| April 29, 2003 | Tuesday | Safar 26, 1424 |
‘Dancing in the minefields’
Fazl warns of Durand
Unending tribal feuds
SOME people in the ruling establishment of the country and others among mediamen and political observers seem to be startled by Afghan President Hamid Karzai’s demand for arresting some of the Taliban commanders who, according to Afghan leaders, are fighting an undeclared war against Afghanistan.
IN a small, dingy and smelly room isolated from the rest of the wards at a major public hospital in Rawalpindi lies a poor woman in the fourth stage of cancer.
The room, if you can call it a room, says a third-year medical student, stinks so much that even they cannot bear to stay there for more than two minutes. Is this the best possible health care we can provide to someone in the final days of her life, asks the medical student?
It has been nearly two years since the federal government first enunciated in June 2001 its 10-year perspective Health For All plan. Government officials every now and then reiterate the resolve to achieve Health For All.
The latest reiteration came from the President himself, who was reported to have stated in Lahore last week that the provision of quality health care for all without discrimination was a top priority of the government.
But, apart from rhetoric, and the introduction of the controversial Board of Governors (BoGs) - which according to a recent report in Dawn has only turned the situation in public hospitals in Rawalpindi from bad to worse - very little else seems to have been done to translate the resolve to improve the quality of health services into concrete and viable policies.
The hospital lacks the very basic facilities without which hospitals cannot function. The emergency ward, for instance, does not even possess necessary equipment such as stitching needles, injections and tourniquet (a device for stopping the flow of blood), says a fourth-year medical student.
Patients brought into the emergency ward are asked to get the necessary equipment from the chemist themselves for their treatment - something unthinkable in any modern hospital.
Recently, a road accident victim was brought into the emergency ward by a passer-by (who did not know the victim) and he had to get the necessary materials and drugs from the chemist for the emergency treatment of the accident victim.
Last year, recalls the medical student, one of the wards in the hospital did not even have a sphygmomanometer (an apparatus for measuring blood pressure), whereas there is supposed to be at least one in each ward. This is a clear indication of administrative mismanagement, she says, because one such instrument only costs Rs800 to Rs2,000 depending on the quality. Rather than waiting for months for the hospital administration to get the BP apparatus, the medical students all decided to chip in and buy one for that ward.
The lift of the hospital is also perpetually out of order. Even though it is only a two-storey building, still there are patients on stretchers or wheelchairs, who need to use this facility.
And, in the obstetrics ward of the hospital, two sometimes even three women have to share one bed simply because the number of patients far outnumber the ward’s capacity.
Should the patients at this hospital consider themselves fortunate that they at least have access to this kind of health care rather than no health care at all? For, according to a 2003 United Nations report of the Asia-Pacific region, a staggering 45% of the population of Pakistan do not have access to health services at all.
According to the above UN report, Pakistan’s population access to health services is only 55% (1990-1995), after Bangladesh (45%) and Cambodia (53%). India is 85%; Mongolia 95%, with South Korea and Singapore, 100%.
According to the same UN report, Pakistan also has one of the lowest rate of births attended by skilled health staff - only 20% of the total births in Pakistan (1995-2000) are attended by skilled health staff, after Nepal (12%) and Bangladesh (13%) (figures for Afghanistan and Myanmar are not available). The figure for India is 42%; Hong Kong and Singapore are 100%.
Naturally, the infant mortality rate in Pakistan is one of the highest in the Asia-Pacific region - 85 per 1,000 live births (2000), whereas it is 8 per 1,000 live births in Malaysia and 4 per 1,000 live births in Singapore. Even Bangladesh’s infant mortality rate is 54 per 1,000 live births and India is 69 per 1,000 live births.
Even though these statistics are of those before the 2001 Health For All policy was announced, it is obvious from the ground situation today that Pakistan’s health sector is not being given the dose of top priority, which the government says it is being given.
The government would need to do much, much more than eradicating polio or increasing the number of lady health workers to really improve the country’s health facilities, says a senior government doctor in Islamabad.
The most important indication of any real effort to improve the quality of health services in the country, he says, would be an increased allocation of funds for this sector. Yet, there has been no indication that the government has increased or is planning to increase funding for the health sector, he remarks.
