A matter of right response

“I SINCERELY and genuinely believe that the challenge of this earthquake can be converted into an opportunity of a lifetime which was never available to India and Pakistan to improve relations.... I appeal to the media in India and also Pakistan, the government of Indian-held Kashmir, APHC (Hurriyat Conference) and other Kashmiri groups ... let us together solve the Kashmir dispute once for all ... Therefore, let good, let success and let happiness emerge from the ruins of this catastrophe, for the devastated people of Kashmir, let this be the Indian donation to Kashmir.” (President Musharraf speaking at the donors’ conference in Islamabad on November 19).

India was ready to resolve all issues including Kashmir through dialogue “in an atmosphere free of terrorism and violence.” It was very encouraging to see that people in both countries came forward to help the victims of the tragedy and contribute wholeheartedly for their relief. “This spontaneous outpouring of sympathy and goodwill for the victims of the earthquake gives us the strength and motivation to work for greater people-to-people contact and confidence-building measures between our two countries.” (Indian Minister of State for Foreign Affairs E. Ahmad speaking at the same conference after President Musharraf).

While President Musharraf’s plea was greeted with thunderous applause there was an almost audible collective sigh of disappointed resignation elicited by what in that setting could only be seen as the casting of a dash of cold water on the proposal by the Indians. Minister Ahmad’s remarks should have been expected. Pakistan’s failure to rein in the militants and to “dismantle the network of terrorism” that is alleged to exist in Pakistan thus failing to create an atmosphere free of violence and terror — an Indian sine qua non for a dialogue on Kashmir — is the leitmotif of India’s plaint to the world and India’s principal explanation for the slow progress in the India-Pakistan dialogue.

To re-emphasize the point, the minister, on his return to New Delhi in a written reply to a Lok Sabha question maintained, without giving any specific figures, that the level of infiltration across the LoC was the same this year as it was last year. The leader of the Congress, Sonia Gandhi, publicized her remarks to Prime Minister Manmohan Singh that “While we move forward on the path of dialogue, let us categorically insist that terrorist attacks initiated across our western border must cease.”

The Indian concern about terrorism is understandable. The horrific bombing of two markets in New Delhi when the markets were jammed with Diwali and Eid shoppers took a heavy toll on civilian lives and was a reminder of the threat that India and other countries in South Asia have to live with. What was less understandable was the knee jerk reaction in the Indian media — no doubt prompted by official off-the-record briefings — that Pakistan was somehow responsible.

In the same context, it was, by Indian reckoning, an act of statesmanship that Prime Minister Manmohan Singh participated in the Saarc summit and that in his conversation with his Pakistani counterpart he did no more than suggest the suspicion that a Pakistan-based group was involved. Publicly, too, the Indian prime minister maintained that it would be premature to say anything definitive until the investigation had been completed. By so doing the Indians maintain that the threat of collapse of the peace process was averted.

One assumes that Pakistan’s point of view is very different. The Indian stance, reinforced by the New Delhi bombings, has meant that dialogue remains stymied on all matters that are of interest to Pakistan. Such progress as has been made seems to relate to issues which in the public mind are part of the Indian agenda. To illustrate, all preparations have been completed for the opening of the consulates in Mumbai and Karachi, the rail link between Khokrapar and Munabao has also been almost restored. Visas are being granted much more liberally than in the past and people-to-people exchanges have grown exponentially in the last year.

The freer trade regime envisaged under the Sapta agreement has not been finalized but that is only because of objections from the smaller Saarc members and not from Pakistan. If not by January next year it can be anticipated that freer trade will become a reality by the middle of next year.

I am not suggesting that these steps are of benefit to India alone. They are not. The more liberal visa regime and the opening of the Khokrapar rail link are long standing demands of the “new Sindhis” who can now more easily meet their kinfolk in India.

The fact, however, is that in the public perception the Indians have been pressing for greater people-to-people exchanges and greater trade while putting off discussions on other substantive issues including Kashmir. Previously, it was the Indian stance that, as relations improved through such things as greater trade and greater interaction, the atmosphere would be created for resolving the Kashmir issue. But now it seems that while other things can go ahead no discussions can be held on Kashmir, nor can anything be done to ameliorate the plight of the Kashmiris until the Indians are satisfied that the “terrorism network” in Pakistan has been dismantled.

