70-year-old Chiute Tamang, his wife, daughter and son-in-law lost their house when the earth shook on Apr 25, 2015 in Nepal. They now lives a one-room cabin made of a wooden skeleton encased in corrugated iron. Credit: Robert Stefanicki/IPS

By Robert Stefanicki
KATHMANDU, Jul 12 2015 (IPS)

70-year-old Chiute Tamang was working in his field when the earth shook on Apr 25. He grabbed a tree. His wife and daughter were inside the house at the time, but managed to run out. In the blink of an eye, the building turned into a heap of stones. They were the lucky ones.

“Earthquakes don’t kill, buildings do” – this otherwise common knowledge – had just reached Nepal. Almost all the victims were buried in the rubble of their houses made by untrained masons of stones barely stuck together with mud. It is a very popular method, because it is the cheapest – stones and mud are free, bricks and cement cost.

In Ramche, Chiute’s village scattered over the terraced hills of district Dhading, 38 km northwest of Kathmandu, 168 houses out of a total 181 are no longer inhabitable.”Only time will tell if, in the process of planning reconstruction, the government of Nepal will use an opportunity to find out why the Tamangs are so vulnerable to natural disasters and what can be done to protect them from future calamities”

According to the latest government report, the disaster damaged 607,212 buildings in 16 districts. Of them, 63 percent in areas dominated by Tamangs – the largest and the most destitute group among the Tibeto-Burman speaking peoples of the Himalayan region – although they constitute less than six percent (1.35 million) of Nepal’s population.

”Earthquakes don’t kill, inequity does” – out of 8,844 people who died in the earthquake, 3,012 were Tamangs. Over 50 percent of the victims belonged to the marginalised communities. More than half the victims were women.

Ramche is a Tamang village. Some of the people own small plots of land on which they grow corn and potatoes of walnut size, but crops can feed the farmers’ family only for two to three months. For the rest of the year they live on contracted labour.

The residents of Ramche admit they are very poor. Why? Because, their answer goes, their fathers were poor, as well as the fathers of their fathers. They accept this as a judgment of fate and do not feel discriminated against, only showing how inequity is grown into the tissue of the society, the result of concerted exploitation for centuries.

This brawny hill tribe has always provided a labour reserve pool for the rulers of Kathmandu. In the past, Tamangs were prevented from joining the administration and the military. Even today they may man the barricades but have little role in the upper hierarchy of the armed forces or police, and are unrepresented in the country´s national affairs.

Being Buddhists did not immunise Tamangs from the caste system evolved by ruling Hindus. Those who wield power belong to Brahmin, Newars and Chhetri people and these “well-born” elites look down on the Tamangs.

In the blink of an eye, houses turned into heaps of stones when the Apr. 25, 2015 earthquake hit Nepal. Credit: Robert Stefanicki/IPS

Economic deprivation has increased the influx of indigent peasants to the job markets of Kathmandu, where they make up half of the porters and the majority of three-wheeler tempo (”taxi”) drivers. Prison surveys have shown that a disproportionate number of Tamangs are behind bars for criminal offences.

They have never counted on any government’s help, and this time is no different. After the earthquake, the residents of Ramche helped each other, cooked meals together and joined hands to raise themselves up from the rubble. With a little help from NGOs, the situation was brought under control.

One week after the disaster, the residents of Ramche were given blankets, tarpaulins and mosquito nets funded by the European Commission’s Humanitarian Aid and Civil Protection department (ECHO).

Today, the whole village is queuing at the barracks where ADRA, the Nepalese NGO, is handing out big plastic water jars with the blue logo of the European Union and “sanitary kits”: a few tubes of toothpaste, toothbrushes, water purification tablets, sanitary napkins and birth control pills. A young female activist tirelessly explains to one villager after another how to use these items.

Chiute Tamang’s family spent the first three days after they lost their house in a flimsy hut cobbled together with a few pieces of wood. Then made a tent of tarpaulin, where they moved together with goats, their most valuable asset. Livestock, the old man explains, must not be left outside at night because it could fall prey to tigers or leopards.

After one week, Chiute borrowed some money, bought materials and with the help of his neighbours put a house together for himself, his wife, their youngest daughter and her husband.

It has a simple design – a one-room cabin made of a wooden skeleton encased in corrugated iron, the floor covered with oilcloth, and equipped with simple beds, cupboards and a gas cooker.

”Even if this collapses,” says Chiute ironically, “at the worst, the corrugated sheet would pin us down, not stones.”

Construction took two weeks, because the wood had to be brought from a distance. When the house was already standing, the government finally sent some relief – any Nepalese family who lost a house is entitled to a 15,000 rupee (150 dollars) loan. Chiute could pay off half the loan.

