Wednesday, April 8, 2009

Widespread over-medication driven by profit in Asia

From Reuters AlertNet .
 
 
 
06 Apr 2009
Source: Reuters
 

By Fitri Wulandari and Tan Ee Lyn
 

JAKARTA/HONG KONG, April 6 (Reuters) - Ria Pane took her 7-year-old daughter Kezia to a doctor in Jakarta to check on her fever and sore throat, and was prescribed seven drugs, including antibiotics and medicine to prevent febrile seizures.

Experts say it was another classic, but only too common, case of over-medication, or prescribing drugs patients do not need. Here, the antibiotic was unnecessary, as was the drug to prevent febrile seizures as the child had no history of such attacks, said several pharmacists and doctors who were asked by Reuters.

Experts warn that driven by profits from selling medicine, some doctors from Indonesia to Hong Kong are overprescribing medicines, a practise they say will be disastrous in the longer term.

"Polypharmacy (overmedication) is very popular here, it means they use a lot of medicines which are unnecessary, like giving you many types of antibiotics for a cold," said William Chui, honorary associate professor at the Clinical Trials Centre attached to the University of Hong Kong.

"Every time they sell a drug, they get a profit, it is a profit motive. When they give lots of medicine, parents feel happier, more happy than when they are told to go home to sleep."

The consumption of multiple drugs triggers drug reaction and unpredictable side effects. Worse, it gives rise to bacterial resistance.

The most recent example of growing resistance involves the drug oseltamivir, which researchers in the United States found was now ineffective against 98 percent of the H1N1 seasonal human influenza virus strains.

Oseltamivir is known by the brand Tamiflu and manufactured by Roche AG <ROG.VX>.

Oseltamivir is also recommended as a first line of defence against the H5N1 bird flu virus in case it triggers a flu pandemic and experts are now questioning how well, and how long, the drug will stand up against the H5N1 virus.

 
SERIOUS SIDE EFFECTS

 
Apart from eventually reducing the effectiveness of drugs, exposing bacteria and viruses to drugs unnecessarily also has other serious consequences.

"They harm the patient. The more drugs, the worse the compliance, especially for old people. They fall easily because of drug interaction and side effects. They get dizzy, hypotension, it is something we don't recommend," Chui said.

Doctors in Indonesia often prescribe antibiotics to patients suffering a common cold when such drugs are only to be used for bacterial infections.

"Most parents rush to treat symptoms, not the disease. Doctors may feel pressure to give treatments, even when it is not necessary or in the best interests of the child's health," said Purnamawati S. Pujiarto, a paediatrician trying to promote a more informed use of drugs in Indonesia.

Experts say such a mentality has led not only to polypharmacy, but also the use of compounding medicine, known in Indonesia as "puyer".

Compounding medicine is the practise of crushing different drugs into a powder in a bowl and dividing it into small sachets. Sometimes it is mixed with syrups.

It is carried out under strict guidelines in some countries. But in Indonesia, it has been used liberally for decades, particularly to treat health problems in children.

Experts warn this practise could result in errors as the drugs may not be evenly divided or pharmacists may not clean the bowl thoroughly, leaving residues from previous prescriptions.

"The issue is not 'puyer' itself but the competence and knowledge," said Iwan Dwiprahasto, a pharmacoepidemiology professor at Gadjah Mada University in Yogyakarta.

"Does the pharmacist know which drugs are not allowed to be compounded? Do doctors know certain drugs are not allowed to be mixed together because they are dangerous to patients?"

"The compounded form makes patients unaware they have consumed many drugs as it looks like a single medicine," said Dwiprahasto, who is also chairman of the Indonesian Pharmacologist Association.

 
RESISTANCE

I
n Hong Kong, Chui and his colleagues recently discovered widespread abuse of carbapenem, a class of the powerful, broad-spectrum antibiotic in private hospitals.

This class of antibiotics is recommended as a prophylaxis for major procedures such as colorectal operations, but pharmacists found they were given to patients even for minor procedures.

"Alternative prophylaxis require three doses a day, but this is just one dose daily. Private hospitals use this as it's very convenient and it's broad spectrum so it can block all infections," said Chui.

"But what we are most afraid of is resistance especially with the (bacteria) stenotrophomonas maltophilia. If you abuse carbapenem, this bacteria will get more resistant."

Stenotrophomonas maltophilia is a bacteria that causes uncommon infections that are difficult to treat, such as pneumonia, urinary tract infection or blood stream infection. (Editing by Sugita Katyal)
AlertNet news is provided by
 
Source is here.

Afghanistan: Success through building RELATIONSHIPS

 
From Reuters AlertNet.
 
Excerpts:
 
"They have seen an ebbing and flowing of different people. The way to success here was that we needed to gain the acceptance of the people," Jackman told Reuters.
 
"When we first came, people wouldn't speak to us unless we stopped them. Now they shout at us from across the fields," says Warrant Officer Duncan Hedges, who makes up one half of the team. "We spent four months just getting to know them," he says.
 
"Some people measure success in terms of how many buildings they have built. Our success is not measured from building anything except relationships," said Hedges.
 