At a recent conference — a part of track II diplomacy — I reminded my Indian colleagues that from 1993 to 1997, Pakistan and India were not able to talk, despite Indian efforts, because Pakistan insisted that as a prelude to such talks India should take some steps like the release of political prisoners, the revocation of draconian laws, etc, to improve the situation in Indian-held Kashmir. At that time, there was no Indian insistence that cross-border infiltration must stop before talks could be held.

I argued that now that Pakistan was ready to talk to India, the latter, if it was seeking good neighbourly relations, should not take advantage of the global preoccupation with terrorism to press for concessions that it had not demanded in the past and which ignored the many concessions that Pakistan had already made. The Indian attitude reminded me, I said, of a soft drink advertisement jingle shown on Indian TV channels which ended with the line “Dil Maange More”.

Whatever concessions Pakistan made became a stepping stone for further Indian demands. The Pakistan government found itself being accused of allowing the Indians to constantly shift the goal posts and of having secured nothing for Pakistan or for the Kashmiris. I argued that India as the bigger and more powerful country needed to take initiatives, even if they appeared risky because it had the capacity to reverse course if Pakistan did not respond. At that time I had in mind the resolution of the Siachen glacier issue, but, of course, the argument has applicability across the entire spectrum of India-Pakistan issues including Kashmir.

Do the facts on the ground support the Indian assertion that the level of infiltration from across the LoC remains unchanged or the allegations by the Indian press that Pakistan was somehow responsible for the Delhi bombings or that the terrorism network in Pakistan remains intact?

It had been the Indian stance in the days when the LoC witnessed almost daily artillery duels that all infiltration occurred under the cover of the artillery barrage laid down by the Pakistan army. They also argued that the physical presence of the Indian army on the LoC had to be reinforced by the creation of a physical obstacle and by the installation of surveillance equipment to effectively check the flow of militants across the border. In the last year there has been a ceasefire on the LoC and, therefore, no artillery barrages.

The Indians have had no interference from the Pakistanis in erecting a security fence — apparently three layered — along the entire length of the LoC, and Indian experts have lauded the efficacy of the sensors and other surveillance devices that they have installed on this fence. It should tax the credulity of Indian public opinion as much as it does of Pakistani and international public opinion that despite all this the level of infiltration remains unchanged.

The fact is that in August 2000, when the much heralded ceasefire was agreed by the Indians with the Hizb, Indian newspapers had reported that 80 per cent of the approximately 2,000 militants/freedom fighters in Kashmir were Kashmiris (“our boys”, as Mr Advani put it) and that foreign elements comprised no more than 20 per cent. One can assume that even with the complete sealing of the LoC, these Kashmiri fighters, who have been given little reason to believe that India-Pakistan talks on Kashmir, are making headway and who remain dissatisfied with conditions in Indian-held Kashmir, would continue their activities with or without support from across the LoC.

In the immediate aftermath of the deadly earthquake there were reports that the Hizb had offered the Indians a ceasefire. It was conjectured in the Indian press and elsewhere that the offer had been prompted by the fact that the earthquake had destroyed the “camps” that the Hizb and other organizations had maintained in Azad Kashmir. It appears that no particular attention was paid by the Indians to this offer and one wonders why.

The Indian establishment has long known and acted on the premise that there are strong proponents in the Pakistan establishment of the thesis that Pakistan must not foreclose its options until negotiations have progressed to a point where substantive results can be expected. The wisdom or otherwise of this retention of options, particularly in the context of its impact on the domestic campaign against extremism, is questioned by many Pakistanis.

However, for the moment it is a part of policy largely because President Musharraf faces the dilemma of seeking to continue with the peace process even while acknowledging that the many concessions Pakistan has made in moving away from its previous stance on how the Kashmir issue was to be resolved have brought little in exchange from India.

How these concessions are viewed by the Kashmiris became evident at a recent seminar in Islamabad where Kashmiris of all stripes expressed their opposition to what was termed as the so called India-Pakistan peace process, criticized the Pakistani proposals for demilitarization and self-governance as being in conflict with Pakistan’s constitution and emphasized that no solution was possible unless the Kashmiris were at centre stage in devising a solution. It is unrealistic, in these circumstances for India to suggest that all the possible concessions that India demands must be made by Pakistan before any substantive talks can be held.

