Jack Niedenthal, the secretary of Health and Human Development in the Republic of Marshall Islands stands in front of the poster that records the dark past of the Pacific island nation and the need for good healthcare. Credit: Stella Paul/IPS

By Stella Paul
MAJURO, Apr 5 2019 (IPS)

In Jack Niedenthal’s office in Majuro, there is an ominous reminder of the dark history of the Marshall Islands—once the site for dozens of nuclear tests conducted by the United States between 1946 and 1962. But it also provides a strong message about the future of island nation.
“Given what the Marshall Islands has done for humankind, we deserve the best healthcare in the world,” reads a poster on his wall.

“What you see here is what I strongly believe,” says Niedenthal, the secretary of Health and Human Development here.

In fact, today the Pacific island nation’s main national income, aside from the sale of fishing rights to foreign firms, is the money the U.S. pays as compensation for conducting the nuclear tests through the Compact Trust Fund.

Many of those who live on the islands where the nuclear tests where conducted suffer from cancer. These cases are in addition to the high occurrences of tuberculosis (TB), diabetes and leprosy that the health authorities here have to address.

Niedenthal tells IPS that although the latter three diseases are not directly connected to the nuclear tests or radiation, the nation’s citizens, some 53,000, must be able to realise their right to good health and have the opportunity to live long lives. However, the resources to ensure that good healthcare is available to all remains limited.

So, Niedenthal is adopting practical measures by integrating services to provide care for people suffering from two of the country’s most endemic diseases, TB and leprosy. From the screening of citizens for potential new cases, to consultations with doctors and nurses, the integration is supposed to mean better and more accessible services. “It’s a small place. If tomorrow there is an epidemic, it will affect everyone. So, [an integrated] programme will help us be better prepared,” Niedenthal says.

The integration is a natural step in strengthening the healthcare sector here, but it should also include the sustained availability of services, say health experts. Without ensuring the latter, integration will neither result in significant improvement nor will it help eliminate the diseases, especially leprosy, says Dr. Arturo Cunanan, the head of the Culion Sanitarium and General Hospital in the Philippines and a world leprosy expert.

“Ideally, this is how it should be. Care for leprosy should be integrated with the general healthcare services. It is the only way to ensure the care is available at every level of the healthcare sector—right from the village to the city.
“If this can be done, a person who is affected, doesn’t have to travel far and wide to a specialised clinic or be dependent on a niche expert because every healthcare centre will have a person with some level of leprosy expertise. However, the two much go hand in hand because without sustained services and availability of that expertise, the integration cannot achieve anything,” Cunanan tells IPS.

Jefferson Barton, the Deputy Secretary of the Republic of Marshall Islands, says that the government considers leprosy elimination a high priority. Credit: Stella Paul/IPS

According to Cunanan, leprosy, is a “victim of its own success” meaning that due to the decreased number of cases, it is not a high priority with the governments anymore, even in countries were it is not yet eliminated.

The low priority is reflected in the low resource allocation, inefficiency in the management of the programme besides lack of facilities and skilled staff.

But while supplying integrated healthcare services promises to ease the management of the leprosy programme at an administrative level, it also can create scarcity of staff with specialised skills to treat leprosy. Sustainability, therefore, must be the key, Cunanan explains.

But Jefferson Barton, Deputy Chief Secretary of Republic of Marshall Islands (RMI), says that the government considers leprosy elimination a high priority.
“Health and education are our top priorities and even in health, we are focusing on educating the Marshallese people, especially the children, about the biggest health issues,” Barton tells IPS.

He, however, also assures that the country is willing to collaborate more with international experts, and donors such as the Sasakawa Health Foundation and its parent body the Nippon Foundation, to ensure better healthcare in RMI.
Globally, the treatment of leprosy is free. Manufactured and donated by Novartis, multidrug therapy or MDT, is distributed through the World Health Organisation.

But access to other services such as information about the disease, and credible, accurate and cleaned data on leprosy and TB is less than adequate—a fact that Niedenthal admits. He, however, believes that with support from the international community the country can overcome these challenges and ensure sustained healthcare for all.

“A lot of Marshallese travel and work abroad. If they carry a disease, it will affect people there. So, when you give us money to control the disease here, you are investing in your own well-being,” Niedenthal says.

Dr Ken Jetton (left) and Dr Arturo Cunanan (centre) with a patient who has been cured of leprosy in the Majuro leprosy clinic in the capital of the Marshall Islands. The patient is now seeking further help due to post-treatment complexities. Credit: Stella Paul/IPS

By Stella Paul
MAJURO, Apr 4 2019 (IPS)

It’s a Friday morning and Dr. Ken Jetton, the only doctor who treats leprosy in Majuro, the capital of the Marshall Islands, is seeing a patient recently cured of the disease.
David, 32, has received multidrug therapy (MDT) treatment for a year already. But he is back in the doctor’s office because of a reversal reaction that has occurred.

David, who asks to be referred to only by his first name to protect his privacy, has a stiffness in his fingers. A carpenter by profession, the stiffness is causing David greater financial loss than leprosy did as he cannot hold the tools of his trade in his hand any longer.

“This is the kind of patient I typically attend to…people who have been cured of leprosy, but have physical disability due to reversal reaction to the treatment,” Jetton tells IPS.

According to authors Francisco Vega-Lopez and Sara Ritchie in ‘Manson’s Tropical Infectious Diseases’, reversal reaction is one of two distinct reactions that occur after becoming infected by the bacterium that causes Hansen’s disease, also known as leprosy.

“Reversal reactions may cause acute inflammation causing rapid loss of nerve function and require prompt initiation of treatment with oral steroids,” the authors note. They also note that this reaction can occur before, during or after treatment.

Dr. Arturo Cunanan, a world expert on Hansen’s disease, tells IPS that almost everyone shows some symptom of reversal reaction. However, the degree to which it presents varies from person to person. Those who are diagnosed and treated late have more visible signs of disability than those who were diagnosed and began treatment early.

Resource crunch limiting services
But Jetton tells IPS that he is restricted by a lack of resources and unable to reach out to other patients who, like David, need his services as a doctor.

“It is at this stage that they need me even more because they are puzzled by this [disability] and they also suffer financially. But I cannot see all of them, especially those living in the outer islands,” Jetton explains.
The physician is based in Majuro, the capital of the island nation. But Marshall Islands has 28 other atolls, where there are many active cases of leprosy reported.

But while some of these islands are a short boat ride away, the others are not so easily reachable.
“There is a car for our office use but I do not get an allowance to buy petrol for the car. Who will pay for the boat and the visits to the outer islands?” Jetton asks.

The resource crunch seems a direct result of the decreasing budgetary allocation for health in the country’s five-year funding plans. According to government records, in 2016 the Department of Health was allocated just over 25,000 dollars for its budget. However, this year the amount was 23,000 dollars.

Even for a tiny nation like the Marshall Islands, which has a population of just over 53,000, the health budget is considered small.
There are reportedly 65 healthcare centres across the various atolls. And according to Jetton there are only a handful of staff managing these.

