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Killing Children: The Sad Politics behind the Yemen Health Crisis

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Interview with Dr. Matthew Crosston about the situation in Yemen, conducted by journalist Mohammad Homaeefar for the Tehran Times in Iran. August 2017

Yemen’s Ministry of Health estimates that at least 10,000 Yemenis died from lack of access to the international medical treatment that they had sought. What countries are responsible for the medieval siege that led to such catastrophe?

The obvious and easy short answer is that the Saudi-led and Saudi-constructed land, air, and sea blockade of Yemen is responsible. Since the official start of military operations on March 26, 2015 it has been incredibly difficult to import the necessary medicines needed for the treatment of both basic and more complex illnesses and diseases. Unfortunately, a more subtle and less-noticed aspect in the West about the blockade is that it has also hindered the importation of essential raw materials that would at least give local hospitals and clinics around Yemen the opportunity to manufacture their own medicines on site. The reason for this raw materials ban is the cursed multi-functionality of such resources: some of these raw materials that could make critical medicines could also, if stolen or commandeered by illicit actors, be used to manufacture explosives. Anything that has the potentiality for such dual-usage has been basically restricted by blockade forces. Alas, you can interpret that dual functionality in either liberal or conservative ways: if the latter, then local hospitals in Yemen would have access to these resources and thus be capable of manufacturing their own medicines. However, if the interpretation is liberal (and the Saudi-led blockade is certainly defining it in extremely liberal ways), then almost nothing gets through and hospitals and clinics are left to try to help the sick with almost no medicine whatsoever. This is what has caused an outbreak of illnesses and disease that really should not be existing at all.

Reports indicate that since the outbreak of Cholera in Yemen in April, attempt to get the disease under control have all been in vain. Thousands have been inflicted and around 1,900 lost their lives according to local sources. What should the UN do in this regard?

Given the information I relayed above, the only substantive and effective policy change the UN could try to do is directly appeal to and put influence on the Saudi-led coalition blockade. Specifically, the UN needs to define either a list of essential medicines or critical raw resources that could locally manufacture medicines and then ENSURE that the Saudi-led blockade would not interfere or hinder the delivery of such materials. In addition, if the UN was feeling especially pro-active and helpful (which, admittedly, it often doesn’t in active war zones), then it would also use UN-led forces to ensure the quality of the resources and their successful delivery to critical medical points all over Yemen. If these two things could be done, then there would be a significant improvement in the medical crisis in Yemen, if not necessarily a lessening of the political conflict overall.

Is the international community helping Yemen to combat cholera? What are the obstacles to the delivery of humanitarian aid?

Allow me to not repeat myself from the previous two questions and focus on some other nuances in this crisis that need more attention. First, war is not just complex, it is utterly chaotic. While the Saudi-led blockade continues to get in the way of the delivery of essential medicines and acts as a hindrance to international humanitarian organizations truly inspired and motivated to make a difference on the ground (like the Red Cross and WHO), Saudi Arabia also pledged fully, along with other countries like the United States, Kuwait, the UK, and Germany, $1.1 billion dollars to help alleviate the suffering and medical crisis in Yemen. How should we interpret this confusing contradictory policy? The nation that constructed the blockade and other major Western powers tacitly approving its continuation (which has basically caused this health crisis) are simultaneously pledging to alleviate suffering with financial aid?

One first immediate problem, of course, is that this pledge has not yet been fulfilled and so there is not nearly enough money being put into Yemen to alleviate suffering. The second problem is an internal one: as is the case with any war zone, it is nearly impossible to guarantee the safe and accurate delivery of supplies to those most in need because of organized crime, corruption, and illicit activity inside of the country. Just delivering the supplies in-country is not enough: they must be physically delivered to the very door of the needed facilities. Otherwise, the efficiency percentage plummets dramatically. In this case, not only will the cholera epidemic not improve, we will start to see the emergence of other diseases and medical crises will go unchecked. Unfairly, the pledge givers of aid usually demand that these internal problems get resolved before actual funds are dispersed. However, in this case, the same pledge-givers are the drivers of the situation creating the domestic obstacles. Hypocritical and contradictory dilemmas like these are what drive Yemen analysts to despair.

Saudi Arabia has targeted and bombed many of Yemen’s hospitals and health centers. What does the regime want to accomplish by such acts?

I wish there was some unique and compelling reason being offered as to why this would be happening, but reality reveals the same tired old clichés being used on the global stage. Namely, that Saudi Arabia is not ‘purposely’ targeting civilian sites like hospitals but that ‘mistakes have sometimes taken place.’ And then, of course, the classic inversion technique is applied: the Saudis will say if only the Houthi rebels would stop mixing/hiding within civilian populations, then such mistakes would be less common. What most analysts tend to not follow up with when such statements are made is to ask Saudi Arabia if it thinks it would be more appropriate for the Houthi rebels to come out into the open on vast desert plains, far away from any civilian locations, so that they could be bombed indiscriminately?

