Showing posts from category Pakistan.
-
The Cholera Quandary
›
The original version of this article first appeared in the Stimson Center Spotlight series, November 19, 2010.
Cholera is usually seen as one of the most devastating infections of the 19th century. Trade routes carried cholera from India to the great cities of Europe and the United States. Disease, fear, and political unrest spread in great waves that cost millions of lives. After much destruction, it was only with science and resources that certain populations were able to curb the epidemic.One of the most celebrated lessons in the history of public health involves a cholera outbreak in London in 1854 and efforts by John Snow – celebrated as the father of epidemiology – to control it. At the time, it was not clear that cholera was a waterborne bacterial infection that caused severe diarrhea and vomiting, and sometimes fatal dehydration. Snow proved that the outbreaks decimating communities spread from contaminated water. Water and sanitation services had virtually eliminated cholera epidemics in the developed world by the early 1900s.
Today, cholera has been nearly eradicated in the developed world, but continues to be endemic in poorer countries. Risks seem to be rising as larger populations are crowded into unsanitary conditions. The World Health Organization (WHO) estimates three to five million illnesses and 100,000-200,000 deaths from cholera each year. If caught early, infections are treatable with inexpensive oral rehydration solutions. For much of the world, these options are unavailable or underused – the mere presence of cholera serves as an indicator of a country’s socioeconomic status and health system capabilities.
The cholera epidemics that are currently menacing countries on three different continents – Asia, Africa, and North America – raise tough questions about what is required to protect the world’s vulnerable populations. We know how to predict the crisis of cholera, prevent outbreaks, and contain them when they occur. To control cholera, what is needed is not cutting-edge technologies, but will, transparency, and resources – and where cholera appears, at least one of these three factors has failed.
Currently, cholera outbreaks in Pakistan, Haiti, and Nigeria are piling misery upon misery. Cholera in post-flood Pakistan comes as no surprise. When floodwaters left millions homeless and without access to clean drinking water in a region where cholera remains endemic, health officials could have reasonably assumed infected human waste would seep into water supplies and spread disease. The inability of health networks on the ground to prevent and then detect cholera demonstrates cracks in the country’s health system. What is apparent here is a lack of will and resources. Disease surveillance is especially vital in a post-disaster scenario where steps can be taken, such as treating water with chlorine, to prevent an outbreak.
Haiti had been free of cholera for at least 50 years, but the disease struck and spread rapidly 10 months after the devastating January 2010 earthquake. It reached Haiti’s capital and spread to its neighbor, the Dominican Republic. Since October, more than 114,000 people have become ill and more than 2,500 have died (Editor’s note: updated since original publication).
Haiti lacked resources for basic infrastructure even prior to the earthquake; the cholera crisis is not only costing lives, but also diverting aid from “building back better.” But regardless of the source of the cholera strain, if basic infrastructure and resources to protect Haiti’s vulnerable populations had been in place, cholera’s re-emergence would have been far less devastating.
This particular outbreak draws attention to the practical and political challenges of identifying health risks in humanitarian workers and peacekeepers, many of whom come from developing countries themselves. Evidence suggests that peacekeepers from Nepal, housed at a UN base, may have been the source of the outbreak clustered around the Artibonite River. Cholera outbreaks frequently exacerbate frictions between communities and aid workers – suspicions that have led to riots and murder more than once in recent years. At least two people were killed in Haiti in riots with peacekeepers during November.The delayed decision by the UN to investigate whether the outbreak originated with peacekeepers may have conserved resources for the race to stave off more cases, but did little to build trust between communities and foreign workers. Further violence and protests surrounding the recent disputed presidential election in Haiti do little to ease the devastation and in fact, threaten the relief effort. There has been discussion in Congress of cutting direct aid and suspending visas for Haitian officials until the dispute as been resolved. The Organization of American States is now reviewing the results.
In Africa, Nigeria is experiencing its worst cholera outbreak since 1991, and the disease is crossing borders. An onslaught of cases raised the 2010 death toll to more than 1,500 fatalities out of 40,000 cases. This mortality rate is three times higher than the seasonal cholera outbreaks of 2009, and seven times higher than 2008. Despite Nigeria’s oil wealth, most of the population is impoverished. Two-thirds of rural Nigerians lack access to safe drinking water and fewer than 40 percent of people in cholera-affected areas have access to toilet facilities, according to the Nigerian Health Ministry. A combined lack of will, transparency, and resources mean that cholera epidemics occur annually, and in clusters throughout sub-Saharan Africa.