Another Ramche resident, 29-year-old Deepak Bhutel, received 180,000 rupees but he had been less fortunate – his wife and 18-month-old daughter lost their lives under the rubble of their stone house.

The amount would be enough to buy a sturdy house, certain to survive any future earthquake but Deepak, together with his older and now only daughter, says he is also going to end up in a corrugated iron-clad cabin. Having lived from hand to mouth all his life, he says he does not want to spend all his wealth on the house.

Only time will tell if, in the process of planning reconstruction, the government of Nepal will use an opportunity to find out why the Tamangs are so vulnerable to natural disasters and what can be done to protect them from future calamities.

Past mistakes should not be repeated, warned Jagdish Chandra Pokhrel, former Vice Chair of National Planning Commission, quoted by ‘Nepali Times’.

Pokhrel recalled the example of the Tamangs displaced when the reservoir in Makwanpur was built in the early 1980s. Around 500 families whose lands were acquired by the authorities did not want cash compensation but resettlement elsewhere.

“But the government gave them money anyway, and very few bought land with that,” said Pokhrel. “Soon, the money was gone and they were destitute.”

Edited by Phil Harris    

Zambian cotton grower sitting on his bales. Some African governments and local cotton producers have high hopes that GM technology will boost African competitiveness in the dog-eat-dog world that characterises the global cotton market. Credit: Nebert Mulenga/IPS

By Haidee Swanby
MELVILLE, South Africa, Jun 15 2015 (IPS)

Genetically modified (GM) cotton has been produced globally for almost two decades, yet to date only three African countries have grown GM cotton on a commercial basis – South Africa, Burkina Faso and Sudan.

African governments have been sceptical of genetically modified organisms (GMOs) for decades and have played a key role historically in ensuring that international law – the Cartagena Protocol on Biosafety – takes a precautionary stance towards genetic engineering in food and agriculture.

They have also imposed various restrictions and bans on the cultivation and importation of GMOs, including on genetically modified (GM) food aid.

But now resistance to GM cultivation is crumbling as a number of other African countries such as Malawi, Ghana, Swaziland and Cameroon appear to be on the verge of allowing their first cultivation of GM cotton, with Nigeria and Ethiopia planning to follow suit in the next two to three years.“Scrutiny of actual experiences [with GM cotton] reveals a tragic tale of crippling debt, appalling market prices and a technology prone to failure in the absence of very specific and onerous management techniques, which are not suited to smallholder production”

Some African governments and local cotton producers have high hopes that GM technology will boost African competitiveness in the dog-eat-dog world that characterises the global cotton market.

At the moment African cotton productivity is declining – it now stands at only half the world average – while global productivity is increasing. The promise of improving productivity and reducing pesticide use through the adoption of GM cotton is thus compelling.

However, African leaders and cotton producers need to take a close look at how GM cotton has fared in South Africa and Burkina Faso to date, particularly its socioeconomic impact on smallholder farmers.

Scrutiny of actual experiences reveals a tragic tale of crippling debt, appalling market prices and a technology prone to failure in the absence of very specific and onerous management techniques, which are not suited to smallholder production.

As stated by a farmer during a Malian public consultation on GMOs, “What’s the point of encouraging us to increase yields with GMOs when we can’t get a decent price for what we already produce?”

In Burkina Faso, the tide turned against GM cotton after just five seasons as low yields and low quality fibres persisted. In South Africa, GM cotton brought devastating debts to smallholders and the local credit institution went bust. Last season, smallholders contributed to less than three percent of South Africa’s total production.

In Malawi, Monsanto has already applied to the government for a permit to commercialise Bollgard II, its GM pest resistant cotton, to which there has been a strong reaction from civil society and an alliance of organisations has submitted substantive objections.

Even Malawi’s cotton industry, the Cotton Development Trust (CDT), has publically voiced its concerns over a number of issues, including inadequate field trials, the high cost of GM seed and related inputs, and blurred intellectual property arrangements.

In addition, CDT has expressed unease over the potential development of pest resistance and the inevitable applications of herbicide chemicals.

Regional economic communities (RECs), such as the Common Market for East and Southern Africa (COMESA) and the Economic Community for West African States (ECOWAS), are also key players in readying their member states for the commercialisation of and trade in GM cotton, through harmonised biosafety policies. Together COMESA and ECOWAS incorporate 34 countries in Africa.

The COMESA Policy on Biotechnology and Biosafety was adopted in February 2014 and member states validated the implementation plan in March 2015.