Indeed, Pakistan’s expenditure on health has consistently been 0.7% of GDP since 1999-2000. According to official figures, the expenditure on health in 1999-2000, 2000-2001 and 2001-2002 was 0.7% of GDP. The figures before 1999 were not any better: 0.8% in 1995-1996, 0.5% in 1996-1997, 0.7% in 1997-1998 and 0.9% in 1998-1999.
In contrast, most of the developed countries have been spending between 5% to 8% of their GDP on health (World Bank 1999 report). As for the developing countries in the Asia-Pacific region, most of them spend at least 1% of GDP on health (2000), with some spending more than 2%. The countries, which like Pakistan, spend less than 1% include the Philippines (0.4%) and Myanmar (0.3%) (2003 UN report).
Studies by international organizations have long established a strong linkage between the resources devoted to health and the achievement of this sector (in terms, e.g., of life expectancy at birth and infant mortality rate). Generally, countries with higher expenditure show better outputs and outcomes.
Although private expenditure has been making an increasing contribution to the health sector in Pakistan, public expenditure still remains the major contributor in the provision of health services. The above UN report recommends that developing countries need to put more public resources into this sector in order to expand access to and improve the quality of health care facilities.
A recent study by the World Health Organization proposes a financing strategy for developing countries under which an increase in domestic budgetary resources for health of 1% of GDP by 2007 and up to 2% of GDP by 2015 is envisaged.
In Pakistan’s case, the results of such a step, if at all undertaken, will also depend on the effective and efficient utilization of resources.
As in other public sectors in Pakistan, the lack of good governance is also pervasive in the health sector. Any increase in spending on health will, therefore, be nullified if the poor quality of service in this sector is not also improved by minimizing leakages and mismanagement of resources.
If one of the government’s top priority is indeed providing quality health care to all without discrimination, then it is time this priority is reflected in terms of percentage of GDP spent on the health sector. The government needs to show that its Health For All policy is more than just rhetoric.
But is it really such a “bombshell”? Was it not expected in view of the growing tension on the borders between the two countries as a consequence of the activities of the extremist elements in the area?
For keen political observers it is hardly surprising. In fact the special envoy of the US government for this region, Zalmay Khalilzad, reportedly raised this question with Pakistani authorities a week earlier. However, what is astonishing is the response of the government of Pakistan. The Foreign Office spokesman categorically denied the presence of Taliban initiating commando activities or their alleged activities on Pakistani soil. Quite contrary to this, General Musharraf, in his press briefing on Thursday, conceded the need for apprehending “foreign extremists” who might be using Pakistani soil to promote their “own agendas”.
The intensive coverage of events in Iraq over the last few months was too overwhelming for the armed clashes on the Pakistan-Afghanistan border to get media attention. While the international media was totally focused on the unfolding conflict in the Middle East, the Urdu media in Pakistan did report news about the growing Taliban attacks on the border as part of a “new round of jihad” in Afghanistan. This impression was reinforced by a new generation of ‘jihadi’ pamphlets appearing in Peshawar and Quetta.
People in Pakistan were made to believe that the Pukhtun population in eastern and southern Afghanistan was up in arms against the new government in Kabul. So much so that the attack on border town of Spin Boldak near Chaman in Balochistan made the headlines in a number of Urdu language papers with little realization of the fact that such an attack, like attacks on Khost and Gardez in Paktia, could take place only from within Pakistan. The war communiques of Taliban spokespersons make regular appearance in the Pakistan press. It is pretty clear that these statements emanate from within Pakistan as Taliban commanders cannot afford to make use of satellite phones from Afghanistan, which involves the grave risk of being detected by US forces. That is not all. Some of the Taliban leaders gave interviews to journalists inside Pakistan laying out their future plans. In the meanwhile, the Foreign Office spokesman in Islamabad never tires of making pious noises about his ministry’s deep desire for Pakistan-Afghanistan friendship.
Be that as it may, the substantial question that remains to be answered is what has changed in Pakistan’s Afghan policy in the aftermath of Sept 11. It is true that the then Taliban regime along with its Arab overlords was ditched after a phone call from Washington. But the Pakistani godfathers of the Taliban make a distinction between the government of Taliban and their movement. They strongly believe that this movement cannot decline and it is destined to not only re-emerge but has the potential of dominating the whole region. The hawks in the security establishment of the country see a military dimension to this extremist doctrine. For them it comes very handy to “secure” the country’s western borders.