While MDT is provided free by Novartis, through the World Health Organisation (WHO), there are no funds to staff a leprosy centre outside of Majuro. And the country records some 75 new cases of Hansen’s disease each year.

Dr. Ken Jetton, is the only doctor who treats leprosy in Majuro, the capital of the Marshall Islands. Credit: Stella Paul/IPS

New leadership, new approach
The constraints of working with an inadequate budget goes beyond fuel allowances, Jack Niedenthal, the Secretary of Health and Human Services in the Department of Health, tells IPS.
The biggest challenges of the department, says Niedenthal who took over the post early this year, are the lack of skills, capacity and infrastructure required to fight endemic diseases in the island nation.

“All the staff here are underpaid and overworked. They need skill-building training, and we need infrastructure, including new facilities to detect, diagnose and treat,” Niedenthal is heard saying during a meeting with a team from the Sasakawa Health Foundation led by its CEO, Takahiro Nanri.

There are several areas where the staff would benefit from further training. Data and record keeping is one of them, points out the secretary before making an appeal to international experts.
“Instead of inviting us abroad, visit us here and train our staff right here,” says Niedenthal. He was formerly the Secretary General of the country’s Red Cross Society and has a strong human rights approach to health.

Addressing the right audience
Niedenthal’s appeal could potentially bring some positive changes as Yohei Sasakawa, WHO Goodwill Ambassador for Leprosy Elimination, and chair of the Nippon Foundation, the parent body to the Sasakawa Health Foundation, is expected to visit Marshall Islands later this month.

Sasakawa, who is also Japan’s Ambassador for the Human Rights of People Affected by leprosy, and recent recipient of the Gandhi Peace Prize, is keen to understand the situation of combatting leprosy in the country and wants to extend his support to both those providing healthcare as well as those affected by leprosy here.

Jetton is positive that with the help of the foundation they will be able to improve their services to leprosy patients.
In the meantime he prescribes prednisolone, a drug generally used to treat reversal reactions, to David.

Meretha Pierson, a nurse in the leprosy clinic of Majuro, Marshall Islands, shows the medication to cure leprosy that are provided for free. Credit: Stella Paul/IPS

By Stella Paul
MAJURO, Mar 28 2019 (IPS)

Meretha Pierson has been a nurse for the past seven years, working in the government-run leprosy clinic in Majuro, the capital of the Marshall Islands. Her patients come in all ages, from different economic backgrounds and different professions. But, aside from their diagnosis, they all have something else in common: everyone wants to keep their illness a secret.

“Everyone requests me not to tell their neighbours. But women who are young, request me to not inform even their spouses. ‘Please don’t tell my husband,’ they say.  Sometimes, such a request is really hard to keep,” Pierson tells IPS.

Unwanted labels

There is a reason why Pierson, one of the handful of trained health workers who can detect a case of leprosy, also known as Hansen’s disease, can’t always promise full confidentiality to her patients.

Marshall Islands is believed to have 50 to 80 new cases of leprosy every year – a number that is very big for a population of only 60,000.

According to the World Health Organization (WHO), if more than 1 in every 10,000 people are affected by leprosy, then it should be considered as a disease that has not been eliminated.

Marshall Islands, as classified by the WHO, is therefore far from eliminating the disease.

But it is a classification that the government is eager to get rid of. In mid-2018, the government and the country’s Ministry of Health, ran a three-month long health screening campaign where over 27,000 citizens were tested for both leprosy and tuberculosis so that every affected person could receive treatment.

Concrete details on the number of leprosy cases are yet to be made public, but health workers like Pierson have already been instructed to keep a close eye on the patients who do not return to report on their health and who stop treatment in the middle of the course. And this is why it makes it really difficult to keep the promise of not alerting anyone to their illness as health workers are often compelled to seek out the patients.

Tracking these patients down and convincing them to restart their medication is both a necessity and a requirement that forms part of the government’s new campaign to curb the disease.

But as they do so, the requests for confidentiality becomes more frequent.

“They do not want us to go to their houses. So, we make phone calls, call them to a place outside of their homes and their neighbourhood and that’s where we do our counselling and advise them to return to the clinic for a check-up and continue the treatment. But it’s hard,” Pierson tells IPS.

The leprosy hotspots in the Marshall Islands. Credit: Stella Paul/IPS

Discrimination towards the caregiver

However, it is not only patients who are stigmatised on this island nation. Health workers themselves often bear the brunt themselves in a society where over 80 percent of the population are of Christian faith. Pierson, a Mormon, says that she has often faced discrimination from her neighbours and relatives who have suspected her of having leprosy.

“They think because I work in a leprosy clinic, I am carrying the germ or the disease myself. Some even ask why I do not give up this job. I have to always tell them that I am a nurse and I do not have leprosy myself. Even in the church, I get those stares,” she says. Fortunately, her husband is supportive and has never asked her to leave her job.

The hotspots

There are around 30 atolls that comprise the Marshall Islands and about a quarter of them are known as the hotspots of leprosy, according to Dr. Ken Jetton, the main physician at the country’s Department of Public Health.

Jetton officially diagnoses and confirms leprosy cases after Pierson detects a possible case and refers the patient to him.

He tells IPS that few of these ‘hotspots’ include the atolls of Kwajalein, Ailinglaplap, Mili, Arno, Wotje and Ebon. During the recent mass health screening, about 47 new cases were reported from these places.

The data sheet is yet to be complied, but once this is done, a proper plan will be drawn up to treat each patient until they are cured, Jetton reveals. The medication, Multi Drug Therapy (MDT), an oral medicine, is given free of charge in 6 packs for children and 12 packs for adults.

Understanding the gaps in country’s leprosy elimination campaign is one of the reasons why a team from the Sasakawa Health Foundation, led but its executive director Takahiro Nanri, as well as the world’s leading expert on leprosy, Dr. Arturo Cunanan, are travelling around the Marshall Islands and the Micronesia region. They have been meeting with senior government and health officials and leprosy experts and have visited clinics in Marshall Islands and the Federated State of Micronesia. Yohei Sasakawa, chair of the Nippon Foundation, the parent body for SMHF, is the WHO Goodwill Ambassador for Leprosy Elimination, and Japan’s Ambassador for the Human Rights of People Affected by leprosy. He will be touring the region in April to also assess the progress governments have made.

However, Pierson says that despite the screening and follow up activities, social stigma, especially towards the female leprosy patients might take longer than expected to fade away. This is because the island nation is still largely ignorant of the fact that leprosy as a curable disease, she explains.

Patience, therefore, is the key, she reminds. “We must be patient and  also have empathy for those who hide their diseases from others. They are vulnerable and scared of losing their dignity and we need to understand this,” says the nurse.

Demonstrators protesting at the Business & Climate Summit in Paris, May 20. Credit: A.D. McKenzie/IPS

By A. D. McKenzie
PARIS, May 21 2015 (IPS)

When it comes to climate change, business as usual is simply “not an option”.

