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| January 23, 2007 | Tuesday | Muharram 03, 1428 |
Poor state of private healthcare
Whither prison reforms?
Bush’s flawed threat perception
After the storm
THE 21st century began with President George W. Bush assuming the leadership of the US. In the decade following the end of the Cold War, the power elite in the US discovered both the challenges and opportunities arising out of this role. Madeleine Albright, secretary of state during President Bill Clinton’s second term, defined this role as that of the “indispensable power” without whose active involvement no major crisis could be resolved in the world nor any significant global initiative succeed.
PAKISTAN faces crises of all kinds. There is the water crisis on account of the shortage of water in the rivers and a shortfall in its storage capacity. The country is also in the midst of a power crisis because of inadequate generation of electricity. These shortages have affected agriculture as well as industry which could cause a slowdown in economic growth. Obviously, this is worrying for the government which has pinned its political future on its economic success. Hence the official knee-jerk reaction, with Islamabad making it known that it plans to build five big and small dams by 2016 — in nine years from now. The dams have acquired the status of a magic wand which is waved from time to time in the belief that it will solve the country’s water and power problems. But the reality is quite different.
While one cannot be certain that all these dams, namely, Kalabagh, Bhasha, Munda, Kurram Tangi and Akhori, are feasible and environmentally safe, technical opinion is also divided on their feasibility. This is only one aspect. The other is their political and economic impact. Thus, Kalabagh became such a contentious issue last year even after the technical committee had given its report — by no means unanimous — that President Pervez Musharraf had to go on television to announce that this mega dam was being put on hold for the moment. As a sop, he announced that work on the Bhasha dam would begin in February 2006. But that has not happened because the government is now trying to mobilise funds amounting to $17 billion to construct these dams. Meanwhile, a new set of protesters challenging the construction of the Bhasha dam has emerged, making it unlikely that politically this and other projects can have a smooth sailing. The government seems to be bent on going ahead with the construction of these dams irrespective of the people’s opposition to them. Thus on Saturday an inter-provincial committee finalised a draft report on the dams claiming that a consensus had been reached on implementing the cabinet’s decision.
It is not known when and how this consensus was reached. The fact is that the federal government has not adopted a transparent policy on consensus building. Islamabad has made no visible effort to initiate a consultation process involving not just official opinion in all the provinces but also private and NGO views on the issue. Besides obtaining the cooperation of all the provinces, it is also important that the people extend their support to the projects as in the final analysis they will be the ones who will have to repay the massive loans to be incurred. Rather than hastening with work on these projects, the government should proceed methodically and look into all aspects such as economic feasibility, environmental impact assessment, and so forth, without bypassing any of them. It is also important that the engineering aspect of the projects is carefully studied to ensure that none turn out to be unfeasible midway. The disadvantage of bringing up this issue every now and then is that it distracts from the alternative proposals that have been made from time to time and deserve to be fully considered. Since the lower riparians, especially Sindh, fear that their water flow in the river will be considerably reduced, sound arguments based on facts and figures will have to be produced to convince the sceptics.
SEVEN months after a draft ordinance was prepared to regulate the private health sector in Sindh, nothing has been heard about its promulgation that would have created a regulatory mechanism to discipline the thousands of hospitals, clinics and diagnostic centres that are fleecing patients in the province. Besides controlling the fee structure at private institutions, the authority would have also tackled other irregularities. Under the proposed law, hospitals and clinics would not be allowed to turn away patients requiring emergency services. Any complaints on this score or relating to other lapses would result in a stiff penalty for the hospital in question. When the details of the ordinance were first made public last year, they had sounded, as noted in this space at that time, “too good to be true”. Several months later, the promulgation of the ordinance remains a pipedream, and no government official is clear on why it has been shelved and for how long. In the meantime, hundreds of thousands of patients continue to suffer. The poor state of public-sector hospitals has left them with no choice but to turn to private medical institutions where many cannot afford the high fee. The result is that increasingly people are turning to quacks who offer their “services” for whatever they are worth at a fraction of the cost.
It is sad that the Sindh government should be so impervious to the hardship all this is causing to the people. The insensitivity of the authorities is underscored by the absence of any effort to improve the services at public-sector hospitals. Steps taken to improve the quality of medical care in government hospitals could bring down the demand for treatment at private health centres, thus forcing the latter to offer better and less costly treatment. One can only hope that last year’s draft ordinance is retrieved and promulgated soon to allow thousands of patients to benefit from quality healthcare at private institutions without going bankrupt in the process.