 
 
 
05 Apr 2009
Source: Reuters
 By Jonathon Burch
 

MUSA QALA, Afghanistan, April 5 (Reuters) - For the British soldiers stationed in Musa Qala in southern Afghanistan's insurgent-ridden Helmand province, success is not so much about building schools and wells but gaining the trust of the people.

While the small and dusty town of Musa Qala, sitting on the edge of a small tributary, may lack the strategic importance of other towns located along the main Helmand River, its history has given it iconic status and the British want to make their mark.

In the past three years, the town has passed from the Taliban to the British, to tribal elders, to the Taliban and for the last year now back to British and Afghan government troops.

"The population were quite wary at the beginning of whether we were going to stay," Major Toby Jackman says, sitting outside the operations centre at the main base in Musa Qala -- a concrete building dubbed the "Taliban Hotel" after its former inhabitants.

"They have seen an ebbing and flowing of different people. The way to success here was that we needed to gain the acceptance of the people," Jackman told Reuters.

To the north and south of the main base are two small bases, acting as the "frontline" with the Taliban. Reluctant to use the word "control", the British say they now have "influence" over an area measuring 10 km (6 miles) from north to south.

While U.S. President Barack Obama tells his European allies they must contribute more to win the war in Afghanistan, success on the ground is slow and is more likely to be achieved with low-tech counter-insurgency tactics aimed at winning over the people.

One of the ways the British military has been trying to reach out to the population inside the Musa Qala security "envelope" is through Military Stabilisation Support Teams (MSST), who try to assess local needs by talking to the Afghan residents.

The teams are made up of soldiers in uniform, with specialised training and are embedded within a company. The concept is not new to the British military, Jackman says, but is one that has re-emerged since the British arrived in Afghanistan.
 

RELATIONSHIPS

 
At Patrol Base Woqab in the north, the MSST consists of two soldiers that accompany foot patrols around the base. Their aim is to engage villagers and find out their needs and complaints.

"When we first came, people wouldn't speak to us unless we stopped them. Now they shout at us from across the fields," says Warrant Officer Duncan Hedges, who makes up one half of the team. "We spent four months just getting to know them," he says.

Broad-shouldered and towering well over six feet tall, the white-bearded Hedges, who studied the local language, Pashto, for 15 months. He has made quite an impression on the local population, even earning him the nickname "Delawar Khan" or "Brave King".

He and his MSST partner, Sergeant Sharon Goodall have spent the last six months talking and listening to the locals and have slowly managed to build up a level of trust.

"Some people measure success in terms of how many buildings they have built. Our success is not measured from building anything except relationships," said Hedges.

The MSST are now negotiating with the mullah, or religious elder, in the area to help renovate the local mosque and have dealt with numerous compensation claims after crops were damaged by soldiers out on patrol.

While poppy is still a major crop around Musa Qala -- Helmand alone produces half the world's opium -- the MSST has been paying farmers immediately around the patrol base not to grow maize as the tall plants provide ideal cover for the insurgents.

"The farmers are more than willing as they don't want to provide cover for the Taliban and don't want any fighting on their land," said Hedges.

The approach seems to have paid off with villagers regularly approaching the bases, often at great risk to themselves, warning soldiers of insurgent movements or of roadside bombs.

While the area around Musa Qala, where the British soldiers have a presence, is relatively small, it seems to have had a measurable impact on those living inside it.

"Since the foreign troops came, security has got a little better. Before, we couldn't go too far from our house because of the Taliban. Now we can move around 10 km (6 miles) from our house," said Kashwi Sawadi, from a nearby village.

The main focus of the British soldiers remains in providing security, with insurgents still launching almost daily attacks on outlying bases, but says Jackman, the area of "influence" has allowed some form of governance to return.

"Don't get me wrong, there's a way to go. This is counter insurgency on a small scale," said Jackman. (Editing by Jeremy Laurence)
AlertNet news is provided by
 
 

Interdependence of nations' security - as between Pakistan and Afghanistan

From Reuters AlertNet.

Excerpts:

"...unless you can manage the tribal areas of Pakistan from where a lot of the Taliban is gaining strength, you cannot deal with Afghan security,"

...al Qaeda is encouraging a Taliban insurgency in Pakistani tribal lands bordering Afghanistan as they seek to destabilise the Muslim nation of 170 million people.


02 Apr 2009 10:24:58 GMT
Source: Reuters
By Yoko Kubota

TOKYO, April 2 (Reuters) - Stabilising Pakistan's economy and fighting poverty there are key to combating the insurgency in neighbouring Afghanistan, a special adviser to Japan's prime minister said ahead of a Pakistan donors' conference this month.

"It has become much, much more clearly recognised that unless you can manage the tribal areas of Pakistan from where a lot of the Taliban is gaining strength, you cannot deal with Afghan security," Sadako Ogata, the special envoy for Japanese Prime Minister Taro Aso to the two countries, told Reuters in an interview on Thursday.

Ogata, who was high commissioner for the U.N. refugee agency from 1991 to 2000, said while various factors such as religion and politics have encouraged a Taliban insurgency, those struggling from poverty are the most vulnerable.