That was the view of Eldar Saetre, CEO of Norwegian multinational Statoil, as international industry leaders met in Paris for a two-day Business & Climate Summit, six months ahead of the next United Nations Climate Change Conference (COP 21 ) that will also be held in the French capital.

Subtitled “Working together to build a better economy”, the May 20-21 summit brought together some 2,000 representatives of some of the world’s largest retail and energy concerns, including  companies that NGOs have criticized as being among the worst environmental offenders.

At the end, business leaders proclaimed that they wanted “a global climate deal that achieves net zero emissions” and that they wanted to see this happen at COP 21.

Throughout the conference, participants stressed that businesses will have to change, not only to protect the environment, but for their own survival. “Taking climate action simply makes good business sense. However, business solutions on climate are not being scaled up fast enough,” declared the summit organizers.

They pledged to lead the “global transition to a low-carbon, climate resilient economy.”

Saetre, for example, said his company wanted to achieve “low-carbon oil and gas production” and that it had embarked on renewables in the form of offshore wind energy. But he said that fossil fuels would still be needed in the future, alongside the various forms of renewable energy.

Acknowledging the widespread scepticism about multinational companies’ commitment, business leaders said that they could not “go it alone”, and called for support from governments as well as consumers.

Mike Barry, Director of Sustainable Business at British retailer Marks & Spencer, told IPS in an interview that global commitment was important in the drive to transform industry to have more environmentally friendly practices.

“Collective action can bring about real change,” he said. “We’re here today because we believe that climate change is happening and it’s going to have a significant impact on our business in the future and our success.

“Our customers would expect us to take the lead on this, and we want governments to take this seriously as well in the run-up to COP 21 [the 21st session of the Conference of the Parties to the United Nations Framework Convention on Climate Change to be held in Paris from Nov. 30 to Dec. 11].”

He said that Marks & Spencer and other companies in a network called the Consumer Goods Forum wanted to “stand shoulder to shoulder with government to say ‘this matters and we’re here to help’.”

But government consensus on how to address climate change has proved difficult, and even French President Francois Hollande, who opened the summit, conceded that it would require a miracle for a real agreement to be reached at COP 21.

“We must have a consensus. It’s already not easy in our own countries, so with 196 countries, a miracle is needed,” he said at the Business & Climate Summit, expressing the conviction, however, that agreement will be reached through negotiation and “responsibility”.

Hollande and other officials said the involvement of businesses was essential, and France, with its huge oil and electricity companies, evidently has a big role to play.

However, demonstrators outside the summit, held at the headquarters of the United Nations Educational, Scientific and Cultural Organisation (UNESCO), slammed big business.

“These multinationals (and the banks that finance their activities) are in fact directly at the origin of climate change,” read a statement from organisations including Les Amis de la Terre (Friends of the Earth, France) and the civil disobedience group J.E.D.I. for Climate.

Saying that it was ironic to have fossil-fuel companies represented at the summit, the groups asked: “Can one imagine for a second that the tobacco industry would be associated with policies to combat smoking aimed at ending the production of cigarettes? No, that would be the best way to ensure that the world continued to chain-smoke.”

The protesters added that if Hollande and his ministers wanted to show a real commitment to the environment, they should make it clear that “the climate is not a business”.

“The fight against climate change is not the business of fossil-fuel multinationals: they belong to our past,” the groups said in a joint release, handed out on the street.

At the summit, Christiana Figueres, Executive Secretary of the U.N. Framework Convention on Climate Change (UNFCCC), said that businesses should not be “demonised” and she called for collaboration rather than confrontation.

“We all start with a carbon footprint,” she said. “It is not a question of demonising anyone but realizing that we’re all here … This is not about confrontation. This is about collaboration. If you’re thinking about confrontation, forget it. Because we’re not going to get there.”

The summit – co-hosted by Entreprises Pour l’Environnement, an association of some 40 French and large international companies, and UN Global Compact France, a policy initiative for businesses – also addressed the vulnerability of island states in the face of climate change.

Tony de Brum, the Marshall Islands’ Minister of Foreign Affairs, said that island states in the Pacific and elsewhere had an interest in keeping pressure on carbon emitters because their populations’ survival was at stake.

Angel Gurría, Secretary General of the Paris-based Organisation for Economic Cooperation and Development (OECD), also highlighted the threat to vulnerable countries, saying that for them, climate change is not about protecting the environment for future generations, but “it’s about how long the water will take to overcome the land.”

Gurría said that greater reductions in carbon emissions were required than has so far been proposed by states, and he stressed that countries over time needed to “develop a pathway to net zero emissions globally” by the second half of the century.

“Governments at COP 21 need to send a clear directional signal that will drive action for decades to come,” he said. “We are on a collision course with nature, and unless we seize this opportunity, we face an increasing risk of severe, pervasive and irreversible climate impact.”

Edited by Phil Harris    

Natural disasters and climate change, including sea level rise, are already impacting many coastal communities in Pacific Island countries, such as the Solomon Islands. Credit: Catherine Wilson/IPS

By Catherine Wilson
CANBERRA, Australia , Mar 24 2015 (IPS)

As Pacific Islanders contemplate the scale of devastation wrought by Cyclone Pam this month across four Pacific Island states, including Vanuatu, leaders in the region are calling with renewed urgency for global action on climate finance, which they say is vital for building climate resilience and arresting development losses.

In a recent public statement, the Marshall Islands’ president, Christopher Loeak, said, “The world’s best scientists, and what we see daily with our own eyes, all tell us that without urgent and transformative action by the big polluters to reduce emissions and help us to build resilience, we are headed for a world of constant climate catastrophe.”

“Like other small vulnerable countries, we have experienced great difficulty in accessing the big multilateral funds. The Green Climate Fund must avoid the mistakes of the past and place a premium on projects that deliver direct benefits to local communities." -- Tony de Brum, minister of foreign affairs for the Republic of the Marshall Islands
Progress on the delivery of climate funding pledges by the international community could also decide outcomes at the United Nations Climate Change Conference to be held in Paris in December, they say.

“It is reassuring to see many countries, including some very generous developing countries, step forward with promises to capitalise the Green Climate Fund. But we need a much better sense of how governments plan to ramp up their climate finance over the coming years to ensure the Copenhagen promise of 100 billion dollars per year by 2020 is fulfilled,” Tony de Brum, minister of foreign affairs for the Republic of the Marshall Islands, told IPS.

“Without this assurance, success in Paris will be very difficult to achieve.”

The Pacific Islands are home to about 10 million people in 22 island states and territories with 35 percent living below the poverty line. The impacts of climate change could cost the region up to 12.7 percent of annual gross domestic product (GDP) by the end of this century, the Asian Development Bank (ADB) estimates.