The ECOWAS Biosafety Policy has been through an arduous process for more than a decade now and pronounced conflicts between trade imperatives and safety checks have stalled agreement between stakeholders. However, recent reports indicate that agreement between member states and donor parties has been reached and a final draft of the Biosafety Policy will soon be published.

Experiments and open field trials with GM cotton have been running for many years in a number of African countries and are increasingly at a stage where applications for commercial release are imminent.

However, there are many obstacles to the birth of a new GM era in Africa, chief among them the fact that this high-end technology is simply not appropriate to resource-poor farmers operating on tiny pieces of land, together with fierce opposition from civil society and sometimes also from governments.

Attempts by the biotech industry to impose policies that pander to investors’ desires at the expense of environmental and human safety may be easier to realise at the regional level, through the trade-friendly RECs. This is where many biotech industry resources and efforts are currently being channelled.

Despite whatever legal environments may be implemented to enable the introduction of GM cotton regionally or nationally, the fact remains that Africa’s cotton farmers are operating in a difficult global sector – prices are erratic and distorted by unfair subsidies in the North, institutional support for their activities is often lacking, and high input costs are already annihilating profit margins.

Fighting for the introduction of more expensive technologies that have already proven themselves technologically unsound in a smallholder environment is deeply irresponsible and short-sighted.

It is time that African governments turn their resources to improving the local environments in which cotton producers operate, including institutional and infrastructural support that can bring long-term sustainability to the sector, without placing further burdens and vulnerability on some of the most marginalised people in the world.

Civil society actions will continue to vehemently oppose and challenge the false solutions promised by GM cotton and will insist on just trading environments and true and sustainable upliftment for African cotton producers.

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. 

* This opinion piece is based on the author’s more extensive paper titled Cottoning on to the Lie, published by the African Centre for Biodiversity, June 2015

Excerpt:

Haitian-Italian designer Stella Jean (right) has been working with the Ethical Fashion Initiative (EFI), using Haitian craftsmanship in areas such as embroidery and beadwork in her collections. Credit: ITC Ethical Fashion Initiative 5

By A. D. McKenzie
PARIS, Jun 4 2015 (IPS)

“Work is dignity,” says Simone Cipriani. “People want employment, not charity.”

With that in mind, Italian-born Cipriani founded a programme in 2009 called the Ethical Fashion Initiative (EFI) that links some of the world’s top fashion talents to marginalised artisans – mostly women – in East and West Africa, Haiti and the West Bank.

Now a flagship programme of the International Trade Centre, a joint agency of the United Nations and the World Trade Organization (WTO), the Geneva-based EFI works with leading designers such as Stella McCartney and Vivienne Westwood to facilitate the development and production of “high-quality, ethical fashion items” from artisans living in low-income rural and urban areas.

The EFI says its aim is also to “enable Africa’s rising generation of fashion talent to forge environmentally sound, sustainable and fulfilling creative collaborations with local artisans.” Under its slogan “not charity, just work”, the Initiative advocates for a fairer global fashion industry.“We work with women who sometimes face discrimination in their communities, but by having a job, their position in society improves. They gain independence and respect, and in many situations they become the only breadwinner in their families” – Simone Cipriani, Ethical Fashion Initiative

This year, for the first time, the EFI is collaborating with the most important international trade fair for men’s fashion, Pitti Immagine Uomo, to host designers who represent four African countries.

Taking place June 16 to 19 in Florence, Italy, the fair will present a special edition of its Guest Nation Project, in which a particular area is designated for the “rising stars” of fashion from various countries, according to Raffaello Napoleone, CEO of Pitti.

Napoleone said that the African designers in this year’s Guest Nation give priority to manufacturing in their home countries, helping to reduce poverty, and that they are already known on the international market.

The stylists will put on a runway show, highlighting their men’s collections, in a special event titled ‘Constellation Africa’. The brands – Dent de Man, MaXhosa by Laduma, Orange Culture and Projecto Mental – have designers who represent Cote d’Ivoire, South Africa, Nigeria and Angola, and were selected as part of the African Fashion Designer competition launched by the EFI last December.

“This is where our global society is going: interconnectedness. Global and local dimensions brought together through fashion,” said Cipriani.

Market analysts expect the global value of the apparel retail industry to rise about 20 percent from 2014 levels to reach some 1,500 billion dollars in 2017. With such high volumes, the various sectors of the industry could be an increasing source of employment in many regions, from design to garment-making to sales.

But over the past several years, there has been controversy about the apparent exclusion of fashion designers and models of African descent in high-profile ‘Fashion Weeks’ and other international events

Tansy E. Hoskins, author of a polemical book published last year titled Stitched Up: The Anti-Capitalist Book of Fashion, has a whole chapter devoted to the question “Is Fashion Racist?”