"The poor people having very little resources would be easily recruited to radical action," the 81-year-old envoy said.

Nuclear-armed, and a hiding place for al Qaeda, Pakistan has become a foreign policy nightmare for the West.

Pakistan's leaders know al Qaeda is encouraging a Taliban insurgency in Pakistani tribal lands bordering Afghanistan as they seek to destabilise the Muslim nation of 170 million people.

Japan and the World Bank will host a Pakistan donors conference in Tokyo on April 17, which Pakistani President Asif Ali Zardari will be attending.
Read source is here.

Thursday, April 2, 2009

Human dignity? rights? Zimbabwe prisoners so weak cannot stand


From www.thestar.com. Source is here.


THE ASSOCIATED PRESS
Images from inside Zimbabwe's prison of inmates so weak from hunger they can't stand are shocking proof of the impact of the country's economic collapse on those who can't escape, said a producer who helped make the behind-the-walls documentary.
Apr 01, 2009

THE ASSOCIATED PRESS

JOHANNESBURG – Newly released images that provide a rare look inside a Zimbabwean prison show emaciated inmates too weak to stand and eating as if they can barely bring food to their mouths.

Human rights activists and former prisoners have spoken of horrifying conditions in the country's jails and prisons but there has been little firsthand evidence available.

Producer Godknows Nare spent four months on the behind-the-walls documentary, training insiders to capture the footage. His work, ``Hell Hole," aired Tuesday on SABC, the South African state broadcaster, and was being syndicated internationally by Associated Press Television News today. Nare said he hoped the footage would persuade Zimbabwe's new coalition government and the international community to step in to help.

"Just hearsay, without visual proof, is not enough to change people's minds," he said.

Attempts to reach the Zimbabwean cabinet minister in charge of prisons today were not immediately successful.

In one scene from "Hell Hole," a man stands shirtless in a prison yard, his ribs and pelvic bone shockingly prominent until he pulls on a ragged T-shirt.

In other scenes, emaciated prisoners, wasting away because of vitamin deficiencies, according to SABC, are shown on mats in cells furnished with only blankets and the thin mattresses. Nare said prison menus have been reduced to daily bowls of corn porridge, which the inmates are shown eating slowly, as if they barely have the energy to bring the food to their mouths.

The Associated Press could not independently determine if the prisoners' ailments were caused by the jail conditions or by an illness or malnutrition they were suffering before being incarcerated.

Annah Y. Moyo, a Zimbabwean lawyer who works with the Southern African Centre for Survivors of Torture, said conditions in Zimbabwean prisons were "a form of torture."

Moyo, who was not involved in making the documentary, said Zimbabwe's soaring inflation and shortages of basic goods have made it difficult to supply prisons. But she said corruption also played a role, with prison officials taking food that should go to prisoners and selling it on the black market.

And she said there was a political aspect, with security officials making sure political activists know of the prison conditions.

"Everyone knows that if you're sent to prison, your chances of coming out alive are slim," Moyo said in an interview Tuesday. ``It's quite a complex situation. You cannot classify it as only economic or political."

Lack of medical care in jails and prisons also has been an issue, with concern that cholera, at epidemic levels among free Zimbabweans, would take an even higher toll in crowded cells.

Last year, the Zimbabwean civic group Women of Zimbabwe Arise dedicated a report on the collapse of the country's health system to one of its leaders, Thembelani Lunga. The group said she died after being jailed for four days in Bulawayo Central Police Station, where she was denied access to AIDS medication.

Earlier this month, Roy Bennett, a former opposition politician who is now part of the unity government, spoke about harsh jail conditions he endured for a month before being granted bail in an arms case. He said prisoners survive on one meal a day and are given salty water.

Bennett, noticeably thinner after his jailing, told reporters five people died during his incarceration and it took authorities 24 to 48 hours to collect the bodies.

Bennett's Movement for Democratic Change joined longtime President Robert Mugabe's ZANU-PF in a unity government in February.

The arms accusations against Bennett, which his party says are trumped up for political reasons, are evidence of the difficulties the new governing partners will have putting political tension and violence behind them and turning their energies to rebuilding the country.




Wednesday, April 1, 2009

Somalia: MILLIONS of refugees - are we prepared?

Numbers can bewilder one, as do refugee counts as these from Somalia. Which country can, in light of this, be SURPRISED to encounter these and other displaced peoples knocking at their door in search of the most basic human needs - shelter, safety? From Reuters AlertNet. Sources found here and here.
Map of FOOD AID DISTRIBUTIONS in Somalia (September 2008), from OCHA.
CLICK here (or map) to enlarge.




OCHA Somalia, supporting coordination efforts through the sharing of information on humanitarian and development issues.











Last reviewed: 19-02-2009

'WORLD'S WORST HUMANITARIAN CRISIS'

More than one in 10 Somalis have been forced out of their homes by conflict as Islamist insurgents who ruled the country briefly in 2006 battle against the government. Years of anarchy since the fall of dictator Mohamed Siad Barre in 1991, combined with frequent drought and rampant inflation, have turned Somalia into the world's worst humanitarian crisis, according to the United Nations.