The Pacific Islands contribute a negligible 0.03 percent to global greenhouse gas emissions, yet are the first to suffer the worst impacts of global warming. Regional leaders have been vocal about the climate injustice their Small Island Developing States (SIDS) confront with industrialised nations, the largest carbon emitters, yet to implement policies that would limit global temperature rise to the threshold of two degrees Celsius.

In the Marshall Islands, where more than 52,000 people live on 34 small islands and atolls in the North Pacific, sea-level rise and natural disasters are jeopardising communities mainly concentrated on low-lying coastal areas.

“Climate disasters in the last year chewed up more than five percent of national GDP and that figure continues to rise. We are working to improve and mainstream adaptation into our national planning, but emergencies continue to set us back,” the Marshall Islands’ Foreign Minister said.

The nation experienced a severe drought in 2013 and last year massive tidal surges, which caused extensive flooding of coastal villages and left hundreds of people homeless.

“Like other small vulnerable countries, we have experienced great difficulty in accessing the big multilateral funds. The Green Climate Fund must avoid the mistakes of the past and place a premium on projects that deliver direct benefits to local communities,” de Brum continued.

Priorities in the Marshall Islands include coastal restoration and reinforcement, climate resilient infrastructure and protection of freshwater lenses.

Bilateral aid is also important with SIDS receiving the highest climate adaptation-related aid per capita from OECD countries in 2010-11. The Oceanic region received two percent of OECD provided adaptation aid, which totalled 8.8 billion dollars.

Sixty percent of OECD aid in general to the Pacific Islands comes from Australia with other major donors including New Zealand, France, the United States and Japan. But in December, the Australian government announced far-reaching cuts to the foreign aid budget of 3.7 billion dollars over the next four years, which is likely to impact climate aid in the region.

Funding aimed at developing local climate change expertise and institutional capacity is vital to safeguarding the survival and autonomy of their countries, islanders say.

“We do not need more consultants’ reports and feasibility studies. What we need is to build our local capacity to tackle the climate challenge and keep that capacity here,” de Brum emphasised.

In the tiny Central Pacific nation of Kiribati, a Ministry of Foreign Affairs spokesperson expressed concern that “local capacity is limited”, a problem that is “addressed through the provision of technical assistance through consultants who just come and then leave without properly training our own people.”

Kiribati, comprising 33 low-lying atolls with a population of just over 108,000, could witness a maximum sea level rise of 0.6 metres and an increase in surface air temperature of 2.9 degrees Celsius by 2090, according to the Pacific Climate Change Science Program.

The country is experiencing higher tides every year, but can ill afford shoreline erosion with a population density in some areas of 15,000 people per square kilometre. The island of Tarawa, the location of the capital, is an average 450 metres wide with no option of moving settlements inland.

As long-term habitation is threatened, climate funding will, in the future, have to address population displacement, according to the Kiribati Ministry of Foreign Affairs:

“Climate induced relocation and forced migration is inevitable for Kiribati and planning is already underway. Aid needs to put some focus on this issue, but is mostly left behind only due to the fact that it is a future need and there are more visible needs here and now.”

Ahead of talks in Paris, the Marshall Islands believes successfully tackling climate change requires working together for everyone’s survival. “If climate finance under the Paris Agreement falls off a cliff, so will our response to the climate challenge,” de Brum declared.

Edited by Kanya D’Almeida

A lawsuit by the Marshall Islands accusing the United States of failing to begin negotiations for nuclear disarmament has been thrown out of an American court.

The Marshall Islands is currently pursuing actions against India, Pakistan and the United Kingdom in the International Court of Justice, for failing to negotiate nuclear disarmament as required in the 1968 Nuclear Non-Proliferation Treaty.“By side-stepping the case on jurisdictional grounds, the U.S. is essentially saying they will do what they want, when they want, and it’s not up to the rest of the world whether they keep their obligations.” -- David Krieger

Action against the U.S. had been filed in a federal court in California, as the United States does not recognise the compulsory jurisdiction of the ICJ.

David Krieger, president of the Nuclear Age Peace Foundation, said the U.S. conducted 67 nuclear weapons tests in the Marshall Islands between 1946 and 1958, the equivalent of 1.6 Hiroshima bombs detonating daily for 12 years.

Despite documented health effects still plaguing Marshallese islanders, U.S. Federal Court judge Jeffrey White dismissed the motion on Feb. 3, saying the harm caused by the U.S. flouting the NPT was “speculative.”

White also said the Marshall Islands lacked standing to bring the case, and that the court’s ruling was bound by the “political question doctrine” – that is, White ruled the question was a political one, not a legal one, and he therefore could not rule for the Marshalls.

Krieger, whose Nuclear Age Peace Foundation supports Marshall Islands in its legal cases, called the decision “absurd.”

“I think it was an error in his decision. There were very good grounds to say the Marshall Islands had standing, and this shouldn’t have been considered a political question,” he told IPS.

“The Marshall Islands know very well what it means to have nuclear bombs dropped on a country. They’ve suffered greatly, it’s definitely not speculative.”

The foundation of the multiple cases brought by the Marshall Islands was that the U.S., and other nuclear powers, had not negotiated in good faith to stop the spread of nuclear weapons. White ruled it was “speculative” that the failure of the U.S. to negotiate nuclear non-proliferation was harmful.

Krieger said the Marshalls would appeal the decision to the Ninth Circuit of Appeals. He said the decision set a troubling precedent regarding U.S. adherence to international agreements.

“The U.S. does not accept the jurisdiction of the ICJ, and in this case, the judge is saying another country does not have standing [in an American court]. In essence, it means any country that enters into a treaty with the U.S. should think twice,” he said.

“Another country will be subject to the same decision of the court. Where does that leave a country who believes the U.S. is not acting in accordance with a treaty?

“By side-stepping the case on jurisdictional grounds, the U.S. is essentially saying they will do what they want, when they want, and it’s not up to the rest of the world whether they keep their obligations.”

Krieger said that the judge’s comments about the “speculative” nature of the case meant essentially that a nuclear accident or war would have to break out before such a case for damages could be heard.

“It’s saying a state must wait until some kind of nuclear event, before damages won’t be speculative,” he said. “It’s absurd that the claim that the U.S. has not fulfilled its obligations to negotiate in good faith to end the nuclear arms race, is called ‘speculative’ by the judge.”

Marshall Islands had intended to pursue all nine nuclear powers – the U.S., China, Russia, Pakistan, India, the U.K., France, North Korea and Israel – in the ICJ on their failure to negotiate for nuclear non-proliferation.

The Marshall Islands is still pursuing cases in the ICJ against Pakistan, India and the U.K., but John Burroughs, executive director of the Lawyers Committee on Nuclear Policy, said the other cases had stalled as those nations did not accept the compulsory jurisdiction of the ICJ.

“The other six states, the Marshall Islands invited and urged them to come before the court voluntarily, which is a perfectly normal procedure, but none of them have done so,” Burroughs told IPS.

Burroughs, also a member of the international team in the ICJ, said China had explicitly said it would not appear before the court.

“Any of those countries could still agree to accept the court’s jurisdiction,” he said.