SOME of the revelations made at a workshop on prison reforms in Karachi were disturbing. For instance, Karachi prisons can hold up to 6,000 prisoners but are housing 20,000 inmates. This anomaly is naturally posing all sorts of problems. While they may be criminals in the eyes of the law, prisoners nonetheless have rights, and being treated properly and humanely is just one of them. However, they are regularly mistreated by jail officials and do not have proper access to food, medicines or even basic sanitary facilities like toilets. Living in cramped barracks only adds to their miseries. Then there is corruption within prisons that sees the “fittest” among the prisoners surviving; only those who can grease palms are protected. Violence among inmates is rampant. Drug addiction seems to be common; it caused most of the 49 deaths last year. Amidst this gloomy scenario, how can one focus on prisoners’ rehabilitation when so many of their basic needs are not being met?
It is not just prison reforms that have to take place, judicial reforms too are necessary. A major reason behind the overcrowded prisons is the sheer number of under-trial prisoners who are housed in jails while awaiting a court verdict. The trial process itself is drawn out and quite often, by the time a person has been sentenced, he has already spent half or more of that time in prison. This is a miscarriage of justice that must be rectified. The government must implement whatever prison reforms it had initiated and move towards ensuring that UTPs’ cases are quickly disposed of. This will at least reduce the jails’ population and allow authorities to treat prisoners in accordance with the law and work for their rehabilitation. Prison authorities’ concerns should also be addressed and the corrupt elements within them rooted out.
The neo-conservatives, who were rightist Republicans began to plan for the New American Century and tended to perceive the ferment in the Muslim world as the successor threat to communism, with resurgent China as a potential ally. The theory of a clash of civilisations put forward by Samuel Huntington was really inspired by the need of the military-industrial complex to revive the arms race as most major countries proceeded to reduce their defence budgets. Persisting political injustice in many parts of the Muslim world (Palestine, Kashmir, Chechnya) and of economic inequality fuelled tensions, and the resort to state terrorism by Israel, India and Russia, forced a resort to suicidal terrorism as the international system failed to address these problems seriously.
President Bush started out with a unilateralist approach and repudiated major accords his predecessor had entered, such as the Kyoto Protocol, and the establishment of an International Criminal Court to outlaw war crimes. He also launched his plan for Ballistic Missile Defence, supposedly to counter rogue states but really to achieve total hegemony and to contain China’s rise. India, ruled by the Bharatiya Janata Party, supported the initiative immediately, while Pakistan voiced reservations, as did China.
The 9/11 terrorist attacks, that constituted the biggest ever military attack on the US mainland gave Bush the opportunity to declare a global war against terror, which was virtually made synonymous with that on the Muslim world.
Pakistan joined in this war and has played the most active role in apprehending the largest number of terrorists with President Musharraf recognised as a valuable ally. Not only has he survived assassination attempts but hundreds of Pakistani military men have been killed in anti-terrorist operations along the Pak-Afghan border. Pakistan has cooperated closely with President Hamid Karzai’s regime in Kabul and extended substantial assistance for reconstruction in Afghanistan despite resource constraints at home.
President Bush launched a pre-emptive attack on Iraq in March 2003 despite the objections of the majority of Security Council members. Not only did the intelligence about Iraqi military capabilities used to justify the war prove erroneous, the US has got bogged down in Iraq and is suffering high casualties. Public opinion even within the US has turned against the Bush policy in Iraq, and the Republicans lost control of the Congress in the mid-term elections held in November 2006.
President Bush had again sought to invoke the fear of terrorism, which had won him a second term in 2004. But the strength of the insurgency grew and even an increase in US troops in Baghdad did not stabilise the situation. US tactics added to sectarian tensions, and the number of Iraqi casualties grew steadily. At the start of the year 2007, President Bush was to announce his revised Iraq policy, after having studied the report of the bipartisan Iraq Study Group, and receiving a briefing from the higher echelons of the State Department and the defence department.
The president remains convinced that the western-dominated world he leads faces a long-term threat from the Muslim world in which Al Qaeda and other terrorist organisations have increased their influence after 9/11, and that winning a US-backed victory in Iraq is crucial. Though he is not totally averse to diplomacy as evident from Secretary of State Condoleeza Rice’s mission to the Middle East, with the aim of reviving the roadmap in Palestine, his basic reliance is on a “surge” in which the induction of 21,500 additional US troops in Iraq reflects persistence of the policy of achieving a total military victory. A reduction of casualties during 2007 is unlikely.