She says that several decades after a renowned fashion magazine had its first black model on the cover, “all-white catwalks, all-white advertising campaigns and all-white fashion shoots are still the norm”.

Simone Cipriani, founder of the Ethical Fashion Initiative (EFI). Credit: A.D. McKenzie/IPS

The Ethical Fashion Initiative is primarily concerned with poverty reduction and ethical treatment of artisans, but Cipriani acknowledges that racism is an issue and that poverty can be linked to ethnicity as well as gender.

Still, the fashion industry does have companies that try to adhere to ethical standards, including diversity, working conditions and environmental sustainability; and 30 international brands have signed on to the EFI project. But not every company is a good fit.

“We try to work almost exclusively with brands that have a clear scheme on responsible business and social engagement, otherwise there’s always the risk of being used and having to clean up after somebody else,” Cipriani told IPS in an interview, during a trip to Paris to meet with designers.

“We’ve had our troubles and have had to work through a long learning curve”, he added. “We also tried to work with big distributors and realised it wasn’t possible for what we do, so here we are.”

Groups such as the EFI and activists like Hoskins say that their major concern is how to make the fashion industry fairer, particularly with decent labour conditions for workers everywhere.

Two years ago in Bangladesh, for instance, more than 1,100 workers died and 2,500 were injured when a factory building collapsed after safety warnings were ignored. The workers made clothing for brands including Benetton, which only this year announced that it would contribute to a compensation fund for the victims.

That agreement followed a campaign in which one million people signed an online petition calling for the company to take proper action.

“What happened in Bangladesh was a horror, and there are many situations in which exactly the same horror can occur,” Cipriani said. “The first thing about responsibility should always be people. Dignified working conditions for people.”

He said that many artisans working in the fashion industry’s supply chain also do not earn enough to live on. “They don’t get the remuneration for their work that allows them to have a dignified life,” he told IPS. “Many of them are paid in such a way that they have to live at the margin.”

In Haiti, which is known for its artistry as well as its poverty, activists say that linking local artisans with international designers can and have made some impact. The Haitian-Italian designer Stella Jean has been working with EFI, using Haitian craftsmanship in areas such as embroidery and beadwork in her collections, for example. She also employs textiles made in Africa.

Jean has been an EFI “partner” since 2013 and she sources several elements of her designs through its projects, Cipriani said. The collaboration started with a visit to Burkina Faso – one of the largest producers of cotton in Africa with an important tradition of hand-weaving – where the designer saw the possibilities of “working with these ethically produced textiles”. She incorporated them as a key feature of her women’s and men’s ready-to-wear collections.

Last year, she also launched a new range of bags, produced in Kenya with fabric from Burkina Faso and Mali and vegetable-tanned leather from Kenya, “making each bag a pan-African product,” says the EFI.

In Kenya, British designers McCartney (who declined to be interviewed) and Westwood have placed several orders for fashion items, and the EFI has carried out “Impact Assessment” studies to evaluate compliance with fair labour standards “and the impact the orders had on people and the communities they live in.”

“We work with women who sometimes face discrimination in their communities, but by having a job, their position in society improves,” Cipriani told IPS. “They gain independence and respect, and in many situations they become the only breadwinner in their families.”

The Ethical Fashion Initiative has testimonials from artisans about the improvement in their lives from the income they received through the orders, with several workers detailing their new ability to pay rent and school fees, among other developments.

Hoskins says that these steps are important, but that the fashion industry cannot be fully transformed without massive, collective action. “Ethical fashion has become a catch-all phrase encompassing issues such as environmental toxicity, labour rights, air miles, animal cruelty and product sustainability,” she argues.

“After 20 or so years and despite some innovative initiatives, it holds an ‘exceptionally low market share’ at just over 1 percent of the overall apparel market.”

In an interview, she said that asking whether fashion can ever be ethical is like asking “can capitalism ever be ethical?”

“For me the answer is ‘no’ because it’s based on exploitation, it’s based on competition, and above all it’s based on profit, and that’s what in the fashion industry drives wages down, drives environmental standards down and down and down,” she told IPS.

“There are small companies doing things differently but they’re producing maybe a few thousand units every year. The fashion industry produces billions and billions of units every single year.”

Hoskins also asked the question: “Why is it not the case that all products are ethically made?”

But reform evidently takes time. With the Pitti trade fair in Italy now collaborating with EFI, the “ethical fashion” movement may get a boost. It is also up to consumers to make the right choices, activists say.

“Consumers must demand change. Consumers can’t be too docile,” says Cipriani.