He said preliminary briefs had been filed in the India and Pakistan cases, with responses due by mid-2015. A brief will be served on the U.K. case in March.

Burroughs said he doubted the decision in U.S. federal court would impact the cases in The Hague.

“I don’t see the decision having any effect at all,” he said.

Edited By Kitty Stapp

Mushroom cloud over Bikini Atoll in the Marshall Islands from Castle Bravo, the largest nuclear test ever conducted by the United States. Credit: United States Department of Energy [Public domain] via Wikimedia Commons

By Julia Rainer
VIENNA, Dec 9 2014 (IPS)

Ahead of the Dec. 8-9 Vienna Conference on the Humanitarian Impact of Nuclear Weapons, activists from all over the world came together in the Austrian capital to participate in a civil society forum organised by the International Campaign to Abolish Nuclear Weapons (ICAN) on Dec. 6 and 7.

One pressing issue discussed was the Marshall Islands’ lawsuit against the United States and eight other nuclear-weapon nations that was filed at the International Court of Justice (ICJ) in April 2014, denouncing the over 60 nuclear tests that were conducted on the small island state’s territory between 1946 and 1958.“The Marshall Islands is a small, gutsy country. It is not a country that will be bullied, nor is it one that will give up. It knows what is at stake with nuclear weapons and is fighting in the courtroom for humanity’s survival” – David Krieger, President of the Nuclear Age Peace Foundation (NAPF)

The location was chosen not only because it was an isolated part of the world but also because at the time it was also a Trust Territory of the Pacific Islands governed by the United States. Self-government was achieved in 1979, and full sovereignty in 1986.

The people of the Marshall Islands were neither informed nor asked for their consent and for a long period did not realise the harm that the testing would bring to the local communities.

The consequences were severe, ranging from displacement of people to islands that were strongly radiated and cannot be resettled for thousands of years, besides birth abnormalities and cancer. The states responsible denied the harm of the practice and refuse to provide for adequate amount of health care.

Castle Bravo was the code name given to the first United States‘ test of a nuclear bomb in 1954 and was 1000 times more powerful than the bomb dropped on Hiroshima in 1945.

Addressing the ICAN forum, Marshall Islands Foreign Minister Tony de Brum explained that his country had decided to approach the ICJ to take a stand for a world free of nuclear weapons.

De Brum said that the Marshall Islands was not seeking compensation, because the United States had already provided millions of dollars to the islands, but wants to hold states accountable for their actions in violating the Nuclear Non-Proliferation Treaty (NPT) and international customary law.

The NPT, which entered into force in 1970, commits nuclear-weapon states to nuclear disarmament and the peaceful use of nuclear power. The nine countries currently holding nuclear arsenals are the United States, United Kingdom, France, Russia, China, India, Pakistan, North Korea and Israel.

Tony de Brum, Foreign Minister of the Marshall Islands, who talked about “stopping the madness and banning nuclear weapons once and for all”, with Daniela Varano, ICAN Campaign Communications Coordinator. Credit: ICAN

Although a certain degree of disarmament has been taken place since the end of the Cold War, these nine nations together still possess some 17,000 nuclear weapons and globally spend 100 billion dollars a year on nuclear forces.

The Marshall Islands case, which has received worldwide attention and support from many different organisations, is often referred to as “David vs. Goliath”. One eminent supporter is the Nuclear Age Peace Foundation (NAPF), whose president, David Krieger, said: “The Marshall Islands is a small, gutsy country. It is not a country that will be bullied, nor is it one that will give up.”

“It knows what is at stake with nuclear weapons,” he continued, “and is fighting in the courtroom for humanity’s survival. The people of the Marshall Islands deserve our support and appreciation for taking this fight into the U.S. Federal Court and to the International Court of Justice, the highest court in the world.”

Another strong supporter of the case is Soka Gakkai International (SGI), a Buddhist organisation that advocates for peace, culture and education and has a network of 12 million people all over the world. The youth movement of SGI even launched a “Nuclear Zero” petition and obtained five million signatures throughout Japan in its demand for a world free of nuclear weapons.

The campaign was encouraged by the upcoming 70^th anniversary of the atomic bombing of Hiroshima and Nagasaki in 2015 as well as the holding of the 2015 Nuclear Non-Proliferation Treaty (NPT) Review Conference.

Addressing the ICAN, de Brum urged participants to support the cause of the Marshall Islands. “For a long time,” he said, “the Marshallese people did not have a voice strong enough or loud enough for the world to hear what happened to them and they desperately don’t want it to happen to anyone else.”

He went on to say that when the opportunity arose to file a lawsuit in order to stop “the madness of nuclear weapons”, the Marshall Islands decided to take that step, declaring in its lawsuit: “If not us, who? If not now, when?”.

De Brum recognised that many had discouraged his country from taking that step because it would look ridiculous or did not make sense for a nation of 70.000 people to take on the most powerful nations in the world on such a highly debated issue.

However, he said, “there is not a single citizen on the Marshall Islands that has not had an encounter with one or another effect of the testing period … because we have experienced directly the effects of nuclear weapons we felt that we had the mandate to do what we have done.”

The Vienna Conference on the Humanitarian Impact of Nuclear Weapons is the third in a series of such conferences – the first was held in Oslo, Norway, in March 2013 and the second in Nayarit, Mexico, in February 2014.

(Edited by Phil Harris)

The atomic bomb dome at the Hiroshima Peace Memorial Park in Japan was designated a UNESCO World Heritage Site in 1996. Credit: Freedom II Andres_Imahinasyon/CC-BY-2.0

By Suvendrini Kakuchi
TOKYO, Aug 7 2014 (IPS)

It has been 69 years, but the memory is fresh in the minds of 190,000 survivors and their descendants. It has been 69 years but a formal apology has yet to be issued. It has been 69 years – and the likelihood of it happening all over again is still a frightening reality.

As foreign dignitaries descended on Japan to mark the 69^th anniversary of the atomic bombing Wednesday, the message from officials in the city of Hiroshima was one of urgent appeal to governments to seriously consider the enormous threat to humanity and the planet of another nuclear attack.

Survivors, known here as hibakusha, who have worked tirelessly since August 1945 to ban nuclear weapons worldwide, urged diplomats – including ambassadors from four of the nine nuclear weapons states (United States, Israel, Pakistan and India) – to heed the words of the 2014 Peace Declaration.

Representing the anguished wishes of aging survivors and peace activists, the declaration calls on policy makers to visit the bomb-scarred cities to witness first-hand the lasting devastation caused when the U.S. dropped its uranium bomb (Little Boy) on Hiroshima and its plutonium bomb (Fat Man) on Nagasaki three days later.

The Center for Arms Control and Non Proliferation reported earlier this year that the nine nuclear weapons states possessed a combined total of 17,105 nuclear weapons as of April 2014.
Some 45,000 people observed a minute of silence Wednesday in a peace park close to the epicenter of the bomb, which killed an estimated 140,000 people in Hiroshima before the second bomb claimed a further 70,000 lives in Nagasaki.