This is an explosive combination, but strong enough to hijack Pakistan’s Afghan policy for the last so many years.
In spite of the monumental changes in the international and regional political situation and the total collapse of the GHQ’s disastrous Afghan policy, there seems no critical evaluation to this day, at least not to the public’s knowledge. The foolish quest for achieving “strategic depth” in Afghanistan has yet to be formally criticized and rejected by the quarters concerned. How can the government of Gen Pervez Musharraf formulate a new policy without having a critical analysis of the old one? But the most important problem would be the capability of the Musharraf government to implement a new Afghan policy even if it musters enough political will to formulate one. This is said because the Foreign Office remains as clueless about an Afghan policy as before.
The elements manipulating state institutions and resources to enforce a subjective and extremist policy had demonstrated complete defiance of the civilian government of Benazir Bhutto and Nawaz Sharif. If the experience of the last three years is anything to go by, Gen Musharraf has not done much better. For example, just after taking power in October 1999, he tried to persuade the Taliban leadership to change their policy on Osama bin Laden and some other issues. He invited the late Mulla Rabbani, Mulla Omar’s number two, to create a “moderate lobby” among the Taliban. After Rabbani’s visit, Gen Musharraf publicly expressed his desire to visit Kabul to take the process ahead. But this could not materialize, as the Taliban leadership did not get a wink from the relevant quarters in Pakistan.
Another factor that further complicates the situation is the Taliban’s relationship with Pakistani militant groups. Gen Musharraf’s government in the past went in for arresting Arab militants alleged to be Al Qaeda operatives, but it has stayed away from local militancy. Rounding up of Taliban commandos would require a political will strong enough to confront internal militants in case the latter oppose a crackdown on Taliban activists.
Gen Musharraf’s dilemma intensifies with every new day. He cannot indefinitely sail in two boats. He, along with his fellow generals, has to make some tough choices. Pakistan simply cannot afford to live with an image of a militancy-exporting factory in the present international situation. On the eastern borders, the Indian government is conditioning its dialogue offer with stopping what they call cross-border terrorism. On the western border, Afghanistan has a list of people who are fighting in Afghanistan and are based in Pakistan.
Nobody in the world will buy the denials by our foreign ministry. Guerrilla warfare cannot be sustained without a supply line and a sanctuary. These facts are too obvious to be denied. It is high time we worked out the contours of a new foreign policy after public debate if we are to avoid an impending catastrophe.
ISLAMABAD: The following is the edited version of the Dawn Dialogue with Maulana Fazlur Rehman, secretary-general of the Muttahida Majlis-i-Amal (MMA) and chief of the Jamiat Ulema-i- Islam:
Question: Is there any chance of the present situation between the government and the opposition about the Legal Framework Order coming to an end?
Answer: Our hapless people only read newspapers or watch TV and see only two powers — the government and the opposition — and form their opinion after seeing the attitude of these two powers. But the real cause of the deadlock is not visible to them, which is the military leadership without whose approval the government cannot take any decision. Whatever the generals decide, the message is conveyed to the government. I told the (National Assembly) speaker (in a meeting) to tell the general (Pervez Musharraf) to come out and talk to us directly. We accept that General Musharraf has been the ruler for three years and is still continuing in that position.
If he wants to retain his position, he should talk to us directly. Why is he ashamed of this? If the power of decision is with him, then he should talk to us, rather than the ruling party.
Q: The ruling party says the MMA had reached an agreement with it on many points of the LFO. What do you have to say about this?
A: We had adopted the most reasonable attitude and said we don’t reject the whole of the LFO. But we will not compromise on the principle — and are not ready to accept two opinions on it — that any amendment will become part of the constitution only if it is approved by a two-thirds majority of parliament. To say that the elections were held under the LFO so there can be no objection to it now is not a knowledgeable argument. Under a de- facto government, when there is no parliament, there can be no forum for such approval (for decrees) which are implemented. But as soon as a parliament comes into being, everything comes before it for approval.