A century and a half after John Snow’s discovery, we know how to control cholera. Globally, the resources exist, but the question of a collective will remains. For those who lack clean water to drink, to wash, or even proper toilets, the gap between knowing and doing is not easily closed. The international community has shown repeatedly that it can confront cholera outbreaks like those in Haiti, Pakistan, and Nigeria in the midst of crisis. The question remains as to how those efforts can eliminate the conditions that fostered outbreaks in the first place. The answer is not as riveting as the causes that often receive funding: basic infrastructure and resources. Roads, wells, clean water, toilets, education, and the willingness to recognize that if the foundation is not sound, nothing will be able to stand. Sometimes the simplest problems are the most difficult to solve.
Sarah Kornblet is a research fellow at the Global Health Security Program at the Stimson Center. Her research focuses on the International Health Regulations, health systems strengthening, global health diplomacy, the intersection of public health and security, and the potential for innovative and dynamic health policy solutions in developing countries.
Sources: Agence France-Presse, BBC, Washington Post, World Health Organization.
Photo Credit: “UN Peacekeepers Provide Security During Port-au-Prince Food Distribution,” courtesy of flickr user United Nations Photo. -
International Responses to Pakistan’s Water Crisis
›December 6, 2010 // By Michael KugelmanExcerpt from the executive summary of the NOREF Policy Brief, via the Norwegian Peacebuilding Centre:
Pakistan faces a multidimensional water crisis that claims hundreds of thousands of lives every year. The root causes of the crisis are twofold:- Circumstantial, which are linked to poor water-resource management policies (including water-wasting flood irrigation);
- Structural, tied to factors deeply ingrained in politics and society such as the obsession with India, inequitable rural land-ownership and endemic water misgovernance (for example, exploitation of the rotational irrigation system to the detriment of the poor).
However, international responses must be measured. They should actively target the circumstantial causes but, at the same time, recognize that their ability to take on the structural ones is limited. While the international community can help mitigate the effects of the underlying structural drivers, Pakistan itself must take the ultimate steps to eliminate them.
Circumstantial causes can be addressed through international aid provision and international exchanges. Aid provision must be generous enough to meet Pakistan’s prodigious needs but modest enough to respect the country’s limited absorptive capacities. It should emphasize the restoration of infrastructure and distribution systems, be more responsive to the needs of Sindh and Baluchistan provinces, and be channeled through both government agencies and civil society.
Despite the challenges the international community faces in addressing the structural causes, opportunities do abound. These include embarking on back-channel diplomacy to bring Pakistan and India closer together and cooperative projects with Pakistanis to make water distribution more equitable. To be effective, international responses must target all affected parties and be sensitive to ground realities. They should also be mindful of indigenous success stories and the factors that bring about that success.
The full report, “International Responses to Pakistan’s Water Crisis: Opportunities and Challenges,” is available through the Norwegian Peacebuilding Centre.
Michael Kugelman is program associate with the Asia Program at the Woodrow Wilson International Center for Scholars.
Image Credit: Adapted from “USG Humanitarian Assistance to Pakistan for Floods in FY 2010 and FY 2011 (as of 30 Nov 2010),” courtesy of USAID and ReliefWeb. -
Admiral Mullen and the “Strategic Imperative” of Energy Security
›October 13, 2010 // By Geoffrey D. DabelkoTop American military brass weighed in this morning on energy security with an emphasis on conservation, efficiency, and alternatives. A little climate change even crept into the discussion as well.
The occasion was a Department of Defense conference titled “Empowering Defense Through Energy Security” sponsored by the Office of the Under Secretary of Defense for Acquisition, Technology & Logistics and the United States Air Force, Army, Navy and Marine Corps leadership. The new Office of Operational Energy Plans and Programs was on point.
Starting at the top, Chairman of the Joint Chiefs of Staff Admiral Mike Mullen set the tone:My friend and columnist Tom Friedman has spoken eloquently of the growing need – and awareness – to rethink our views on energy – and minimize our dependence on overseas energy sources that fuel regimes that do not always share our interests and values, while not further damaging a world that is already becoming overheated, overpolluted, and overstretched.
The wider context of climate change and its security implications also found a place in Admiral Mullen’s remarks:
We in the Defense Department have a role to play here – not solely because we should be good stewards of our environment and our scarce resources but also because there is a strategic imperative for us to reduce risk, improve efficiencies, and preserve our freedom of action whenever we can. …
So, to start with, let’s agree that our concept of energy must change. Rather than look at energy as a commodity or a means to an end, we need to see it as an integral part of a system … a system that recognizes the linkages between consumption and our ability to pursue enduring interests.
When we find reliable and renewable sources of energy, we will see benefit to our infrastructure, our environment, our bottom line … and I believe most of all … our people. And the benefits from “sustainability” won’t just apply to the military.Beyond these immediate benefits, we may even be able to help stem the tide of strategic security issues related to climate change.