The tragic events came as Japan was negotiating its surrender in World War II (1939-45).

The presence of so many survivors, whose average age is estimated to be 79 years, provided stark evidence of the debilitating physical and psychological wounds inflicted on those fateful days, with many hibakusha and their next of kin struggling to live with the results of intense and prolonged radiation exposure.

In a tribute to their suffering, the Hiroshima Peace Declaration states, “We will steadfastly promote the new movement stressing the humanitarian consequences of nuclear weapons and seeking to outlaw them.

“We will help strengthen international public demand for the start of negotiations on a nuclear weapons convention with the goal of total abolition by 2020,” the declaration added.

But the likelihood of this dream becoming a reality is dim, with the Center for Arms Control and Non-Proliferation in Washington reporting earlier this year that the nine nuclear weapons states possessed a combined total of 17,105 nuclear weapons as of April 2014.

The United States, the only state to deploy these weapons against another country, has steadfastly held out on issuing an official apology, claiming instead that its decision to carry out the bombing was a “necessary evil” to end World War II.

This argument is now deeply entrenched in global geopolitics, with states like Israel – not yet a signatory to the Nuclear Non-Proliferation Treaty (NPT) – vehemently protecting its arsenal as essential for national security in the face of protracted political tensions in the region.

Following Israel’s military offensive in Gaza, which resulted in 1,800 civilian casualties in the Palestinian enclave before a ceasefire brokered by Egypt came into effect Tuesday, some in the Arab community insist that Israel represents the biggest security threat to the region, and not vice versa.

China, a nuclear state with an inventory of 250 warheads and currently embroiled in a territorial dispute with Japan, was conspicuously absent from the proceedings.

With run-ins between East Asian nations in the disputed South China Sea becoming increasingly confrontational, peace activists here feel an urgent need to address tensions between nuclear weapons powers, including North Korea.

Professor Jacob Roberts at the Hiroshima Peace Research Institute told IPS, “The call is to ban nuclear weapons that kill and cause immense suffering of humans. By possessing these weapons, nuclear states represent criminal actions.”

He said the anti-nuclear movement is intensely focused on holding states with nuclear weapons accountable for not abiding by the 1968 NPT.

He cited the example of the Mar. 1 annual Remembrance Day held in the Pacific Ocean nation of the Marshall Islands, which suffered devastating radiation contamination from Operation Castle, a series of high-yield nuclear tests carried out by the U.S. Joint Task Force on the Bikini Atoll beginning in March 1954.

Thousands fell victim to radiation sickness as a result of the test, which is estimated to have been 1,000 times more powerful than the Hiroshima blast.

In total, the U.S. tested 67 bombs on the territory between 1946 and 1962 against the backdrop of the Cold War-era nuclear weapons race with Russia.

In a bid to challenge the narrative of national security, the Marshall Islands filed lawsuits this April at the International Court of Justice in The Hague, and separately in U.S. Federal District Court, against the nine nuclear weapon states for failing to dismantle their arsenals.

The lawsuits invoke Article VI of the Nuclear Non-Proliferation Treaty (NPT), which contains a binding obligation for five nuclear-armed nations (the U.S., UK, France, China and Russia) “to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament.”

As in Hiroshima, the United States has not apologized to the Marshall Islands but only expressed “sadness” for causing damage. A former senator from the Marshall Islands, Abacca Anjain Maddison, told IPS, “The U.S. continues to view the disaster as ‘sacrificing a few for the security of many’.”

The U.S. is not the only government to come under fire. Hiromichi Umebayashi, director of the Research Center for Nuclear Weapons Abolition (RECNA) at Nagasaki University, is a leading advocate for a nuclear-free zone in East Asia and a bitter critic of the administration of Japanese Prime Minister Shinzo Abe, which is alleged to be currently pushing the argument that nukes are necessary for national security.

Umebayashi is spearheading a campaign to stop Japan’s latest decision to work closely with the United States, under a nuclear umbrella, on strengthening the country’s national defence capacities.

“North Korea’s nuclear threat in East Asia is used by the Japanese government to push for more military activities. As the only nation to be atom bombed, Japan is making a huge mistake,” the activist told IPS.

Edited by Kanya D’Almeida

A Patriot interceptor missile is launched from Omelek Island Oct. 25, 2012 during a U.S. Missile Defense Agency integrated flight test. Credit: U.S. Navy

By Thalif Deen
UNITED NATIONS, Apr 25 2014 (IPS)

The tiny Pacific nation state of Marshall Islands – which depends heavily on the United States for its economic survival, uses the U.S. dollar as its currency and predictably votes with Washington on all controversial political issues at the United Nations – is challenging the world’s nuclear powers before the International Court of Justice (ICJ) in The Hague.

The lawsuit, filed Thursday, is being described as a potential battle between a puny David and a mighty Goliath: a country with a population of a little over 68,000 people defying the world’s nine nuclear powers with over 3.5 billion people."The United States should defend the case and widen the opportunity for the Court to resolve the wide divide of opinion regarding the state of compliance with the disarmament obligations." -- John Burroughs

John Burroughs, executive director of the Lawyers Committee on Nuclear Policy and the U.N. Office of the International Association of Lawyers Against Nuclear Arms (IALANA), told IPS the Marshall Islands and its legal team strongly encourage other states to support the case, by making statements, and by filing their own parallel cases if they qualify, or by intervening in the case.

Burroughs, who is a member of that team, said the ICJ, in its 1996 advisory opinion, held unanimously that there exists an obligation to pursue in good faith and bring to a conclusion negotiations on nuclear disarmament in all its aspects under strict and effective international control.

And these cases brought by the Marshall Islands nearly 18 years after the ICJ advisory opinion “will put to the test the claims of the nine states possessing nuclear arsenals that they are in compliance with international law regarding nuclear disarmament and cessation of the nuclear arms race at an early date.”

The nine nuclear states include the five permanent members (P5) of the U.N. Security Council, namely the United States, the UK, France, China and Russia, plus India, Pakistan, Israel and North Korea.

Burroughs said three of the respondent states – the UK, India, and Pakistan – have accepted the compulsory jurisdiction of the Court, as has the Marshall Islands.

For the other six states, he said, the Marshall Islands is calling on them to accept the Court’s jurisdiction in these particular cases.

“This is a normal procedure but the six states could choose not to do so,” said Burroughs.

Between 1946 and 1958, the United States conducted 67 nuclear weapons tests, triggering health and environmental problems which still plague the island nation.

Tony de Brum, the foreign minister of Marshall Islands, was quoted as saying, “Our people have suffered the catastrophic and irreparable damage of these weapons, and we vow to fight so that no one else on earth will ever again experience these atrocities.”

The continued existence of nuclear weapons and the terrible risk they pose to the world threaten us all, he added.

The suit also says the five original nuclear weapon states (P5) are continuously breaching their legal obligations under the Nuclear Non-Proliferation Treaty (NPT).