The nature of asymmetrical warfare demands that the less-advantaged rival has to employ unorthodox tactics in order to just survive. Unfortunately, that does sometimes involve hiding within civilian areas. This is not new, by any means, or unique to the Houthis. While the rules of war have long been against such actions from smaller parties, these rules have also always been adamant that in such situations the superior military force is not supposed to engage civilian sites and must seek other strategies to ‘flush out its enemy.’ It seems apparent, as analyzed by outside global agencies, that Saudi Arabia has not truly made that effort when trying to destroy Houthi groups.

We have to be sadly careful when we think the global humanitarian community can be a force for good on this problem. To wit: the UN included Saudi Arabia in 2016 on a list of ‘violators of children’s rights’ largely because of the disturbing reports about hospital bombings. Alas, only one week later Saudi Arabia was removed from the list, pending further review. Astonishingly, former Secretary General Ban Ki-Moon said the reason for the removal was that Saudi Arabia had threatened to pull its funding of UN humanitarian programs, though the Kingdom steadfastly denied any such conversations took place. So, on an issue that seems to easily define the moral high ground (do not bomb hospitals or deny sick children medicine), we see how quickly it becomes morally bankrupt in the Yemen conflict – with elements of de facto diplomatic extortion, intimidation, and the violation of long-standing ethical tradition in war. The end result is depressingly familiar: all sides declare how horrible it is that children are suffering and that hospitals are getting destroyed but then conveniently distract us from realizing that they are very same actors ultimately causing the suffering and destruction in the first place. Killing children in the name of political expediency and the pursuit of military, political, and national interests.

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After 10 years of war in Syria, siege tactics still threaten civilians

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The future for Syria’s people is “increasingly bleak”, UN-appointed rights experts said on Tuesday, highlighting escalating conflict in several areas of the war-ravaged country, a return to siege tactics and popular demonstrations linked to the plummeting economy.

According to the UN Commission of Inquiry on Syria, the country is not safe for refugees to return to, after a decade of war.

The panel’s findings come amid an uptick in violence in the northwest, northeast and south of the country, where the Commissioners highlighted the chilling return of besiegement against civilian populations by pro-Government forces.

“The parties to the conflict continue to perpetrate war crimes and crimes against humanity and infringing the basic human rights of Syrians,” said head of the Commission of Inquiry, Paulo Pinheiro. “The war on Syrian civilians continues, and it is difficult for them to find security or safe haven.”

Scandal of Al Hol’s children

Professor Pinheiro also described as “scandalous” the fact that many thousands of non-Syrian children born to former IS fighters continue to be held in detention in dreadful conditions in Syria’s north-east.

“Most foreign children remain deprived of their liberty since their home countries refuse to repatriate them,” he told journalists, on the sidelines of the 48th session of the Human Rights Council in Geneva.

“We have the most ratified convention in the world, the Convention on the Rights of the Child, is completely forgotten. And democratic States that are prepared to abide to this Convention they neglect the obligations of this Convention in what is happening in Al Hol and other camps and prison places.”

Some 40,000 children continue to be held in camps including Al Hol. Nearly half are Iraqi and 7,800 are from nearly 60 other countries who refuse to repatriate them, according to the Commission of Inquiry report, which covers the period from 1 July 2020 to 30 June 2021. 

Blockades and bombardment

The rights experts also condemned a siege by pro-Government forces on the town of Dar’a Al-Balad, the birthplace of the uprising in 2011, along with “siege-like tactics” in Quineitra and Rif Damascus governorates.

“Three years after the suffering that the Commission documented in eastern Ghouta, another tragedy has been unfolding before our eyes in Dar’a Al-Balad,” said Commissioner Hanny Megally, in reference to the siege of eastern Ghouta which lasted more than five years – and which the commissioners previously labelled “barbaric and medieval”.

In addition to the dangers posed by heavy artillery shelling, tens of thousands of civilians trapped inside Dar’a Al-Balad had insufficient access to food and health care, forcing many to flee, the Commissioners said.

Living in fear

In the Afrin and Ra’s al-Ayn regions of Aleppo, the Commissioners described how people lived in fear of car bombs “that are frequently detonated in crowded civilian areas”, targeting markets and busy streets.

At least 243 women, men and children have been killed in seven such attacks over the 12-month reporting period, they said, adding that the real toll is likely to be considerably higher.

Indiscriminate shelling has also continued, including on 12 June when munitions struck multiple locations in Afrin city in northwest Syria, killing and injuring many and destroying parts of al-Shifa hospital.