For instance, when the assembly is not in session, the sun cannot remain static — and the president at the centre and governors in the provinces issue ordinances which have to be placed before the assemblies later. Can anybody say that you have been acting upon an ordinance for, say, 10 days and you need not bring it to the assembly now to make it a permanent law?
Don’t set such traditions for which the nation will suffer tomorrow. God forbid, if another dictator imposes himself on the nation tomorrow and you set this precedent that anything can become part of the constitution without parliament’s approval, he will change the whole constitution and say that parliament was not asked for approval even in the past.
We recognize many parts of the LFO as unavoidable and in accordance with the needs of the hour. There is no objection to provisions such as the holding of elections, increase in the number of parliamentary seats and constituencies, and the lowering of the voters’ minimum age to 18 years. We have told them we will vote for such points and seek an understanding on about six controversial points, some of which are more important and some less important. These are national matters on which we should convince each other by argument.
We told them that the referendum (on General Musharraf’s presidency) was not acceptable to us even when it was announced and we also did not accept its result because an individual cannot call his person a national issue and hold a referendum on it. We also told them that we object to General Pervez Musharraf being president as a result of the referendum as well as being army chief at the same time. While the president is “haakim” (ruler) and the army chief is a servant, both positions cannot be combined in one person.
But in view of the prevailing objective situation, we said since after remaining in power for three years, General Musharraf wants to remain a partner in the new system, we will accept him as Mister Pervez Musharraf. When he gets our votes in the provinces and at the centre along with those of the PML-Q, he can easily become a constitutional civilian president.
On 58(2)(b), we said we don’t accept it. This is a sword hanging over both the prime minister and parliament. They said it is necessary for the president to have this authority for the sake of checks and balances. We had a difference of opinion and they said the application of this power could be limited to the prime minister and cabinet and not to parliament. On this we agreed with them, but we don’t know whether they have changed their mind on that.
On the third point, we have totally rejected the establishment of a National Security Council, which was also totally rejected by the non-party assembly of the Ziaul Haq era. Two suggestions came from them — one for a possible change in its structure by reducing the number of its uniformed members (armed forces chiefs) to only one uniform and second for negotiability of its powers. But we said no, because we do not accept such an institution and the presence of even one uniform will be like the presence of all uniforms.
The fourth point was about the president’s discretionary powers which, in a parliamentary form of government, should be with the prime minister, such as appointment of armed forces chiefs, governors, public service commission chairman, chief election commissioner, and chairmen of NAB and CBR. These are all executive powers which the president has taken in his own hands, saying he is doing it for the sake of the country as if everything he says is for the sake of the country and as if we don’t think of the country. It is regrettable that they (generals) don’t trust politicians and consider themselves as the only ones fit to decide.
Two more things we wanted to discuss with the government. One was that the new municipal system is totally a provincial subject under the Constitution but is being controlled by the centre, rather by the presidency. This should be handed over to the provinces. We accept this system if it is given under provincial control.
The last thing on which we sought an understanding was the number of special seats in parliament or assemblies which is so large that our parliamentary institutions do not appear really elected. We don’t reject this increase totally, but want it to be reviewed.
Besides this, we also wanted to talk about foreign and economic policies. In foreign policy, we acknowledge Pakistan’s 55-year-old relationship with America and the western world, and we have not come to make a revolution. We have come with the people’s mandate within the bounds of the Constitutions. We don’t want to cut this relationship with an axe.
We want to continue Pakistan’s relationship with those countries. But we object to American presence at our airfields and FBI agents roaming our streets and raiding people’s homes. We expect the government as well as America to honour the people’s mandate given to the MMA, and want foreign personnel to be given a timetable to leave and told that our people don’t accept them on our soil.
We acknowledge that Pakistan is not so strong as to free itself from foreign influence or do things without listening to others, but we should appear to be an independent nation.
On the economy, if the government has really a good economic policy we will accept it. But as a matter of principle our economic policy should be changed so that it is based on our own resources rather than on foreign debts. We don’t say the whole policy should be changed overnight, but we want experts to plan on how long it will take to achieve this target — three years, five years, six years. Until we are economically strong, we cannot link the world’s interests with us. Our foreign policy is weak compared to India’s because India has been more successful in linking up with the world’s interest than we have been. Despite our right and just stand, we can’t get votes internationally because every country’s foreign policy is based on its national interests. We can win the Kashmir struggle only when we have more support in world forums.