Admiral Mullen then gave way to General Norton A. Schwartz, chief of staff of the U.S. Air Force; General Peter W. Chiarelli, vice chief of the U.S. Army; Aneesh Chopra, the federal chief technology officer; and Secretary of the Navy Ray Mabus, with Sharon Burke, director of operational energy plans and programs, running the show.
This is no small matter. In addition to the newly developing waterways near the polar icecaps, in 2008, the National Intelligence Council identified twenty of our bases that are physically at risk as a result of the rising level of the ocean.
And regardless of what the cause of these changes is – the impacts around the world could be sobering – and far-reaching.
As glaciers melt and shrink at a faster rate, water supplies have been diminishing in parts of Asia.
Rising sea levels could lead to mass migration and displacement similar to what we have seen in Pakistan’s flood … and climate shifts could drastically reduce the arable land needed to feed a burgeoning population as we have seen in Africa.
This scarcity of – and potential competition for – resources like water, food, and space – compounded by an influx of refugees if coastal lands are lost … could not only create a humanitarian crisis, but create conditions of hopelessness that could lead to failed states … and make populations vulnerable to radicalization.
These challenges highlight the systemic implications – and multiple-order effects – inherent in energy security and climate change.
And while the brass met inside, clean energy companies exhibited their wares in the Pentagon’s inside courtyard.
Photo Credit: “the Pentagon from above,” courtesy of flickr user susansimon. -
Wilson Center Scholar Huma Yusuf on Pakistan’s Population Policy: Will it Work?
›October 8, 2010 // By Wilson Center StaffExcerpt from op-ed by Huma Yusuf in Dawn:
The best news Pakistanis have received in the past week comes in the form of the National Population Policy 2010. The policy recognises that demographics are the key to promoting economic development and security in Pakistan. It also prioritises family planning — particularly in an effort to promote birth spacing — as the best strategy for achieving ambitious population targets (2.1 births per woman in 2025).
In many ways, the story of Pakistan is one of a failure of family planning. Although the Family Planning Association of Pakistan was set up as early as 1952, we have seen a five-fold increase in our population between 1951 and 2009, from 34 million to 171 million.
The urgent need for revamped family planning service delivery cannot be understated. Although 96 per cent of married Pakistani women are aware of at least one modern contraceptive method, only 22 per cent are currently using modern contraceptives, while another eight per cent use less effective traditional methods. One quarter of married women want to wait before having another child, or do not want more children, but are not using contraception. And 24 per cent of married women admit that their last child was mistimed or unwanted.
Many Pakistanis bemoan the prevalence of abortion here (a 2004 Population Council study estimates that there are 890,000 abortions annually), but this too should be understood as a shortcoming of our government’s family planning service delivery. According to the 2006-07 Pakistan Demographic Health Survey, 65 per cent of women who had an abortion were over the age of 30, while 80 per cent had more than three children. In this context, the population policy’s emphasis on family planning is a welcome paradigm shift.
Continue reading on Dawn.
Photo Credit: Adapted from “chitral photos,” courtesy of flickr user groundreporter. -
Pakistan After the Floods: A Continuing Disaster
›September 29, 2010 // By Hannah MarquseeA month after Pakistan’s worst flood in 80 years, millions remain without access to food, clean water, or health care.
-
Derek S. Reveron, The New Atlanticist
When National Security Overlaps With Human Security
›August 24, 2010 // By Wilson Center StaffThe original version of this article appeared on the Atlantic Council’s New Atlanticist blog. By Derek S. Reveron.
For the second time this year, naval forces have been involved in major operations that have little to do with combat at sea. Instead, Sailors and Marines operating from dozens of warships have responded to natural disasters.
Earlier this year in Haiti, traditional warships delivered food, water, and medical supplies. On amphibious ships, the large flight decks designed to move Marines ashore via helicopters proved to be temporary airports for search and rescue teams; medical facilities designed to treat wounded infantry became floating clinics for sick and injured civilians. The use of naval ships as airports, hospitals, or as refugee camps must be temporary, but in a crisis, temporary relief is what is necessary.
Similar uses of militaries are occurring in response to flooding in Pakistan and wildfires in Russia today. NATO is planning and executing responses to alleviate human suffering created by natural disasters, which are certainly non-traditional.
But militaries around the world are being called to serve their people and others in distress. Increasingly, militaries are including humanitarian assistance and disaster relief as a core concept in how they train, equip, and organize. Militaries have reluctantly embraced these new roles because their governments expect them to provide responses to humanitarian crises, support new partners, and reduce underlying conditions that give rise to instability.