Insecurity in areas under the control of the Syrian Democratic Forces (SDF) in northeast Syria has also deteriorated, according to the Commission of Inquiry, with increased attacks by extremist “remnants” and conflict with Turkish forces.

Division remains

The Commissioners noted that although President Assad controls about 70 per cent of the territory and 40 per cent of the pre-war population, there seems to be “no moves to unite the country or seek reconciliation. On the contrary.”

Despite a welcome drop in the level of violence compared with previous years, the Commission of Inquiry highlighted the dangers that continue to be faced by non-combatants

The senior rights experts also highlighted mounting discontent and protests amongst the population, impacted by fuel shortages and food insecurity, which has increased by 50 per cent in a year, to 12.4 million, citing UNFPA data.

“The hardships that Syrians are facing, particularly in the areas where the Government is back in control, are beginning to show in terms of protests by Syrians who have been loyal to the State,” said Mr. Megally. They are now saying, ‘Ten years of conflict, our lives are getting worse rather than getting better, when do we see an end to this?’”

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IAEA Director General reaches agreement in Tehran, as Biden’s clock is ticking

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IAEA Director General Rafael Grossi at a press conference. Photo: IAEA/Dean Calmaa

A meeting to resolve interim monitoring issues was held in Tehran on 12 September between the head of Iran’s Atomic Energy Organization, Mohammad Eslami, and the Director General of the International Atomic Energy Agency (IAEA), Rafael Grossi. Grossi was on a visit to Tehran to fix roadblocks on the stalled monitoring of Iran’s nuclear program, which is ever more challenging in a context where there is no diplomatic agreement to revive or supersede the JCPOA. Grossi said in a press conference on 12 September that the IAEA had “a major communication breakdown” with Iran. But what exactly does that mean?


The IAEA monitoring equipment had gone three months without being serviced and Grossi said he needed “immediate rectification” of the issues. He was able to get the Iranian side to come to an agreement. The news from Sunday was that the IAEA’s inspectors are now permitted to service the identified equipment and replace their storage media which will be kept under the joint IAEA and AEOI seals in Iran. The way and the timing are now agreed by the two sides. The IAEA Director General had to push on the terms of the agreement reached in February 2020.

Grossi underlined on Sunday that the new agreement can’t be a permanent solution. Data from the nuclear facilities is just being stored according to what commentators call “the continuity of knowledge” principle, to avoid gaps over extended time periods but the data is not available to inspectors.

When it’s all said and done, basically, it all comes down to the diplomatic level. The American withdrawal from the JCPOA nuclear agreement in 2018 keeps undermining the Iran nuclear inspections on the technical level. All the inspection activities have been stalled as a result of the broken deal. The IAEA’s strategy in the interim is that at least the information would be stored and not permanently lost.

Everyone is waiting for the JCPOA to be restored or superseded. As Vali Nasr argued in the New York Times back in April this year, the clock is ticking for Biden on Iran. Iran diplomacy doesn’t seem to be on Biden’s agenda at all at the moment. That makes the nuclear inspectors’ job practically impossible.  Journalists pointed out on Sunday that the Director General’s visit found one broken and one damaged camera in one of the facilities. Grossi assured it has been agreed with Iran that the cameras will be replaced within a few days. The IAEA report notes that it was not Iran but Israel that broke the IAEA cameras in a June drone attack carried out by Israel. Presumably, Israel aimed to show Iran is not complying by committing the violations themselves.

Grossi’s visit was a part of the overall IAEA strategy which goes along the lines of allowing time for diplomacy, without losing the data in the meantime. He added that he thinks he managed to rectify the most urgent problem, which is the imminent loss of data.

The Reuters’s title of the meeting is that the agreement reached on Sunday gives “hope” to a renewed Iran deal with the US, after Iran elected a hardliner president, Ebrahim Raisi, in August this year, but that’s a misleading title. This is not the bit that we were unsure about. The question was never on the Iranian side. No one really expected that the new Iranian president would not engage with the IAEA at all. Earlier in November 2019, an IAEA inspector was not allowed on a nuclear cite and had her accreditation canceled. In November 2020, Iranian lawmakers passed a law that mandated the halt of the IAEA inspections and not to allow inspectors on the nuclear sites, as well as the resuming of uranium enrichment, unless the US sanctions are lifted. In January 2021, there were threats by Iranian lawmakers that IAEA inspectors would be expelled. Yet, the new Iranian President still plays ball with the IAEA.

It is naïve to think that Iran should be expected to act as if there was still a deal but then again, US foreign policy is full of naïve episodes. “The current U.S. administration is no different from the previous one because it demands in different words what Trump demanded from Iran in the nuclear area,” Khamenei was quoted to have said in his first meeting with President Raisi’s cabinet.