Edited by Phil Harris    

Long before the attack in Paris that inspired the slogan “Je Suis Charlie”, a young French publisher had released a collection of stories titled je suis favela about life in Brazilian slums.

In an ironic twist of history, sales of the collection have taken off since Jan. 7, when gunmen targeted the offices of satirical weekly Charlie Hebdo, leaving 12 people dead.

French publisher Paula Anacaona

Some readers apparently thought the je suis favela stories were an attempt to shed light on the situation of marginalised communities in France, but instead they learned about marginalised populations in South America, where similar forces of exclusion may push young people into crime.

“We can all learn from what is happening elsewhere in the world, because we’re all affected by similar social and economic issues,” says Paula Anacaona, the publisher of je suis favela and founder of Éditions Anacaona, whose mission is to publish Brazilian books in France.

Educated as a translator of technical texts, Paris-born Anacaona, 37, became a literary translator and publisher by chance. On holiday in Rio de Janeiro in 2003, she happened to start chatting with a woman who revealed she was a writer and who promised to send her a book.

Back in Paris, Anacaona received the book two months later and “loved it”, as she told IPS in an interview. She translated the work, written by Heloneida Studart and later called Le Cantique de Meméia, and managed to get a Canadian company to publish it.“To understand the favela, you have to understand the grandparents who came to the cities from rural areas, often with nothing and unable to read or write” – Paula Anacaona, founder of Éditions Anacaona

Studart, who died in 2007, was also an essayist, journalist and women’s rights activist, and the book caught the attention of French-speaking readers in several countries.

Other writers got in touch, and Anacaona found herself becoming a literary translator. But by sending out the works to publishing companies, she was also taking on the role of agent, a time-consuming task.

“With all that was involved, I thought why not publish the books myself?” she recalls. She set up Éditions Anacaona in 2009 and decided to focus initially on literature from and about the ghetto or favela in Brazil, because “no one else was doing it.”

The first published book under her imprint was le Manuel pratique de la haine (Practical Handbook of Hate), a very violent and dark work set in the favela and launched in 2009.

Two years later came je suis favela, published in 2011. Anacaona selected the writers for the collection, choosing authors from both the favela and the “middle class” and translating the works written in Portuguese into French.

Her motivation, she says, was to try to change perceptions of those considered to be living on the fringes of society. The cover of je suis favela features a young black woman sitting on a balcony and doing paperwork, possibly homework, with the city in the background.

“As you can see, she’s not dancing, so this isn’t about stereotypes,” Anacaona says.

Cover of ‘je suis favela’

The book has since been published in Brazil, with the title Eu sou favela, giving Anacaona a certain sense of accomplishment. “In Rio, twenty percent of the population lives in the favela, so the book is relevant to many readers,” she says.

In France, where there has been national soul-searching since the Charlie Hebdo attacks – with Prime Minister Manuel Valls calling the social exclusion of certain groups a form of “apartheid” – the book provides insights into the reasons and consequences of marginalisation, albeit from a distance of 8,620 kilometres.

“French readers have responded to the book because people really are trying to understand the space we all share and the reasons for radicalisation,” says Anacaona.

Now representing more than 15 authors, she has widened her company’s scope to include “regionalist” authors such as the late Rachel de Queiroz and José Lins do Rego, from the northeast of Brazil, who wrote about characters outside urban settings.

“To understand the favela, you have to understand the grandparents who came to the cities from rural areas, often with nothing and unable to read or write,” Anacaona says.

Her company’s contemporary writers include the award-winning Tatiana Salem Lévy, named one of Granta’s Best Young Brazilian Novelists, and the stand-out Ana Paula Maia, who began her career with “short pulp fiction” on the Internet and now has numerous fans.

Both writers were part of the contingent of 48 Brazilian authors invited to this year’s Paris Book Fair, which took place from Mar. 20 to 23.

Billed as “un pays plein de voix” (a country full of voice), Brazil was the guest of honour, and the writers discussed topics ranging from the depiction of urban violence to dealing with memory and displacement. Anacaona had a central role as a publisher of Brazilian books, with her stand attracting many readers.

Brazilian writer Ana Paula Maia. Credit: Marcelo Correa

She has translated and published two titles by Maia – Du bétail et des hommes (Of Cattle and Men) and Charbon animal (Animal Coal) – which focus on characters not normally present in literature. Maia writes about a slaughterhouse employee and a worker at a crematorium, for instance, in an unsentimental manner with minimal dialogue and almost no adjectives.

“She really can’t be categorised,” says Anacaona, who adds that despite Maia’s fashion-model appearance, the writer identifies with those living on the margins because she grew up among people who did not fit into the mainstream.