Article VI of the NPT requires states to pursue negotiations in good faith on cessation of the nuclear arms race at an early date and nuclear disarmament.

India, Pakistan, Israel and North Korea are not parties to the treaty.

But the lawsuit contends that all nine nuclear-armed nations are still violating customary international law.

Far from dismantling their weapons, the nuclear weapons states are accused of planning to spend over one trillion dollars on modernising their arsenals in the next decade.

David Krieger, president of the Nuclear Age Peace Foundation, which is strongly supportive of the law suit, said, “The Marshall Islands is saying enough is enough.”

He said it is taking a bold and courageous stand on behalf of all humanity, “and we at the foundation are proud to stand by their side.”

In a statement released Thursday, Archbishop Desmond Tutu of South Africa said, “The failure of these nuclear-armed countries to uphold important commitments and respect the law makes the world a more dangerous place.

“We must ask why these leaders continue to break their promises and put their citizens and the world at risk of horrific devastation. This is one of the most fundamental moral and legal questions of our time,” he added.

Burroughs told IPS the United States maintains that it is committed both to the international rule of law and to the eventual achievement of a world free of nuclear weapons.

“The United States should defend the case and widen the opportunity for the Court to resolve the wide divide of opinion regarding the state of compliance with the disarmament obligations,” he added.

The other five states which have not accepted the compulsory jurisdiction of the Court are being asked to do likewise.

As to the case against the UK, a key issue is whether the UK has breached the nuclear disarmament obligation by opposing General Assembly efforts to launch multilateral negotiations on the global elimination of nuclear weapons, said Burroughs.

For India and Pakistan, because they are not parties to the NPT, the case will resolve the question of whether the obligations of nuclear disarmament are customary in nature, binding on all states.

He said it will also address whether the actions of India and Pakistan in building up, improving and diversifying their nuclear arsenals are contrary to the obligation of cessation of the nuclear arms race and the fundamental legal principle of good faith.

Faith leaders gathered at the United States Peace Institute to solidify a common stance on nuclear disarmament. Credit: Courtesy of SGI

By Michelle Tullo
WASHINGTON, Apr 25 2014 (IPS)

On the eve of next week’s meeting at the U.N. headquarters in New York on the Nuclear Non-Proliferation Treaty (NPT), more than 100 representatives of 11 faith groups from around the world have pledged to step up their efforts to seek the global abolition of nuclear weapons.

Gathered at the U.S. Institute of Peace here Thursday, the participants, composed of influential representatives of the Buddhist, Christian, Jewish and Muslim faiths, among others, said their traditions teach that the threat posed by nuclear weapons was “unacceptable and must be eliminated”.“Nuclear deterrence theory does not work like it used to. In order to reduce the threat of nuclear weapons, the only way is to create an era in which there are no nuclear weapons.” -- Hirotsugu Terasaki

Soka Gakkai International, a global grassroots Buddhist organisation based in Japan, hosted the event.

“The continued existence of nuclear weapons forces humankind to live in the shadow of apocalyptic destruction,” according to a statement issued at the end of the one-day conference.

“The catastrophic consequences of any use of nuclear weapons cannot be fully communicated by numbers or statistics; it is a reality that frustrates the power of both rational analysis and ordinary imagination.”

Signatories of the statement include representatives from the Muslim American Citizens Coalition and Public Affairs Council, the Friends Committee on National Legislation and Pax Christi International.

The conference, the latest in a series on the humanitarian impact of nuclear weapons, came as delegates from around the world prepared to convene in New York for the NPT PrepCom, set to run Apr. 28 through May 9. That meeting will help lay the groundwork for the 2015 Review Conference, also slated for New York, on implementing the NPT’s goals of non-proliferation and eventual elimination of nuclear weapons.

“Nuclear deterrence theory does not work like it used to. In order to reduce the threat of nuclear weapons, the only way is to create an era in which there are no nuclear weapons,” Hirotsugu Terasaki, vice-president of Soka Gakkai and executive director of Peace Affairs of Soka Gakkai International, told IPS.

“The president of our organisation has said, ‘Nuclear weapons are not a necessary evil, they are an absolute evil.’”

Prodding the process

One goal of Thursday’s symposium was to flesh out the fatal consequences of nuclear weapons, including ramifications that go well the immediate fallout of a nuclear strike.

For instance, keynote speaker Dr. Andrew Kanter, former director of Physicians for Social Responsibility, told the participants of scientific findings that even a small detonation could cause a widespread deadly famine by accelerating climate change and disrupting global agriculture.

Others discussed the need to engage the Permanent Five members of the U.N. Security Council in the broader conversation. As a first step, Thursday’s statement will be presented next week to the chair of the NPT PrepCom.

“We need to think again about what we mean by security and how we experience security,” Marie Dennis, co-president of Pax Christi International, said. “As faith-based communities, we are in a position to ask those kinds of questions.”

Since 1970, when the NPT became effective, its regular review conferences have produced few successes other than the Comprehensive Nuclear Test Ban Treaty (CTBT), which bars all nuclear explosions – including those, such as took place in the Marshall Islands, for testing purposes.

Additionally, the five nuclear-armed signatories have met annually since 2009. Last week, they met in Beijing where they reaffirmed past commitments and solidified a reporting framework to share national progress on meeting treaties.

Also present at Thursday’s symposium was Anita Friedt, an official on nuclear policy at the U.S. State Department. She described some of the reasons that nuclear abolition has been such a frustratingly slow process.

More than 100 representatives of 11 faith groups from around the world have pledged to step up their efforts to seek the global abolition of nuclear weapons. Credit: Courtesy of SGI

“Why can’t we just stop and give up nuclear weapons? This is really hard work,” Friedt said.

“If we just say today we’re just going to give up nuclear weapons, there’s no incentive for other countries to do so, necessarily. Unfortunately, it is more complex than it may seem at the surface.”

There are also significant bureaucratic challenges to the ongoing NPT negotiations. The U.S. Congress, for instance, failed to ratify the CTBT in 1999 and only barely ratified President Barack Obama’s New START Treaty – a strategic arms-reduction agreement between the U.S. and Russia – in 2010.

“It’s a slower pace than I would like; it’s a slower pace than our president would like,” Friedt said.

Yet SGI’s Terasaki says global faith communities are well placed use their broad leverage to try to influence, and speed up, this process. Thursday’s event, he noted, was the first time such a discussion had come to the United States.

“We want to help re-energise the voice of faith communities,” he said, “and explore ways to raise public awareness of the inhumane nature of nuclear weapons.”

Obligation to disarm

The conference occurred on the same day that the Marshall Islands filed an unprecedented lawsuit before the International Court of Justice against the United States and eight other nuclear-armed countries for not upholding their commitments to the NPT and international law.

“Article VI [of the NPT] defines an obligation to negotiate in good faith for an end to nuclear arms and disarmament,” David Krieger, president of the Nuclear Age Peace Foundation and a consultant to the Marshall Islands lawsuit, filed Thursday, told IPS.