“We don’t need a deal – you will just act as if there was still a deal and I will act as if I’m not bound by a deal” seems to be the US government’s line put bluntly. But the ball is actually in Biden’s court. The IAEA Director General is simply buying time, a few months at a time, but ultimately the United States will have to start moving. In a diplomatic tone, Grossi referred on Sunday to many commentators and journalists who are urging that it is time.

I just don’t see any signs on Biden’s side to move in the right direction. The current nuclear talks we have that started in June in Vienna are not even direct diplomatic talks and were put on hold until the outcome of Iran’s presidential elections were clear. US hesitance is making Grossi’s job impossible. The narrative pushed by so many in the US foreign policy space, namely that the big bad wolf Trump is still the one to blame, is slowly fading and reaching its expiry date, as Biden approaches the one-year mark of his presidency.

Let’s not forget that the US is the one that left and naturally is the one that has to restart the process, making the parties come back to the table. The US broke the deal. Biden can’t possibly be expecting that the other side will be the one extending its hand to beg for forgiveness. The US government is the one that ruined the multi-year, multilateral efforts of the complex dance that was required to get to something like the JCPOA – a deal that Republicans thought was never going to be possible because “you can’t negotiate with Iran”. You can, but you need skilled diplomats for that. Blinken is no Kerry. Judging from Blinken’s diplomacy moves with China and on other issues, I just don’t think that the Biden Administration has what it takes to get diplomacy back on track. If he follows the same line with Iran we won’t see another JCPOA in Biden’s term. Several weeks ago, Biden said that there are other options with Iran if diplomacy fails, in a White House meeting with Israel’s new prime minister Bennett. I don’t think that anyone in the foreign policy space buys that Biden would launch a military attack on Iran’s nuclear facilities. But I don’t think that team Biden can get to a diplomatic agreement either. Biden and Blinken are still stuck in the 2000, the time when others would approach the US no matter what, irrespective of whose fault it was. “You will do as I say” has never worked in the history of US foreign policy. That’s just not going to happen with Iran and the JCPOA. To expect otherwise is unreasonable. The whole “Trump did it” line is slowly and surely reaching its expiry date – as with anything else on the domestic and foreign policy plane. Biden needs to get his act together. The clock is ticking.

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Elections represent an opportunity for stability and unity in Libya

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With just over 100 days until landmark elections in Libya, political leaders must join forces to ensure the vote is free, fair and inclusive, the UN envoy for the country told the Security Council on Friday. 

Ján Kubiš, Special Representative of the Secretary-General and Head of the UN Support Mission in Libya (UNSMIL) briefed ambassadors on developments ahead of presidential and parliamentary elections due to take place on 24 December. 

They were agreed under a political roadmap stemming from the historic October 2020 ceasefire between Libya’s rival authorities, and the establishment of a Government of National Unity (GNU) earlier this year. 

At the crossroads 

“Libya is at a crossroads where positive or negative outcomes are equally possible,” said Mr. Kubiš.  “With the elections there is an opportunity for Libya to move gradually and convincingly into a more stable, representative and civilian track.” 

He reported that the House of Representatives has adopted a law on the presidential election, while legislation for the parliamentary election is being finalized and could be considered and approved within the coming weeks.  

Although the High National Election Commission (HNEC) has received the presidential election law, another body, the High State Council, complained that it had been adopted without consultation. 

Foreign fighter threat 

The HNEC chairman has said it will be ready to start implementation once the laws are received, and will do everything possible to meet the 24 December deadline. 

“Thus, it is for the High National Election Commission to establish a clear electoral calendar to lead the country to the elections, with support of the international community, for the efforts of the Government of National Unity, all the respective authorities and institutions to deliver as free and fair, inclusive and credible elections as possible under the demanding and challenging conditions and constraints,” said Mr. Kubiš.  

“The international community could help create more conducive conditions for this by facilitating the start of a gradual withdrawal of foreign elements from Libya without delay.” 

Young voters eager 

The UN envoy also called for countries and regional organizations to provide electoral observers to help ensure the integrity and credibility of the process, as well as acceptance of the results. 

He also welcomed progress so far, including in updating the voter registry and the launch of a register for eligible voters outside the country. 

So far, more than 2.8 million Libyans have registered to vote, 40 per cent of whom are women.  Additionally, more than half a million new voters will also be casting their ballots. 

“Most of the newly registered are under 30, a clear testament to the young generation’s eagerness to take part in determining the fate of their country through a democratic process. The Libyan authorities and leaders must not let them down,” said Mr. Kubiš. 

He stressed that the international community also has a responsibility to support the positive developments in Libya, and to stand firm against attempts at derailment.  

“Not holding the elections could gravely deteriorate the situation in the country, could lead to division and conflict,” he warned.  “I urge the Libyan actors to join forces and ensure inclusive, free, fair parliamentary and presidential elections, which are to be seen as the essential step in further stabilizing and uniting Libya.”

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