  • More than 3.2 million need aid
  • More than 1.1 million displaced
  • Infrastructure in tatters


  • Somalia's Transitional Federal Government has been unpopular and virtually powerless in a country where warlords, Islamist insurgents and troops clash almost daily. Aid workers say Somalia has more than 1.1 million internally displaced people.

    Six months of strict rule by the Islamists in 2006 brought relative peace to Mogadishu. That rule ended when troops from Ethiopia, a key U.S. ally, helped restore the transitional government. Foreign involvement fuelled opposition locally and internationally and appeared to boost support for the Islamists, with some analysts saying U.S. accusations of al Qaeda involvement became a self-fulfilling prophesy. The last of the Ethiopian troops left in early 2009, having failed to stem the insurgency.

    Violence has killed some 10,000 people since the beginning of 2007.

    Hundreds of thousands of people have fled Mogadishu since the end of 2006. Aid agencies say the 15 km (10 mile) stretch of road between the capital and the town of Afgoye is probably the largest concentration of displaced people on the planet. At the end of 2008, an estimated 200,000 people were camped along the side of the road, according to the U.N. refugee agency UNHCR.

    Somalia is the most pressing humanitarian emergency in the world - even worse than the crisis in Sudan's western Darfur region, the UNHCR country representative said in 2008.

    The U.N. Office for the coordination of Humanitarian Affairs said in October 2008 that 3.2 million people needed humanitarian aid. The shortages are caused by conflict, high inflation and frequent drought. But food distribution is hindered by pirate attacks on sea deliveries, roadblocks, and armed attacks on aid convoys.

    Aid agencies rank Somalia one of the most dangerous places in the world to work, and few organisations base international staff there.

    The African Union has deployed troops to replace the Ethiopian soldiers, but they complain they are under-funded and under-staffed.

    In 2009, parliament voted in a moderate Islamist president, Sheikh Sharif Ahmed, who has promised to forge peace with neighbours, tackle rampant piracy offshore and rein in hardline insurgents.

    KEY FACTS

    Total population (2006)
    8.4 million (UNICEF 2008)

    Life expectancy (2006)
    47 (UNICEF 2008)

    Internally displaced people
    1.1 million (OCHA, September 2008)

    Refugees from Somalia (2007)
    457,000 (UNHCR)

    People in need of humanitarian aid
    3.2 million (OCHA, Oct 2008)

    Doctors per 100,000 people
    4 (UNDP 2007)

    Population with access to safe water (2004)
    29 percent (UNICEF 2008)

    Children under five under height for age (2000-2006)
    38 percent (UNICEF 2008)

    Children under five underweight (2000-2006)
    36 percent (UNICEF 2008)

    Under-five mortality rate (2006)
    145 per 1,000 live births (UNICEF 2008)

    Children attending primary school (2000-2006)
    Boys - 24 percent; Girls - 20 percent (UNICEF 2008)

    A Burundian peacekeeper from the African Union Mission to Somalia (AMISOM) stands guard outside their base in Mogadishu March 30, 2009, as residents wait for medical attention at the AMISOM camp. ...

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    Tuesday, March 31, 2009

    Globalization is here to stay, set to expand


    An insightful article from Foreign Policy www.foreignpolicy.com on the important question of globalization.

    Excerpt:

    ...as private economic activity falls, the international movement of public funds is booming. Last fall, the U.S. Federal Reserve and the central banks of Brazil, Mexico, Singapore, and South Korea launched $30 billion worth of currency arrangements for each country designed to stabilize their financial markets. Similar reciprocal deals now tie together central banks throughout Asia, Europe, and the Middle East.

    Yes, some governments might be tempted to respond to the crisis by adopting trade-impairing policies, imposing rules that inhibit global financial integration, or taking measures to curb immigration. The costs of doing so, however, are enormous and hard to sustain in the long run. What's more, the ability of any government to shield its economy and society from outside influences and dangers has steadily evaporated in the past two decades. There is no indication that this trend will be reversed.

    Globalization is such a diverse, broad-based, and potent force that not even today's massive economic crash will dramatically slow it down or permanently reverse it. Love it or hate it, globalization is here to stay.



    Read the source here.

    Think Again: Globalization
    By Moisés Naím
    March/April 2009
    Forget the premature obituaries. To its critics, globalization is the cause of today's financial collapse, growing inequality, unfair trade, and insecurity. To its boosters, it's the solution to these problems. What's not debatable is that it is here to stay
    Forget the premature obituaries. To its critics, globalization is the cause of today's financial collapse, growing inequality, unfair trade, and insecurity. To its boosters, it's the solution to these problems. What's not debatable is that it is here to stay.

    HENNING KAISER/AFP/Getty Images
    Rising tides: Is globalization still lifting these boats?
    "Globalization Is a Casualty of the Economic Crisis."

    No. That is, not unless you believe that globalization is mainly about international trade and investment. But it is much more than that, and rumors of its demise—such as Princeton economic historian Harold James's recent obituary for "The Late, Great Globalization"—have been greatly exaggerated.