“This lawsuit indicates that each of the nuclear armed states are modernising their nuclear arsenal. You can’t modernise your arsenal and say you’re negotiating in good faith.”

Five countries are currently party to the NPT: China, France, Russia, the United Kingdom and the United States. However, the Marshall Islands is also suing India, Israel, North Korea and Pakistan, claiming that those countries are bound to the same nuclear disarmament provisions under international law.

The small island nation, in Micronesia in the Pacific Ocean, is not suing for monetary compensation. Rather, its government wants the International Court of Justice (ICJ) to declare the nine countries in breach of their treaty obligations and to issue an injunction ordering them to begin negotiating in good faith.

Krieger says the Marshall Islands have “suffered gravely” as a result of nuclear testing carried out by the United States between 1946 and 1958.

“They don’t want any other country or people to suffer the consequences that they have,” he said, noting that the residents of the Marshall Islands have suffered health effects in the generations since the testing stopped, including stillborn babies and abnormally high rates of cancer.

Out of the nine nuclear-armed countries, only the United Kingdom, India and Pakistan accept the ICJ’s jurisdiction. The other six countries, including the United States, are not to be invited to the court in order to state their reasons for not fulfilling their obligations under the NPT.

Still, just to be sure that the United States answers for its responsibility to the NPT, the Marshall Islands has also filed a lawsuit in a U.S. federal court in San Francisco.

Cigarettes are a popular buy from vendors selling imported goods here in Port Moresby in Papua New Guinea. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Aug 19 2013 (IPS)

Governments in the Western Pacific Islands, believed to be home to a third of the world’s smokers, have begun a long battle with the growing crisis of non-communicable diseases. Such diseases currently account for 75 percent of the region’s fatalities.

Kiribati and the Marshall Islands have the highest rates of diabetes in the world at 25.7 percent and 22.2 percent respectively. Fiji carries the greatest burden of non-communicable diseases (NCD)-related deaths in the region at 501 per 100,000 in the population.

Major factors include heavy tobacco and alcohol consumption, physical inactivity, and poor nutrition. These are exacerbated by rapid urbanisation, and spreading consumerism.
In 2011 Pacific Island leaders declared NCDs to be at the centre of a health and development exigency with long-term impacts including lower economic productivity, loss of household income and unsustainable health costs.

The limited capacity of health services to cope with escalating financial and service delivery demands is of growing concern. Most national health expenditure, up to 90 percent in Vanuatu and 87 percent in Samoa, is already met by governments, and there is limited potential to increase budgets further.

“I don’t think any country can cope with the burden of NCDs, not even high-income countries,” Dr Wendy Snowdon of the Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases at the Fiji School of Medicine told IPS.

“NCDs are expensive to treat, and while countries in the region are increasing their investment in treating NCDs, the only viable solution is effective promotion [of prevention] which could reduce the burden.”

Challenging entrenched lifestyle habits and controlling access to tobacco are imperative to reducing the prevalence of hypertension, diabetes and cancer, and addressing cardiovascular disease, which is the greatest killer of all.

The World Health Organisation (WHO) cites tobacco as the second highest risk factor in NCD-related deaths, 80 percent of which occur in low- and middle-income countries.

The prevalence of smoking in men ranges from 74 percent in Kiribati and 60 percent in Papua New Guinea to 55 percent in Tuvalu and 47 percent in the Cook Islands. Female smoking rates, while on the increase, are lower at 43 percent in Kiribati, 41 percent in the Cook Islands and 27 percent in Papua New Guinea.

Stephanie Erick of Tala Pasifika, a New Zealand heart service aimed at empowering Pacific peoples in tobacco control, told IPS: “Smoking practices over the years have embedded themselves in [Pacific] cultural practices, for example, with kava drinking. Socially it has become a part of gift giving [of duty free cigarette packs] from overseas travellers coming into Pacific Island countries.”

A report last year by the United States-based health foundation Legacy and the Pacific Partnership for Tobacco Free Islands (PPFTI) highlighted the very young age at which dependence starts. Twenty-five percent of high school students in the Northern Mariana Islands are smokers. In the Marshall Islands, almost 90 percent of smokers start in adolescence, and two-thirds are daily consumers by18 years.

The socio-economic repercussions for this generation as it ages will be serious in a region striving, with mixed progress, to achieve the Millennium Development Goals.

The connection between NCDs and disability, such as stroke paralysis, amputations and blindness, is already taking its toll. In Fiji, diabetes is the main cause of amputations and the second main factor in adult blindness.

A report by the University of Sydney, Australia, blames smoking for the burden of lung cancer in 39-47 percent of men in the Pacific Islands and predicts this will increase to 70-84 percent within the next two decades.

Pacific Island leaders, fully cognizant of the implications for the region’s future, developed crisis response strategies during an NCD Forum last year focussed on tobacco control and building capacity in primary health care services. Their goal is 25 percent reduction in NCD-related fatalities in people aged 30-70 years by 2025.

However, there are significant challenges to implementation, with many health service providers constrained by low funding and resources.

Prevention through ‘whole of society’ and ‘whole of government’ approaches is being advocated by health ministers as the most likely to reverse the present scenario.

A critical step has been ratification of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) by all Pacific Island member states and territories. The framework is supported by the MPOWER strategy which promotes tobacco price and tax increases, tobacco advertising bans, regulation of tobacco use in public spaces and cessation services.

Jeanie McKenzie, NCD adviser on tobacco and alcohol at the Secretariat of the Pacific Community (SPC) in Noumea, New Caledonia, told IPS that the FCTC was an important catalyst to the emergence of tobacco policies in the region.

“SPC has been undertaking tobacco enforcement workshops in Vanuatu, Solomon Islands, Cook Islands and Palau, and these reflect the fact that there is legislation in place in these countries,” she said. “Countries in the Pacific are also increasing the tax on tobacco, with many increases at or above 20 percent.”

This year the sale of single cigarettes and smoking in public places became illegal in the Solomon Islands. Fiji also introduced new requirements that graphic health warnings cover 60 percent of cigarette packages.

“Increasing the price of tobacco affects price-sensitive [social groups], usually youth and women, and acts as a disincentive,” McKenzie explained. “Laws that prevent the sale of small cigarette packs and the illegal breaking open of a pack and selling of single cigarettes also assist in dealing with the problem of young people being able to access cigarettes for a smaller financial outlay.”

WHO claims that every 10 percent increase in the retail price of tobacco induces a drop in consumption in low- and medium-income countries by up to 8 percent.

The coral atoll nation of Niue, located northeast of New Zealand, with a population of 1,611, has emerged as an early success story. Last month it announced that sustained tobacco control and health support measures had led to a massive drop in the smoking rate in men from approximately 58 percent in recent decades to 15.8 percent, and in women from 17 percent to 7.6 percent. This places the island state well ahead of its 2021 objective of less than 25 percent for men and 13 percent for women.