Both publisher and writer bear a resemblance and even have a name in common, and Anacaona acknowledges that she is attracted to Brazil and its literature because of her own mixed background – her French mother is white and her South American father is of African descent.

“In Brazil, it’s possible to be both black and white, and that’s something that is important to me,” she says.

As for the books, she has recently published a boxed set of 14 Brazilian plays, with the translation sponsored by the Brazilian Ministry of Culture, in an attempt to make Brazilian theatre more known in France.

There is also a second favela collection, titled je suis toujours favela (I am still favela), that includes literature as well as journalistic and sociological articles about the slums.

Between the first and second collections, Anacaona says she has found that the “favela has changed so much”, which she credits to the impact of policies to diminish inequality, launched by former president Luiz Inácio Lula da Silva  – perhaps a lesson for France and other countries.

Edited by Phil Harris 

Social worker in the flat of a drug addict in Donetsk doing outreach work. Drug addicts, like other marginalised groups, including Roma, are victims of the collapse of the health system in East Ukraine. Credit: Natalia Kravchuk/International HIV/AIDS Alliance Ukraine©

By Pavol Stracansky
KIEV, Jan 28 2015 (IPS)

With international organisations warning that East Ukraine is on the brink of a humanitarian catastrophe as its health system collapses, marginalised groups are among those facing the greatest struggle to access even basic health care in the war-torn region.

The conflict between pro-Russian separatists and Ukrainian forces has affected more than five million people, with 1.4 million classified by the World Health Organisation (WHO) and human rights bodies as “highly vulnerable” because of displacement, lack of income and a breakdown of essential services, including health care.

Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

A complete lack of vaccines is threatening outbreaks of diseases such as polio and measles, while there are concerns for HIV/AIDS and TB sufferers as supplies of vital medicines dry up and disease monitoring becomes almost impossible.Fighting and accompanying measures imposed by both sides have led to medical supplies being severely interrupted or cut off entirely, hospitals destroyed or battling constant water and power cuts, and crippling staff shortages at health facilities as medical staff flee the fighting.

Massive internal displacement because of the conflict – latest U.N. estimates are of 700,000 internally displaced persons (IDPs) with the figure rising by as much as 100,000 per week – has also left hundreds of thousands living in sometimes desperate and unhygienic conditions, creating a further health risk and the chance that infectious diseases, such as TB, will spread.

But while there is a threat to healthcare provision from collapsing resources, some in the region are facing extra barriers to accessing health care.

Ukraine has one of the worst HIV/AIDS epidemics in the world and the spread of the disease has been fuelled mainly by injection drug use. But, unlike in many Eastern European states, the country has been running for more than a decade an internationally lauded range of harm reduction programmes which have been credited with checking the disease’s spread.

These have included opioid substitution therapy (OST) programmes available to drug users across the country. These are particularly important in East Ukraine because the majority of Ukraine’s injection drug users come from the Luhansk and Donetsk regions.

But local and international organisations working with drug users say that addicts’ access to life-saving treatment in those areas has come under increasing pressure since the start of the conflict and that it could be cut off entirely within weeks as supplies of methadone and buprenorphine used in the treatment run out and cannot be replaced.

The International HIV/AIDS Alliance Ukraine which runs many OST centres as well as other harm reduction programmes, has said that stocks of antiretroviral drugs, OST and other life-saving treatments will have run out by  February.  More than 300 OST patients in Donetsk and Luhansk have lost access to treatment since the conflict began, while a further 550 patients on methadone will run out of drugs soon if emergency supplies cannot be delivered.

U.N. officials in close contact with international organisations helping drug users as well as doctors in Donetsk have confirmed to IPS that clinics have only a few weeks’ worth of stocks of methadone left.

One doctor in Donetsk working on an OST programme, who asked not to be named, told IPS:  “There are serious problems with medicine supplies. The last shipments came in September last year and some patients have already had to finish their treatments. Many had been on it for a decade and in that time had forged new lives, put their, sometimes criminal, past behind them and had families. It was absolutely tragic for them when they stopped.”

It is unclear what will happen to all those no longer able to access OST treatment. Doctors say some have gone into detoxification, while others have moved to other cities in safer areas of Ukraine in the hope of continuing OST.

But with 60 percent of those receiving OST also being HIV positive, according to the Donetsk doctor, and reports that many are now turning to illicit drugs and needle-sharing again as access to OST is cut off, there are concerns that the disease, along with Hepatitis C which is rife among injection drug users, and tuberculosis, could be spread, and that the lives of many drug users will again be at risk.