    Jihadists in Indonesia, after all, can still share their operational plans with like-minded extremists in the Middle East, while Vietnamese artists can now more easily sell their wares in European markets, and Spanish magistrates can team up with their peers in Latin America to bring torturers to justice. Globalization, as political scientist David Held and his coauthors put it, is nothing less than the "widening, deepening and speeding up of worldwide interconnectedness in all aspects of contemporary social life"—and not just from one Bloomberg terminal to another.

    Around the world, all kinds of groups are still connecting, and the economic crisis will not slow their international activities. In some cases, it might even bolster them.

    Global charities, for instance, will face soaring demand for their services as the economic crisis greatly expands the number of those in need. Religions, too, will benefit, as widespread hardship heightens interest in the hereafter. At a time when cash is king and jobs are scarce, globalized criminals will be one of the few, if not the only, sources of credit, investment, and employment in some places. And transnational terrorists will not be deterred by a bad economy. The collapse of the credit-default swap market didn't prevent 10 Pakistani militants from wreaking havoc in Mumbai in November.

    It's true that private flows of credit and investment across borders have temporarily plummeted. By the end of 2008, for example, U.S. demand for imported goods fell drastically, shrinking the country's trade deficit by almost 30 percent. In China, imports dropped 21 percent and exports nearly 3 percent. Last November, capital flows to emerging markets reached their lowest level since 1995, and issuance of international bonds ground to a halt.

    But as private economic activity falls, the international movement of public funds is booming. Last fall, the U.S. Federal Reserve and the central banks of Brazil, Mexico, Singapore, and South Korea launched $30 billion worth of currency arrangements for each country designed to stabilize their financial markets. Similar reciprocal deals now tie together central banks throughout Asia, Europe, and the Middle East.

    Yes, some governments might be tempted to respond to the crisis by adopting trade-impairing policies, imposing rules that inhibit global financial integration, or taking measures to curb immigration. The costs of doing so, however, are enormous and hard to sustain in the long run. What's more, the ability of any government to shield its economy and society from outside influences and dangers has steadily evaporated in the past two decades. There is no indication that this trend will be reversed.

    Globalization is such a diverse, broad-based, and potent force that not even today's massive economic crash will dramatically slow it down or permanently reverse it. Love it or hate it, globalization is here to stay.

    "Globalization Is Nothing New."

    Yes it is. Historians such as A.G. Hopkins have argued in recent years that the wave of globalization that surged in the 1990s is just a continuation of a long-term process that started as far back as when migrating pre-modern human communities first encountered each other. They also note that the steamship revolutionized transportation as much or more than the advent of containerized cargo shipping and that the printing press, the telegraph, and the telephone were technologies as disruptive in their day as the Internet. In short, there is nothing new under the sun.

    Still, the current wave of globalization has many unprecedented characteristics. As Internet access penetrates the most remote corners of the globe, it is transforming the lives of more people, in more places, more cheaply than ever before—and the pace of change is accelerating faster than we can hope to chronicle it.

    Today's globalization is also more individualized than ever. The telegraph was most intensively used by institutions, but the Internet is a truly personal tool that allows Spanish women to find marriage prospects in Argentina, and South African teenagers to share music files with peers in Scotland. Contemporary globalization is also different in that the speed at which it is integrating human activities is often instantaneous and almost costless. Moreover, the quantitative change in each of globalization's components—economic, cultural, military, etc.—is so enormous that it creates a qualitative change. This alone has opened possibilities that are completely new—and also consequences that humanity has never seen before.

    "Globalization No Longer Means Americanization."

    It never did. For some critics, globalization has been little more than an American project aimed at expanding U.S. economic, military, and cultural dominance. Yet, since the 1980s, Japanese sushi has gone as global as Latin American telenovelas or fundamentalist Islam, while massive inflows of Hispanic immigrants have had a huge impact on U.S. society.

    Indeed, it is hard to defend the proposition that globalization is a one-way street designed to spread American values and interests around the world. The changes wrought by globalization have enabled new and improbable rivals to dispute America's hegemony in a wide variety of sectors. Al Qaeda and the Taliban have proven to be resilient adversaries for the mighty U.S. military. Their international mobility, funding sources, and recruiting prowess are greatly enhanced by the forces that drive globalization: ease of travel, transportation, and communication; economic liberalization; and porous borders. The sovereign wealth funds from Asia and the Middle East that have displaced American banks, the successful challenge that Indian filmmakers and Latin TV producers have mounted against Hollywood's leadership in the global entertainment markets, and the success of Chinese manufacturers are also rooted in a world shaped by two decades of rapid economic growth and globalization.

    The United States has greatly benefited from globalization. But it has hardly been alone in doing so.

    "Great Power Politics Are Back."

    They never went away. We only thought they did.

    Back in the 1990s, the dominant view of globalization held that booming business ties between countries were the best antidote to war. International commerce was seen as a strong countervailing force against nationalistic impulses. Thanks to revolutionary innovations in information technology, communication, and transportation, distance and geography were perceived to be less important in shaping international politics and economics. Power, it was thought, would inevitably shift from governments to the private sector and nongovernmental organizations.