At the same time that military aircrews rescue stranded people or military engineers erect temporary housing, critics worry that development is being militarized. But, they miss the larger point that military equipment like helicopters, medical facilities, and logistic hubs are necessary for providing humanitarian assistance during a crisis. Additionally, NGOs increasingly partner with militaries in North America and Europe because militaries have the capacity to reach populations in need where NGOs can deliver their services.
Given the real stress on militaries created by operations in Iraq and Afghanistan, these non-traditional operations are not needed to prove relevance for militaries in a difficult fiscal period. Instead, the inclusion of humanitarian assistance in military doctrine are driven by countries’ national strategies that increasingly link human security and national security. As I wrote in Exporting Security: International Engagement, Security Cooperation, and the Changing Face of the U.S. Military, militaries are being directed to be involved in humanitarian operations.
Far from preparation for major war, humanitarian activities rely on a unique blend of charitable political culture, latent civil-military capacity, and ambitious military officers who see the strategic landscape characterized by challenges to human security, weak states, and transnational actors. Further, changes are informed by international partners that conceive of their militaries as forces for good and not simply combat forces. The United States has been slow to catch up to European governments that see the decline of coercive power and the importance of soft power today.
This change is not only about the state of relations among governments today, but also the priority of human security. Security concerns over the last twenty years have been shifting away from state-focused traditional challenges to human-centered security issues such as disease, poverty, and crime. This is reflected in the diversity of ways by which NATO countries protect their national security. While there are remnants of Cold War conflicts on the Korean Peninsula and in the Persian Gulf region, these are largely the exception. Instead, sub-national and transnational challenges increasingly occupy national security professionals.
Within the United States, the government has embarked on a program to illustrate that its military superpower capabilities can be used for good. The same capability that can accurately drop a bomb on an adversary’s barracks has been used to deliver food aid in the mountains of Afghanistan. The same capability used to disembark Marines from Navy ships to a foreign shore have been used to host NGOs providing fisheries conservation in West Africa. And the same capability to track an enemy’s submarines can detect changes in the migration of fish stocks in response to climate change. To be sure, swords haven’t been beaten into plowshares, but military capabilities once used for confrontation are now used for cooperation.
Derek S. Reveron, an Atlantic Council contributing editor, is a Professor of National Security Affairs and the EMC Informationist Chair at the U.S. Naval War College in Newport, Rhode Island.The views expressedare his own and do not reflect those of the Navy or the U.S. government.
Photo Credit: “100304-F-2616H-060” courtesy of flickr user Kenny Holston 21. -
Historic Floods Plague Pakistan
›August 19, 2010 // By Shawna Cuan“Staggered by the scale of destruction from this summer’s catastrophic floods, Pakistani officials have begun to acknowledge that the country’s security could be gravely affected,” reports the Washington Post. The Pakistani government – already cash-strapped between fighting “the war on terror” and trying to prevent an economic collapse – now faces recovering from the worst flooding in over 80 years.
-
Floods, Fire, Landslides, and Drought: The Guardian’s “Weather Crisis 2010”
›From the Guardian’s DataBlog comes an excellent overview of some of the extreme weather affecting the globe this summer, from the devastating floods in Pakistan which have inflicted “huge losses” to crops and exacerbated an already tenuous security situation, to the wildfires in Russia which have smothered the capital in dangerous smog and crippled domestic wheat supplies.
“Global temperatures in the first half of the year were the hottest since records began more than a century ago,” writes author and graphic artist Mark McCormick.
The orange areas of the map represent high pressure systems and the blue, low pressure systems, which as explained by Peter Stott of the Met Office, are important indicators of the rare climatic conditions that caused this summer’s abnormal conditions across Eurasia.
The flooding in Pakistan has garnered the most international attention, having now affected more people than the 2004 tsunami, 2010 Haiti earthquake, and 2005 Kashmir earthquake combined. Other highlighted areas of the map include flooding in Poland and Germany, drought in England, mudslides in Latin and South America, record-breaking drought and hunger in West Africa, and flooding and landslides in China, which recently pushed the world’s largest hydroelectric dam to its limit and have now been blamed for more than 1,000 deaths.
Although it does a good job highlighting the frequency and severity of extreme weather events this summer, it’s important to note that the map only covers events in July and August. That leaves out the “1000-year” floods in Tennessee this May as well as the heavy snowfall seen in the Northeast United States and the winter of “white death” in Mongolia earlier this year, which also severely disrupted local and national infrastructure as well as a great many people’s livelihoods.
Sources: Agence France-Presse, BBC, Guardian, National Oceanic and Atmospheric Administration, New York Times, Telegraph, UN Dispatch.
Image Credit: “Weather Crisis 2010” by Mark McCormick, courtesy of Scribd user smfrogers and The Guardian.