I agree with the view that the territorial aspects of the Kashmir problem cannot be resolved overnight and that much will need to happen before headway can be made on substantive aspects of this issue and much will depend on how the Kashmiris feel. I do not, however, understand why steps cannot be taken to ameliorate the lot of the Kashmiris. If the Indian government acknowledges, as it sometimes does, that the alienation of the Kashmiri people from India is complete then it is in its own interest to move further along the road of improving the human rights situation and replacing army units particularly in the urban areas with civilian forces which would have far fewer draconian powers.

It will do India no harm if Pakistan projects these changes as part of Indian concessions to Pakistan’s demands. At the very least in Prime Minister Manmohan Singh’s next meeting with the APHC leaders announcements can be made of a further release of political prisoners and equally importantly a reduction of the army deployment in Indian-held Kashmir.

The peace process is irreversible say both parties. Perhaps so. What has been agreed has endured for longer than earlier forays in peace-making but it is still a fragile process. It must be nurtured if it is not to collapse in the face of the opposition from the hardliners on both sides.

The writer is a former foreign secretary

Far too many ‘hang-ups’

IT is a source of constant surprise to me why no sycophant has yet suggested to General Pervez Musharraf that his portrait should adorn all government offices in the country. I think one can safely bet that if someone does so the general will turn down the suggestion. That is sure to be described as another feather in his cap.

Ordinarily a one-portrait people, we have also been a two-portrait country for long periods. During the times of martial law, a picture of the military leaders was also hung in government offices and institutions along with that of the Quaid-i-Azam. Nobody gave a thought to what the feelings of Mr Jinnah, the democrat par excellence, might have been on being bracketed with a martial law administrator. It was like seating two persons on one throne; the usurper along with the rightful ruler.

Only General Yahya Khan missed the honour. Maybe, no courtier got the chance to place the tempting idea before him. I sometimes wonder what happened to all those thousands upon thousands of pictures of his predecessor, the field marshal, which had adorned all big and small offices all over East and West Pakistan. Were they appropriated by admirers or misappropriated by underpaid clerks and their frames sold for a pittance?

The same question could be asked about the innumerable portraits of Z.A. Bhutto and General Ziaul Haq that are nowhere to be seen now. Those of Mr Bhutto must, of course, have been removed on the orders of the military government that removed him. I suppose it’s useless to try to find out now whether the orders also contained directions about their disposal.

Putting up pictures of new leaders in government offices is one aspect of the national psyche. The other is the renaming of existing towns, avenues and buildings after national heroes for whom we can’t seem to take the trouble of erecting new institutions. We remove the mantle of honour put on roads and gardens in the form of names of bygone British administrators and give the mantle a Pakistani name. For example, the Lawrence Garden in Lahore is re-christened Bagh-e-Jinnah.

The trouble is that we are carried away by the momentary ascendancy of personalities. Or we are so overawed by foreign names that we are not able to discover heroes in our own history? The only tribute we can think of paying to these local and foreign personages is to name existing structures after them.

Do you know that for long years the only new structure built in the name of the Quaid was the town hall of Sargodha? But look at what happened after 30 years. An army general who became governor of Punjab under martial law, had a brilliant idea. (It was described as brilliant by the battery of fawning bureaucrats around him.) To honour the Quaid (as he said it) he decreed that every town hall in the province should henceforth be called Jinnah Hall. So, from the architectural monstrosity that is Lahore’s town hall to the puny ramshackle town halls of places like Mandi Burewala and Pindi Bhattian, all were turned into Jinnah Halls. What a magnificent tribute to the founding father!

There are cases where new buildings in Punjab and Sindh were named after one chief minister, but on his unceremonious exit from office, had to be renamed after his successor. Somewhere in the PWD store in Lahore lies a marble plaque supposed to be the foundation stone of Lahore’s stadium which was to be named after Governor Abdul Rab Nishtar.