    These ideas, popularized in articles and books with titles like The End of History, The Death of Distance, and The Lexus and the Olive Tree, gained wide acceptance during the 1990s. Then came the attacks of Sept. 11, 2001. Minimalist government went out of fashion and demands mounted for the state to provide security at any cost. The financial crisis has amplified this trend. Laissez-faire is out and activist governments are in; deregulation has become a four-letter word and the cry for more government control of the financial sector is universal.

    Now that the world economy has tanked, globalization skeptics say the value of commercial ties as a prophylactic against conflict has weakened along with it. And with the return of stronger governments, they say, traditional power plays between rival countries are bound to intensify. Evidence for this view abounds, from resurgent nationalism in Russia, Asia, and Latin America to the obvious role of history and geography in fueling the conflicts in the Middle East and South Asia. Such examples, they argue, show that the stabilizing effects of economic globalization are vastly overstated.

    But claims about the return of strong governments and nationalism are equally overstated. Yes, China might team up with Russia to counterbalance the United States in relation to Iran, but meanwhile, the Chinese and U.S. economies will be joined at the hip (China holds more than a trillion dollars of U.S. debt and the United States is the main destination for its exports). Russian Prime Minister Vladimir Putin's tough talk about restoring his country's international standing and challenging America's leadership will be hard to sustain given that Russia's economy is one of the most damaged by the financial crisis, and the oil revenues that enabled its newfound influence are dwindling. Venezuelan President Hugo Chávez is inviting foreign oil companies back.

    The bottom line: Nationalism never disappeared. Globalization did not lessen national identities; it just rendered them more complex. Even in a Bill Gates era, today's Otto von Bismarcks still wield great power. Globalization and geopolitics coexist, and neither is going anywhere.

    "Globalization Is by and for Rich People."

    Go tell the Indians. Or, for that matter, the Chinese, or the emerging middle classes in Brazil, Turkey, Vietnam, and countless other countries that owe their recent success to trade and investment booms facilitated by globalization. Until the financial crisis broke out in 2008, the middle class in poor countries was the fastest-growing segment of the world's population.

    This trend will undoubtedly slow, and in some countries it will be tragically reversed as the crisis pushes back large numbers of people into the ranks of the poor. But the fact is that in the past two decades, a significant number of poor countries succeeded in lifting tens of millions out of poverty thanks to globalization. In China, for example, the poverty rate fell 68 percent between 1981 and 2005.

    China and India are the paradigmatic examples. Unfortunately, they are also paradigmatic examples of countries where abject poverty coexists with obscene wealth. In poor and rich countries alike, economic inequality has become a major concern and globalization, especially the freer trade it produces, often gets blamed as the source of widening income disparities. It's maddeningly hard, though, to prove that globalization actually produces inequality. We don't even know whether inequality in the world is going up or down.

    When economists Pinelopi Goldberg and Nina Pavcnik recently examined the connection between globalization and inequality, they could not establish a causal link between the two—even after surveying all the major studies on the subject and examining the best available data. In 2008, economists Sudhir Anand and Paul Segal published the results of their equally ambitious survey of recent research on global inequality. They, too, failed to establish a clear trend. "It is not possible to reach a definitive conclusion regarding the direction of change in global inequality over the last three decades," they wrote. On the other hand, the evidence that absolute poverty has sharply declined during the same time frame is overwhelming.

    "Globalization Has Made the World a Safer Place."

    Not really. It's true that in the past 20 years, the number of armed conflicts between countries has plummeted. Even accounting for the wars in Iraq and Afghanistan, the amount of armed conflict in the world is at an ebb not seen since the 1970s. One study found that between 1989 and 2003, only seven wars between nation-states broke out. The likelihood that any given country was embroiled in a conflict was at its lowest point since the 1950s.

    The problem is that other forms of conflict and violence have soared. The number of people killed or injured by terrorists has gone from about 7,000 in 1995 to more than 25,000 in 2006. Very often, these terrorist attacks are either directly carried out by foreigners or planned, funded, and coordinated by networks that operate internationally. Violent crimes are also going up in many countries, especially the poorest ones. Often, these high crime rates result from the activities of international criminals, mainly narcotraffickers. These days, more beheadings are taking place in Mexico than in Iraq or Afghanistan. Many European countries are reporting higher crime rates as a result of the expanded presence of international criminal gangs in their midst. One could also add the spread of contagious diseases and nuclear proliferation to the list.

    Today's world may be at a lower risk for total annihilation than it was when rival superpowers armed with large nuclear arsenals threatened each other with mutual assured destruction. But we now live in an age where a large and growing number of actors empowered by globalization have the potential to cause large-scale damage and substantial loss of human lives. (The fading memory of an era when the fate of the planet hinged upon Soviet bureaucrats, rather than rogue Pakistani scientists, seems quaintly comforting in 2009.) As the economic crisis deepens, desperation might lead to heightened violence, and some governments might be more tempted to exploit international conflicts to distract their impoverished populations from their dire situations at home.

