addition to the systematic targeting, Syrian medical facilities are reportedly being “cannibalised” to serve military ends.

Zahir Sahloul, a doctor with the Syrian American Medical Society, told an audience on Friday about the looting of the two main hospitals in Aleppo – an eye hospital and a children’s hospital – that now serve as bases of operations for military battalions.

“Besides the destruction of the public health system, there is no sewer system,” Sahloul said “[There is a] lack of hygiene because of lack of electricity and sometimes water…and lack of diesel fuel. And because of that, you have a resurgence of some of the epidemics that weren’t there before.”

Chronic illnesses that were relatively easily treatable before the outbreak of the conflict – diabetes, or high blood pressure, for example – are now deadlier than ever, leading to what MSF’s Cornish called “silent casualties”.

These patients can’t be referred outside of the country because they aren’t considered emergency cases. But they also can’t be treated inside Syria because the necessary facilities and healthcare providers simply don’t exist anymore.

“Folks who have cancer and had their chemotherapy interrupted, all they can have is palliative medicine,” Cornish said. “And slowly, day by day, they die.”

Health workers are increasingly ill-equipped to deal with these growing problems, expert say, as their capacities are being undercut by suspicions over loyalty.

“In Syria, if you are a physician who is…’treating people from the other side’, you put your life at risk,” Sahloul said.

As humanitarian groups try to find solutions to the challenges to health and humanitarian assistance, observers appear united in their calls to the international community to ramp up pressure on both sides to stop hospital and medical staff attacks and to have more respect for international humanitarian standards.

Geneva Call, a non-governmental organisation in Geneva that focuses on engaging non-state actors in international humanitarian law, released several short video spots promoting respect for international humanitarian standards. One of the videos’ titles was “Respect and Protect Medical Personnel and Objects”.

Tom Bollyky suggested that treating these violations with more seriousness in the International Criminal Court– and recognising the international community’s responsibilities in combating them – would be a step in the right direction.

“You have seen a surge in these attacks, but you have not seen a surge in the indictments being brought against the people behind them,” he said. “The international legal system is not known for being expeditious, but it would be a form of real condemnation.”