Since the stadium was not built for 20 years, people forgot both the stone and Sardar Nishtar when the structure did finally come up. So it was simply called Lahore stadium till the Islamic summit was held in Lahore. Then, in a sentimental-cum-diplomatic gesture, Prime Minister Bhutto gave it Colonel Qadhafi’s name after the latter had addressed a public meeting there. Nishtar Sahib figures nowhere in the stadium’s history.

Poor Murree Road in Rawalpindi! It was with great fanfare that its dastarbandi was held to mark the 2,000th (or was it 10,000th?) anniversary of the Iranian monarchy and it was given the awkward title of Shahinshah Aryamehr Raza Shah Pehlavi Road. But then, after that clay-footed idol fell at the hands of the servants of Islam, it reverted rather shamefacedly to its prosaic name of Murree Road.

As if it was not enough to rename Lyallpur after King Faisal (whom I deeply admire otherwise for qualities not generally found in Arab royalty) a devotee of this Saudi royal family from Sargodha wanted that city’s name to be changed after the present monarch. I wonder what he hoped to get out of the proposal. The question may be asked: do only kings and princes qualify as heroes among the Muslims of Pakistan?

By the way, look at the long names they give in that second-hand fashion. With due respect to the late Aga Khan, do you see any sense in Lahore’s Davis Road being called Sir Shah Muhammad Aga Khan the Third Road? Or the Empress Road being re-christened as Al-Sheikh Abdul Hameed Bin Badees Road after an Algerian hero?

Thank God Lahore’s oldest and prestigious medical college and the city’s most popular hospital continue to be called after King Edward (the Seventh) and Sir Ganga Ram. To the latter philanthropist who died long before partition, Lahore also owes the original building of the Fatima Jinnah Medical College for Women. Sanity has prevailed somewhere at least.

I hope we are never again required to hang the portrait of a “leader” in government offices side by side with that of the Quaid, but “two inches lower,” as a directive once said about the picture of General Zia. I also hope there are no old roads and avenues left to be foisted on the father of the nation.

Roots of the organ racket

A MAJOR international meeting opened yesterday in Karachi. This was the triennial Conference of the Asian Society of Transplantation (CAST) that has brought together 200 experts from Asian countries and a few more from Europe and America.

They will be discussing issues related to organ transplantation. Although CAST gives the impression of being a very technical forum of medical professionals, the major issue to be debated is of a non-technical nature and directly concerns lay people. In Pakistan, it has acquired a grave dimension.

The issue is the ethics of organ transplantation, especially its commercialization that has now, unfortunately, become rampant in this country. True, many others have had to grapple with this problem as well. The example of India having become a kidney bazaar a few years ago may be recalled. But where others have managed to control the malpractice by adopting the required measures and showing the political will to act, we don’t appear to be too overly concerned.

As any society develops and acquires state of the art technology to transplant organs to save people’s lives, initially laws to regulate the new phenomenon do not exist. Therefore, the unscrupulous elements lurking on the sidelines are quick to step into the vacuum to exploit the predicament of the seriously ill, who are desperate for an organ for survival, and impoverished people burdened with debts and in need of money.

Normally, at this stage the state and society intervene to check the operation of the economic law of supply and demand. A look at the scenario all over the world tells the full story. It is estimated that in the developed countries there is a need for 73,000 kidneys, 22,000 livers, 20,000 hearts and 7,000 lungs to save critically ill people. But only 36 per cent of this need is fulfilled. The situation is worse in the Third World where the population is more and the incidence of organ failure is higher — the need being for 350,000 kidneys, 140,000 livers, 85,000 hearts and 33,000 lungs. Only 1.6 per cent of this need is met.

In Pakistan, where only renal transplantations take place in normal course, the crisis is more acute. Nearly 150,000 people develop end-stage renal failure every year. They need dialysis if they are to survive at all and transplantation if the quality of their life is to be improved.

With only 120 dialysis centres all over the country, and most of them charging a hefty amount for each session, dialysis is not always the treatment of choice. A person needs as many as two or three sessions a week each lasting three hours or so and the end result is not a life that can be described as ideal. With a strict regimen of water intake and dialyzing schedules to be observed, many patients find life on dialysis rather restrictive.