    "The Financial Crisis Is a Symptom of Globalization Run Amok."

    No, you just think it is. Longtime antiglobalization activists such as Naomi Klein may feel vindicated by the present state of affairs, faulting villains on Wall Street and in world capitals for promoting a form of "disaster capitalism" that has spiraled out of control. Yes, globalization has multiplied the number of problems that no organization or country can solve on its own: not just international economic crises, but also nuclear proliferation, illegal migration, transnational crime, pandemics, and more. The need to collaborate in solving collective problems is as obvious as the difficulties in achieving solutions. The world's multilateral institutions are Cold War holdovers more often described as "dysfunctional" than "indispensable."

    But they are indispensable, and with the world in crisis mode, demands to shore up global governance have increased. But no matter how many high-level commissions, think-tank reports, books, and articles on the subject, these efforts have not yielded urgently needed drastic changes in multilateral institutions, international law, rules, and coordinating mechanisms.

    One reason for the lack of progress: There's still no clarity on how to overcome the obstacles that have long blocked any major reforms. Most proposals for a global governance structure built for the globalization era rest on the assumption that what has been missing is the political will of the world's most powerful countries, notably the United States. This approach fails to address the obvious fact that collaborating with others often means relinquishing power, a concession that does not come easily to sovereign nations.

    This does not mean that countries ought to cede power to a world government or to an all-powerful, supranational entity that will rule over world affairs. It is precisely because such an institution is not possible that governments must collaborate with one another more effectively. Yet that is a goal that has proved very elusive.

    Unfortunately, it is highly likely that the efforts to minimize the costs of globalization, steer international integration, solve international crises, and better manage the global commons will continue to fall short. Whether the issue is climate change or terrorism, loose nukes or avian flu, the gap between the need for effective collective action at the global level and the ability of the international community to satisfy that need is the most dangerous deficit facing humanity.

    Moisés Naím is editor in chief of Foreign Policy.



    Congo - land of sheer anarchy

     
    From Foreign Policy www.foreignpolicy.com.
     
    Excerpts:
     
    The Congolese government's inability to control its territory has resulted in one of the world's longest and most violent wars. About 4 million people died between 2000 and 2004 -- and that was merely one episode of the ongoing conflict. War has led to the predation of the various armies on the civilian populations, the destruction of what were the country's transport and agrarian systems, and the collapse of any semblance of public health. Internationally, Congo has gained notoriety for the tremendous violence suffered by its civilians and the widespread use of rape as a method of coercion.
    ...
    To clean up the mess, the Central African country has been home to one of the world's largest peacekeeping operations. More than 18,400 United Nations peacekeeping troops and observers are stationed in Congo at an annual cost of $1.24 billion. Yet recent events demonstrate just how impossible their task has become.
     
    Read the source here.
     

    There Is No Congo
    By Jeffrey Herbst, Greg Mills
     
    Posted March 2009
    Why the only way to help Congo is to stop pretending it exists.

    WALTER ASTRADA/AFP/Getty Images
    Awaiting a fix: A Congolese woman greets U.N. envoy Olusegun Obasanjo with high expectations, "We expect you to bring a final solution."

    The international community needs to recognize a simple, albeit brutal fact: The Democratic Republic of the Congo does not exist. All of the peacekeeping missions, special envoys, interagency processes, and diplomatic initiatives that are predicated on the Congo myth -- the notion that one sovereign power is present in this vast country -- are doomed to fail. It is time to stop pretending otherwise.

    Much of Congo's intractability stems from a vast territory that is sparsely populated but packed with natural resources. A mostly landlocked expanse at the heart of Africa, Congo comprises 67 million people from more than 200 ethnic groups. The country is bordered by nine others -- among them some of the continent's weakest states.

    A local Kiswahili saying holds, "Congo is a big country -- you will eat it until you tire away!" And indeed, for centuries, this is precisely what Congo's colonial occupiers, its neighbors, and even some of its people have done: eaten away at Congo's vast mineral wealth with little concern for the coherency of the country left behind. Congo has none of the things that make a nation-state: interconnectedness, a government that is able to exert authority consistently in territory beyond the capital, a shared culture that promotes national unity, or a common language. Instead, Congo has become a collection of peoples, groups, interests, and pillagers who coexist at best.

     

    Congo today is a product of its troubled history: a century of brutal colonialism, 30 years of Cold War meddling and misrule under U.S. ally Mobutu Sese Seko, and more than a decade of war following his ouster in 1997. That conflict, which embroiled much of southern Africa, brought rebel leader Laurent Kabila, a one-time revolutionary colleague of Che Guevara, to power. Kabila was assassinated just a few short years later, leaving his son, Joseph Kabila, in office in Kinshasa, Congo's ostensible capital.