The flawed Huntington thesis of a clash of civilisations with the West versus Islam may become a reality if Mr Bush persists in treating the post 9/11 challenge as a zero sum game. Immediately after 9/11, as worldwide support was extended to the war on terror, there was also a call to address the deeper causes of terrorism. These were identified as follows:
i) Greater efforts by the world community to resolve political issues in which Muslims in particular felt their legitimate rights and grievances were being suppressed. These would include the Arab-Israeli dispute in particular.
ii) With the gap between rich and poor nations constantly widening to the point where poverty, disease and other problems were increasing misery in the developing world, the international system must also address economic concerns.
Unfortunately, the Bush approach has concentrated on high-profile and sophisticated military operations, while efforts to promote reconstruction and resolution of political and economic discontent have been neglected. The worsening of the insurgency and popular resistance both in Iraq and Afghanistan can be traced largely to the western lack of resolve to address the deeper causes of discontent that breeds terrorism if not addressed.
The Iraq Study Group’s report was essentially aimed at changing the emphasis from confrontation to conciliation. In Iraq, a universal view held by Sunnis and Shias alike is that the withdrawal of occupation forces would contribute to peace and stability. In Afghanistan also, barring a small number of warlords and their supporters, most people are worse off after five years of occupation by coalition forces. Many Afghan refugees who returned from Pakistan and Iran had to come back as there was neither shelter nor sustenance for them in their home country.
The Iraq Study Group had recommended that the US engage Syria and Iran to help promote peace and stability in the Middle East. Mr Bush insists on treating them as enemies. Most analysts agree that Baghdad did not have many terrorists before the US attack. It is now a centre of terrorist groups. In Somalia, the US has dubbed the Union of Islamic Courts which had established order in southern Somalia as Al Qaeda allies. Many may actually turn to terrorism now to resist US-backed Ethiopian troops.
As Taliban activity has grown in Afghanistan, senior US officials accuse Pakistan of providing sanctuary to Al Qaeda leaders. Anti-US feelings are already strong among the common people owing to Washington’s strategic alliance with Israel and India. More ill-considered steps could intensify the Pakistani people’s animosity towards the US.
Though Bush is bent upon achieving his anti-terrorism goals through total reliance on force, one hopes he will show sufficient realism not to precipitate a conflict of civilisational proportions with the entire Islamic world.
Avoiding such a conflict should be among the major concerns of his civil and military advisers. The newly elected Congress, reflecting the will of the American people, is not supportive of his strategy, and indeed world opinion is more concerned with other challenges facing mankind and remains opposed to actions that might precipitate a global conflict. Mr Ban Ki-moon needs to sound a note of caution to the US president while his newly nominated ambassador to the UN, Zalmay Khalilzad, a Muslim of Afghan origin, can also play a role.
The writer is a former ambassador.
GALLONS of ink were spilt over the future of Jade Goody at the weekend. This week attention is turning to the future of Channel 4 itself.
For an organisation run by a marketing man, the station has done a spectacularly bad job of handling the fallout from Big Brother. The tongue-tied radio performance of Luke Johnson, the chairman, was an embarrassment.
The belated television interviews by Andy Duncan, chief executive, were not much better. And — when even Ms Goody herself now concedes that her tirade of on-screen bullying was indeed racist — it defies belief that the channel should at first have attempted to deny it, or to have sought comfort in debating what constitutes racism.
If the leaders of any other publicly funded body behaved with such crassness there would be calls for heads to roll. Instead there is a rising crescendo of voices wondering what C4 is for, and why, precisely, it deserves any kind of public subsidy. Some of this fire is coming from predictable sources, who cannot easily accept any notion of public service broadcasting or of funding to support it.
So it is worth reminding ourselves that C4 does still do a pretty good job of broadcasting precisely the sort of programmes that it was set up to commission.
The past year or so has seen a raft of inspired dramas, films and documentaries, encompassing politics, history, science, music and human rights (think, if nothing else, of the Torture season).
Jamie Oliver demonstrated that so-called reality TV can be coupled with social purpose. C4 News remains incisive, serious and necessary. In many of these endeavours, the channel gives the BBC a run for its money.
—The Guardian, London