OST patient Andriy Klinemko, who was forced to flee Donetsk with his wife when their house was destroyed in bombing last summer and who is now in Dnipropetrovsk in central Ukraine, told IPS: “OST patients in East Ukraine are being forced to move, but not all of them can and even those that make it to other regions may not be able to continue OST because there is no money left to run such programmes. It’s a bad situation and at the moment I really can’t see any way it’s going to get better.”

But drug users are not the only marginalised community struggling to access health care.

Historically, the estimated 400,000-strong Roma community in Ukraine has, like Roma in many other Eastern European states, faced widespread discrimination in society, including in employment and education.

They have also always had limited access to healthcare because many Roma lack official ID documentation which makes it difficult for many to obtain official health care, while widespread poverty also means services and medicines which require any payment are also inaccessible to most. Meanwhile, many Roma settlements are in remote locations, far away from the nearest health centres.

Dr Dorit Nitzan, head of the WHO’s Ukraine Office, told IPS: “Even before the conflict, Roma in Ukraine had limited access to curative and preventive health service. As a result, Roma children have extremely low vaccination coverage. Moreover, rates of tuberculosis and other communicable and non-communicable diseases are higher among Roma than in the general population.”

Discrimination is also a problem. Zola Kondur of the Chiricli Roma rights group in Ukraine, told IPS: “In terms of healthcare, Roma are among the most vulnerable in the country. They are treated badly because of their ethnicity.”

However, the problems for Roma have dramatically worsened since the conflict began. Some human rights groups have said that since the separatist regimes took power in the region, Roma have faced systematic violent and sometimes fatal repression.

According to a report this month of an international mission to monitor human rights

by the Kharkiv Human Rights Protection Group, Roma living in separatist-controlled areas have been “subjected to open aggression from militants ….[who] have carried out real ethnic cleansing” against them. Many have fled and become IDPs, subsequently facing health struggles.

Dr Nitzan said: “As in every crisis, if not given special attention, marginalised and vulnerable groups are at higher risk. In Ukraine, many Roma lack civil documentation, and thus cannot be registered as internally displaced persons and are not included in the provision of any health services.

“Moreover, their inability to pay ‘out-of-pocket’ limits their ability to procure medication and/or services. Compounding this is that many Roma IDPs are residing at the margins of society, in remote geographical locations, where no services are available. All of these factors make health services inaccessible to Roma.”

Local rights groups say that Roma who have managed to flee to safe areas have often ended up homeless and starving after facing problems accessing aid because of a dismissive attitude from volunteers and staff at social institutions, while their lack of identification documents also prevented them from accessing any official help.

However, even those who have managed to find treatment have sometimes faced further problems.

Kondur told IPS: “In one case a Roma family moved from Kramatorsk to Kharkiv. A little boy had a heart problem brought on by the stress of the fighting and he was taken to hospital. One night, a group of young people broke the window of the boy’s hospital room, shouting ‘Gypsies get out’. The boy had a heart attack.”

Edited by Phil Harris

Young boy sitting on a wall outside 'Way Home', a UNICEF-assisted shelter providing food, accommodation, literacy trainings and HIV/AIDS-awareness lessons to street children in Odessa, Ukraine. Because of unsafe sex and injecting drug use, street adolescents are one of the groups most at risk of contracting HIV. Credit: UNICEF/G. Pirozzi

By Pavol Stracansky
KIEV, Dec 9 2014 (IPS)

Marginalised communities and civil society groups helping them are warning of a “tragedy” in Eastern Europe and Central Asia (EECA) as international funding for HIV/AIDS and tuberculosis (TB) programmes in the regions is cut back.

The EECA is home to the world’s only growing HIV/AIDS epidemic and is the single most-affected region by the spread of multi-drug resistant TB (MDR-TB). For years, HIV/AIDS and TB programmes in many of its countries have been heavily, or exclusively, reliant on funding from theGlobal Fund to Fight AIDS, TB and Malaria.

But this year has seen the Global Fund move to a new financing model based on national income statistics, under which funding in many EECA countries has already been – or will soon be – heavily cut.“This [reduction in Global Fund financing] could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake” – Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD)

Some of those likely to be most heavily affected by the cuts say that the reduction in Global Fund financing is putting essential HIV/AIDS and TB services, and with it lives, at risk.

Viktoria Lintsova of the Eurasian Network of People Who Use Drugs (ENPUD) told IPS: “This could lead to tragedy because governments are not yet ready to take on the responsibility for addressing the HIV/AIDS epidemic. I would like decision-makers to understand that this is not just [about] epidemiological statistics but that our lives and health are at stake.”