Q: But don’t you appear to be making too many compromises with the military?
A: Yes, we are making too many compromises and are not rigid, although no party had been engaged in a public confrontation with the regime over Afghanistan as we have been.
Q: People say the MMA is making compromises because its stake is very high with a government in one province and a share in another province, and you don’t want this system to be upset.
A: Now, when we are making compromises, then why it is said (by the government) that our stand is rigid and we are accused of not allowing the assemblies to work? I say our attitude is conciliatory.
We want the new system that has emerged after three years’ deadlock to work — the central and provincial governments, the assemblies — our relations with the international community should improve, and we should formulate balanced policies.
On Islamization, some people said we are with the Taliban and the extremists. The 1973 Constitution says Pakistan’s laws will be made in accordance with, and not contrary to, the Quran and Sunnah, and we want legislation in accordance with the recommendations of the Council of Islamic Ideology. What unconstitutional thing have we done?
Q: What do you have to say about General Musharraf’s contention that he cannot set a time-frame to give up his army uniform in view of the present regional situation?
A: This was also said by Ziaul Haq after promising that he would resign as army chief when he took oath as president (after his referendum).
Q: But you accepted a uniformed president addressing the MMA cabinet in the Frontier.
A: When our assemblies were not there, he used to go there and when our assemblies had not taken oath, we would talk to him. His position still is of de-facto (president).
Q: Couldn’t you give a protest note that you accept him only as de-facto president?
A: That has been given ... and we told him that since you are our guest, the provincial government will give you honour only at the government level.
Q: Did you say it?
A: Yes, it was said and was formally conveyed to the (provincial) governor by the chief minister.
Q: Will the MMA remain a permanent religious alliance or its parties can align with others as in the past?
A: We jointly wish to continue this alliance. There are no signs of any cracks developing in the future.
Q: Will you prefer future political alliances to be based on religion or on political and economic programmes?
A: Religious alliances have a universality of objectives, encompassing foreign and economic policies, law and order problems, administrative matters, and they run them on religious lines and project the country as a religious state. The other parties give importance to only some aspects, but they don’t have religious programmes and Islamic legislation as their priorities. We give the same priority to foreign policy as to Islamic legislation, and the same is true of economic policies and administrative affairs.
Q: What are your comments on reports of corruption in the senate elections in the Frontier despite the presence of your government there?
A: It was our big success that none of our (assembly) members could be bought over. But the corruption that happened is really an ugly scar for us. The entire role in this was played by the federal government and I regret it. Our privilege motion (in the National Assembly) (about the alleged kidnapping of National Assembly members from) FATA is still alive ... and we demand that this case should be sent to a privileges committee so that it is known who is the culprit and why this was done.
Q: Why should FATA be kept separate, why not to merge it with the Frontier province?
A: These areas have been separate since before the creation of Pakistan with a special status and this has continued because they are tribal areas.
One aspect is linked to the Durand Line because under the agreement ... whatever change is to be brought about, Afghanistan must be consulted. We have left it to the tribal people to decide what they want in respect of their territory.
Q: Why are gas pipelines damaged in Balochistan when you have a coalition government there?
A: Everybody asks what the provincial government is doing. It is very easy to put the blame on others. But it is the federal government which made all agreements with the Bugti tribe and gave it concessions. They give this authority to the provinces because they say minerals are under federal control. Wherever minerals are extracted, it is the federal government that has entered into agreements with the tribes or their sardars. But when these agreements are not implemented and a law and order situation arises, the province is blamed.
Q: How do you solve this issue?
A: We should be serious to resolve the issue. I don’t justify this confrontation. The bombing and murder of people as in Kashmore are crimes, terrorism. It is not justified, whether done by the Bugtis or the Mazaris or the Marris. But who is responsible, who should come forward to resolve this? If this issue is handed over to us for mediation, we will talk amongst ourselves. But if the federal government thinks it has sole jurisdiction, then what can we do?
Q: How far can you go on the issue of the LFO since a situation may arise when General Musharraf says, enough is enough and winds up the assemblies?
A: General Musharraf cannot wind up the assemblies. He has become most unpopular among the people. An ideological mandate (of MMA) has come, not a traditional mandate, and people will come out on the streets if a government elected by them is wound up. We have street power. It is not possible for an unpopular person to wind up the assemblies and then control the situation.