Hence, more and more patients are turning to transplantation as the treatment for end-stage renal failure. The initial reserve has been broken now that there are successful cases of transplantation surgery with patients leading a full life. With 20 transplant centres in the country — of which 19 are in the private sector, each charging about Rs 500,000 for one transplant surgery — the technique is now quite commonly known. The Sindh Institute of Urology and Transplantation is the only centre in the public sector and it offers all treatment free of cost. Even kidney transplantation costs nothing at SIUT which performs nearly 120 transplant surgeries a year using live, related donors to obtain organs.

Private centres are undertaking 1,500 cases per annum and most of them use organs purchased from unrelated donors. There are villages in Punjab where the entire adult population is known to have donated — rather sold — a kidney for a paltry sum of Rs 100,000. Commercialism is the name of the game in transplantation transactions, and as happens in such cases, money becomes the deciding factor. Whether a patient will get an organ and whether he has the right to life will be determined by his economic status. Small wonder then that 60 per cent of the beneficiaries are foreigners who have the means to pay the exorbitant price.

As for the donor, the one lakh he receives via the middleman vanishes in no time leaving him in debt as before and minus a kidney. Given the conditions he lives in and in the absence of post operative follow-ups the donor may find there are new health problems he has to contend with.

In the absence of a law, the beneficiaries are also suffering, the massive expenses notwithstanding. The surgeons who carry out the operation unethically in such circumstances are not upholding the Hippocratic oath they took when they graduated. Many of the patients are known to fall ill because of the rejection of the organ they receive as the tissue typing had not been carefully done. Others are sent home (to faraway lands) much too soon after their surgery and there is no follow-up care.

What is the solution to this problem? Dr Adibul Hasan Rizvi, the director of SIUT, believes that a cadaver organ donation law which recognizes brain stem death and bans the sale of organs from live donors would help ease the crisis. It would regulate the transplantation process and increase the availability of organs by allowing their harvesting from cadavers.

One cadaver can give the gift of life/sight to 17 people. Recognizing the right to life of each and every individual, the Europeans have centralized their system by creating a registry of organs available and the details of the patients in need of them. Thus, the whole process is coordinated and is managed professionally and fairly.

Many Third World countries, including Muslim states, have also adopted a law to regulate organ donation and transplantation and to give a definition of brain death.

The most important of these are Hong Kong, the Philippines, Singapore, Taiwan, China, South Korea, Japan, Thailand, India, Indonesia, Saudi Arabia, Turkey, Iran, Tunisia, Jordan, Lebanon, Malaysia and Bangladesh.

The idea of having a law of this kind was to check the organ trade and when implemented properly it has proved successful in checking this unscrupulous trade.

It is a pity that none of the six governments that have been in office in Islamabad since 1994 when the revised cadaver bill was introduced in the Senate have deemed it important enough to get the law adopted. This has deprived the country of a rich source of organs and has also allowed the organ trade to flourish. Only two cases of cadaveric organ donation are on record in Pakistan. They were done with the consent of the families who were highly motivated. These were extraordinary acts of altruistic service to humanity but they enjoyed no legal sanction. In the absence of a law, it has not been possible to launch a campaign to create awareness about the issue of brain death and cadaveric donation of organs and to mobilize people to come forward to give the gift of life to others when they themselves die.

The first question that comes immediately to mind is why the cadaveric law has not been adopted. An impression is being created that the religious lobbies are opposed to it as they consider the removal of an organ from the dead as desecration of the human body. But so much work has been done on this by the transplantologists in the Muslim world that resistance from the orthodox ulema has been worn out. So many fatwas have been issued by Islamic organizations to the effect that organ donation (even cadaveric) to save a life is a sawab, that it would now need a bold prayer leader or scholar to condemn organ donation and justify the death of a person rather than his taking recourse to transplantation.

With the countless television channels discussing religion and the right and wrong of things being analysed in the religious context, this issue would have come up in a big way if there was any resistance from the Islamic lobbies. That leads us to the conclusion that at best it is simply the apathy of the government and political leaders that has prevented the cadaveric organ donation bill from becoming law.

At worst, sleaze and corruption of the organ trade has spread so far and wide, high and low, that vested interests have been created that are blocking progress. It is time that those who are honest and not involved in making money from the organ trade should join hands to get the bill through parliament.