At the heart of their concerns are worries over funding for not just medical treatment for existing patients but prevention and other services for at risk and marginalised communities.

Injection drug use has been identified as the main driver of the HIV/AIDS epidemic in the EECA but HIV/AIDS is also being increasingly spread among men who have sex with men and sex workers – groups which are heavily marginalised because of political and societal attitudes to homosexuality and women.

TB, an equally severe health problem in the EECA, is closely linked to the HIV/AIDS epidemic because co-infection rates are often high.

Throughout the region, prevention and harm reduction services for marginalised groups are provided by civil society groups which rely almost exclusively on international funding.

Sveta McGill, health advocacy officer at international advocacy NGO Results UK, told IPS that the withdrawal of Global Fund funding could see many sick people slip under the health care radar.

She said: “It is affecting services provided by NGOs covering at-risk groups. These ‘low threshold entry’ services, while not necessarily medical interventions, are crucial to keep people from risk groups coming to centres where they get referred to medical institutions to get treatment and can access medical services as well.

“Often, they would not feel comfortable going straight to state health care institutions, and closing down these venues would mean that less people would be referred to state health care institutions.”

Critics point to rising HIV/AIDS infections in Romania in recent years as a sign of what could happen in other EECA countries when the Global Fund cuts back its financing.

The Global Fund ended financing for programmes in the country in 2010. According to data from the Romanian government, since then there has been a dramatic rise in HIV infections among people who use drugs: in 2013, about 30 percent of new HIV cases were linked to injection drug use compared with just three percent in 2010.

Under the Global Fund’s New Financing Model (NFM), the major change is a reduction in financing to middle income countries. Many EECA countries are now classified as middle income and critics say that while the organisation’s goal of looking to prioritise use of finite resources is sensible, national income data does not always accurately reflect the ability of people to access health care services, nor whether a country has the funds for an adequate disease response.

They point to studies showing disease burdens shifting from low income countries to middle income states, and poverty being greatest in middle income countries. Also, most people living with HIV live in middle income countries.

But some have also dismissed as naive the notion that, as the Global Fund wants, national governments will automatically fill the gap in funding left as the Global Fund cuts back its financing.

Many point to the situation in Ukraine as an example highlighting the problems of the NFM.

According to a report from the Open Society Foundations, Global Fund spending on HIV will drop by more than 50 percent for Ukraine between 2014 and 2015. This includes reductions in unit cost spending for people who use drugs by 37 percent, for sex workers by 24 percent and for men who have sex with men by 50 percent.

Meanwhile, the national HIV prevention budget was slashed by 71 percent in 2014 amid political and economic upheaval.

Lintsova, who lives in central Ukraine, told IPS of the problems drug users are currently facing.

She said that not only are there shortages of the right drugs to treat TB in some parts of the country, but that very few drug users have access to them. Places on opiate substitution treatment (OST) programmes are very limited and waiting times to join them long, sometimes fatally so.

“I know two people who died waiting to get on an OST programme,” she told IPS. “And there are other problems like a lack of needle exchange centres in rural areas, in fact a lack of any harm reduction services in small towns, which leads to high rates of HIV in those places.”

She added that without proper funding, the situation would not improve. “The only solution to these problems is financing,” she said.

But other stakeholders have also privately raised fears that a greater government role in fields such as drug procurement could see authorities looking to save money and procuring larger quantities of cheaper TB drugs of worse quality. Meanwhile, local legislation also makes procurement tenders long and difficult, leading, some health care experts predict, to governments running out of stocks of some essential medicines.

It is unclear how governments will deal with the reduction of Global Fund financing. The transition from Global Fund to domestic funding, although widely announced and anticipated, is not going smoothly in all countries.

Many are often unclear when the Global Fund will actually leave because no straightforward timing plan has been set. There are also specific problems in individual states. In Ukraine, in particular, domestic TB funding has been severely affected by the military conflict, struggling economy and currency fluctuation.

Late last month, these growing fears prompted 24 prominent NGOs in the region to send an open letter to the Global Fund warning of their ‘grave concerns’ over the allocation of funding in the region and calling for it to work with local groups and affected communities.

They specifically asked it to look at each country individually, rather than adopt a “one size fits all” approach.

The Global Fund declined to respond when contacted by IPS.

However, drug users who spoke to IPS said there was little hope of an improvement in the region’s HIV/AIDS and TB epidemics if the Global Fund fails to heed NGOs’ warnings.

Lintsova told IPS: “A lack of reaction to our calls could lead to problems accessing prevention and treatment programmes and a deepening of the EECA’s HIV/AIDS and TB epidemics.”

(Edited by Phil Harris)