Q: How do you see Pakistan’s relations with Afghanistan?
A: The real power in the present Afghan government is with the Northern Alliance, which is pro-India and not pro-Pakistan. Musharraf Sahib is seeing gain in Afghanistan only in the context of (President Hamid) Karzai. Karzai is an ineffective person and his popularity in Afghanistan is similar to that of General Musharraf here.
Our information is that India has not only strengthened its political ties with Afghanistan but has also extended its defence and military influence up to Pakistan’s western border. In this situation, Pakistan is in a very delicate position. Reports are coming in that while the period of the Durand Line agreement has expired and it is no longer an international line, the Afghan authorities want to settle the matter with India rather than with Pakistan because the old agreement was with (British) India when Pakistan was not there. So long as the Durand Line period had not expired, Pakistan’s regular army did not go to the western border. But now, instead of the Frontier Corps, our regular army has been deployed there.
When Afghanistan comes out of its present restlessness and stability returns there, any government there will raise this issue. The only power that could keep quiet on this issue was the Taliban, which was committed to Pakistan, and was expected to keep silent on these issues and not to create difficulties for Pakistan. But apart from the Taliban, there appears to be no government which will give any concession to Pakistan.
Q: If you were in the federal government, how would you have tackle this issue with Afghanistan and Kashmir with India?
A: On national issues, I think the view of a single party will be insufficient. While different mandates have come (in the last elections) I only say the mandate received by the MMA should be made part of Pakistan’s foreign policy .... In international affairs, continuity of Pakistan’s past relations will have to be kept in view as well as Pakistan’s principled stand (on Kashmir) and the objective conditions. All parties should be taken into confidence for national policies.
The Dawn panel comprised
M. Ziauddin, Raja Asghar, Ahmad Hasan and Aileen Qaiser
IBRAT this week comments on ongoing tribal feuds and writes that the entire upper Sindh has become a hostage to this suicidal phenomenon. Not a single day passes without the news of a tribal clash claiming lives of young people.
Last week, apart from other minor incidents, four people were killed in the Mahar-Jatoi clash in Lakhi Ghulam Shah, three in a clash between two factions of the Atrani clan in another area of Shikarpur district, and another three in the Jagirani-Narejo feud near Pir-jo-Goth in Khairpur district.
The paper says that the situation has become so volatile that petty issues like water sharing and cattle grazing lead to feuds between different tribes, which linger on for years and claim several lives.
As far as the Sindh government is concerned, the daily says, it seems to have failed in containing this bloody trend. Its helplessness is obvious from its yielding to the conditions of the warring tribes. Besides, politically conscious circles of the province have also adopted an insensitive attitude in this regard. This apathy has provided complete freedom to the tribes to turn upper Sindh into a battlefield.
Ibrat calls on the government to take measures to settle tribal disputes and advises political, social and literary circles to create a consciousness among the masses against this fratricidal trend.
The daily Sach refers to retrenchment in the sugar mills of Sindh and points out that 62 permanent employees, recently sacked by the Fauji Sugar Mills, have been observing a token hunger strike at the mill gate. Sacking of employees is not confined to the sugar mills as managements of other industrial units have also adopted anti-worker policies. Nowhere there is any job security for labourers. The government should provide justice to workers by instructing the industrialists to bring an end to their anti-worker policies, the paper says.
Sindu points out that with the advent of summer, different epidemics are spreading in the rural areas. According to press reports, hepatitis has assumed epidemic proportions in the Dokri area while Madeji and its surrounding areas are gripped by chicken pox. But the provincial health department has not taken any step to contain the diseases. It should take immediate measures to provide relief to poor patients, particularly in the remoter areas.
According to Kawish, women councillors have been complaining that their voice is not being heard in district, taluka and union councils. They say that development schemes proposed by them are not being approved and their recommendations for distribution of Zakat funds are being ignored.
The government had allocated 33 per cent seats in local bodies to women in order to ensure their participation in decision-making. In the absence of powers for women councillors, this objective is not being achieved. The National Reconstruction Bureau as well as the ministry concerned should intervene to eliminate discrimination against women councillors, the paper says.