     

    The younger Kabila inherited a broken infrastructure and a tenuous national identity shaped on repression and patronage rather than governance and the supply of basic services. Despite winning internationally sponsored elections in 2006, he still struggles to rule over a territory one quarter of the size of the United States, where a nebulous sense of Congolese identity -- based on French, music, and a shared oppressive history -- has not translated into allegiance to the Congolese state. Innumerable secessionist attempts, including those instigated by his father, have turned Congo into ungovernable fiefdoms tenuously linked to the center. Kabila has few tools at his disposal. There is little in the way of a disciplined army and police force; they are more used to living off than serving the population. Like Mobutu before him, Kabila is dependent on patronage to remain in power and on revenue from aid flows and mining taxes.

     

    Economically, the various outlying parts of Congo are better integrated with their neighbours than with the rest of the country. For instance, it is hard for anyone sitting in Lubumbashi, the capital of mineral-rich Katanga province in the far southeast, to see Kinshasa as ruling. It is a two-day journey from Lubumbashi to South Africa's Johannesburg; the trip from Katanga to Kinshasa -- of similar distance -- is seldom attempted, even contemplated. With more in common with its southern Anglophone neighbors than with Kinshasa, no wonder one Zambian minister privately refers to Katanga as "Zambia's 10th province." Congo's neighbors have learned to ignore its sovereignty.

     

    The Congolese government's inability to control its territory has resulted in one of the world's longest and most violent wars. About 4 million people died between 2000 and 2004 -- and that was merely one episode of the ongoing conflict. War has led to the predation of the various armies on the civilian populations, the destruction of what were the country's transport and agrarian systems, and the collapse of any semblance of public health. Internationally, Congo has gained notoriety for the tremendous violence suffered by its civilians and the widespread use of rape as a method of coercion.

    The many combatants in today's Congo have little incentive to form a united country; they benefit from the violent chaos that ensures that so many can pick at the country's resources. The international community does not have the will or the resources to construct a functional Congo. Nor do neighbors want one Congo, as many find it easier to deal with a plethora of ungoverned parts over which they can exert influence. Rwanda, Angola, and Uganda, for example, have all intervened to protect their security interests over the past decades.

     

    To clean up the mess, the Central African country has been home to one of the world's largest peacekeeping operations. More than 18,400 United Nations peacekeeping troops and observers are stationed in Congo at an annual cost of $1.24 billion. Yet recent events demonstrate just how impossible their task has become. Early this year, Rwandan troops entered eastern Congo's two Kivu provinces with Kinshasa's permission to flush out rebel Hutu militias left over from the Rwandan genocide a decade ago. Despite achieving some military success, reprisals by the Hutu militias left more than 100 civilians dead.

     

    The Kivu provinces are not the only restive areas. Trouble has flared sporadically in the Bas-Congo, Ituri, Katanga, and Kasai provinces of sub-Saharan Africa's largest state. At January 2008's peace talks, the government categorized one of the largest rebel groups, the CNDP, as just one of two dozen armed militias not under government control. Nationwide elections in 2006, on which the international community spent more than a billion dollars, did little to mend Congo's many divisions.

     

    Given the immense human tragedy, it is time to ask if provinces such as the Kivus and Katanga (which are themselves the size of other African countries) can ever be improved as long as they fall under a fictional Congolese state. Although African states recognize the borders on paper, Congo's neighbors have often acted as if no such lines exist. The international community is the only remaining player devoting large amounts of resources to the idea of one Congo -- with dismal returns.

     

    A solution to Congo's troubles is possible with a reimagined approach. The West could start by making development and order its first priority in the Congolese territory, rather than focusing on the promotion of the Congolese state. This simple distinction immediately casts the Congolese problem in a whole new light. It would mean, for instance, that foreign governments and aid agencies would deal with whomever exerted control on the ground rather than continuing to pretend that Kinshasa is ruling and running the country. Such an approach might bring into the picture a confusing array of governors, traditional leaders, warlords, and others rather than the usual panoply of ministers. But that would finally be a reflection of who is actually running Congo.

     

    Instead of continuing to spend billions of dollars on putting Congo together, the international community could regionally address actual security and political problems. For instance, troubles in eastern Congo have as much to do with continuing Rwandan insecurity than with what the government in Kinshasa is (or is not capable of) doing. A more realistic foreign policy toward eastern Congo would assign a high priority to Rwandan security interests, given that many derive from the wake of the 1994 genocide. Get this right and there might actually be a chance to reduce the violence that has haunted the Kivus. It would also incentivize the Rwandans to see Congo as a natural partner in trade and development rather than a security problem to be managed unilaterally. Joint Congolese-Rwandan operations early this year are a step in this direction.Congo is rightly notorious for being one of the most pathological instances of the European division of Africa. Perhaps as a result, Western powers have shied away from anything other than reflexively trying to get Congo to work within the boundaries that the king of Belgium helped establish in 1885. Setting aside the scope of human tragedy, there are real reasons that getting things right in Congo matters now more than ever. The country is the region's vortex; when it has failed in the past, its neighbors have often gone down with it.

     

    The very concept of a Congolese state has outlived its usefulness. For an international community that has far too long made wishful thinking the enemy of pragmatism, acting on reality rather than diplomatic theory would be a good start.


    Jeffrey Herbst is provost of Miami University in Ohio.
    Greg Mills directs the Johannesburg-based Brenthurst Foundation.