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Violence against Healthcare: Social and Humanitarian Implications

Alina Toporas

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Historically, medical treatment during conflict has not been taken for granted as it is nowadays. For instance, in the 16th century, soldiers were not immediately taken from the battlefield to the nearest medical treatment facility, they had to wait two or more days until their conditions stabilized. Worst case scenario, they wouldn’t make it. Their sufferings were alleviated when the first surgeon began treatment on wounded soldiers. Ambroise Pare was the one who decided to give them a chance at survival. Therefore, back in the day, the term “violence” could not be associated with “healthcare”, since there wasn’t any humanitarian assistance available in the first place.

In the 21st, violence against healthcare does very much happen. Campaigns such as “Health Care in Danger” conducted by the ICRC and reports such as the UN Special Rapporteur on the Right to Health have coined the phrase “compounded cost of violence on healthcare” as a result of this type of violence occurring.

The case of Syria is a tragic example and it might seem more relatable to the general public due to the fact that is a contemporary humanitarian disaster. In one of the reports on ‘Protecting Healthcare in Conflict’ released by the Commission of Inquiry on Syria demonstrates just how devastating is the purposeful zeroing in on the destruction of medical facilities, the targeting of health care staff and the refusal of certain ethnic groups to allow the treatment of the ill and wounded. These attacks are having consequences of paramount importance on the increasingly significant exodus of healthcare staff, the vaccination campaigns that are being sharply curtailed and the inventory that is facing a seemingly insurmountable stock-out.

Variations in Violence

The most pervasive mode of violent attacks is on the medical personnel, irrespective of the fact that they are from an INGO or belong to the local workforce.  According to Bruce Eshaya-Chauvin, medical adviser to the ICRC, “healthcare workers in conflict zones are literally being hunted down”. Through the killing by armed groups of expatriate healthcare staff, their kidnapping from the workplace, their arrests and the constant threats coming from insurgents and governments in an equal manner, not to mention the countless explosive weapons used by armed forces during combat that render medical staff collateral victims and cause them severe injuries or even death, the healthcare system is being shattered from its roots.

Interesting cases have occurred when medical staff have been threatened to provide care for specific ethnic groups during the hijacking of an ambulance. An assistant medical coordinator at the ICRC in Bangui, Central African Republic recalled an instance in which she was “threatened by armed men who insisted on getting in the car and making us take them where they wanted to go. When we tried to explain our work to them they became angry and threatened us with machetes and rifles.” (“Effects of Violence on Healthcare”, 2014)

Another way through which violence against medical staff can be seen is through the limitation imposed by armed groups on the doctors while practising their jobs. For instance, a certain Dr. Cox talked to Discovery News about the rules of war and his experiences in Congo by saying that due to mortar rounds having fallen near the hospital, he had to tap the windows of the operating room to prevent them from shattering and perform the surgery while wearing body armour. This severely limits the way they practise medicine and puts them under constant psychological terror.

Violent events that are affecting the healthcare system as a whole are also those aimed at healthcare buildings. By buildings, it is meant hospitals, blood transfusion centres, laboratories, first-aid centres and those buildings in which medication and medical equipment is stored. Healthcare infrastructure is being hit by weapons during conflict, is being entered into by police and state armed forces or is being occupied for strategic reasons by armed groups. This ultimately leads to hospitals being unable to run generators because of lack of fuel or to the same healthcare buildings running out of drugs. According to the World Health Organization, 37% of the hospitals from Syria have been destroyed, while 20% have been severely damaged. There, the hospital under MSF jurisdiction was completely destroyed together with the rest of the town. This was the only hospital with surgery capabilities and the ability to provide treatment for tuberculosis and HIV for 270,000 people. Having suffered such a high degree of destruction – medical equipment, laboratory work and blood transfusions being thoroughly dismantled – it became extremely difficult for MSF to resume its activities. Nevertheless, the MSF personnel did manage to resume its activities by treating approximately 1,600 malnourished children only in the first 3 weeks.

Violent events also affect healthcare transportation. By transportation, it is meant medical vehicles such as ambulances, medical aircrafts, medical ships and machines used for the transportation of medical equipment or medical supplies. These vehicles are being attacked while en route by armed groups or state armed forces, they are being damaged by the same groups with the help of explosive devices and, most commonly, are being delayed and harassed at checkpoints. According to the Syrian-American Medical Society, 78% of the ambulances operating on Syrian territory have been badly damaged. The most representative cases in point are the attacks on healthcare infrastructure happening in Libya, thoroughly reported by the international media and the aid organizations.

Patients are also being attacked. Some even refuse to go to the hospital for fear of being identified by their wounds. Bijan Farnoudi, from the ICRC, told Al Jazeera that “a lot of the time they die because the ambulance didn’t make it in time, because the hospital they were trying to seek shelter in was destroyed the night before, or because they were simply too scared to travel to make it to the nearest clinic”, the latter also being a type of psychological violence against patients.

Doctor Rubin Coupland, a British war surgeon from the ICRC, is also advocating for the safety and dignity of patients by encouraging for the speeding of ambulance inspections at checkpoints. “It should take maybe five minutes to inspect an ambulance, not five hours”. He goes on to say that “you don’t have to put dogs in the ambulances to run all over the patients, as we’ve seen, to check for explosives”.

Another way through which patients are suffering from violence is by being abducted. For instance, in January 2014, the police raided a Ukrainian centre of the Red Cross. This event escaladed even further and the healthcare workers soon found themselves being shot at while witnessing the abduction of their wounded patients (“Attacks on Healthcare”, 2014)

Consequences of violence against healthcare

According to the Iraq’s health ministry, 18,000 out of 34,000 doctors fled the country between the years of 2003 and 2006 due to increasing violence. That led to the breakdown of the country’s health system, according to the founder of the NGO, Doctors for Iraq. The same individual warns that there are only 11 surgeons in Mogadishu, the Somali capital, “if anyone was killed, there would be no one to replace them”.

The worst-case  scenario in this situation is the complete withdrawal of entire agencies from disease-ridden areas. Unfortunately, this is not simply a scenario. For instance, MSF decided to pull out of Somalia in 2013, after 22 years of continuous humanitarian work due to the fact that 16 of its workers had been killed since 1991 and several had been attacked.

Both the fleeing and the withdrawal of healthcare workers have preposterous implications. The skills of these workers are often irreplaceable and the ability to recruit people after all the previous attacks becomes exceedingly problematic since they all have even more reasons to be afraid of getting killed.

There seems to be a whole campaign out there that has as its main purpose the targeting of anti-polio healthcare staff. For instance, only in Pakistan, in December 2012, 9 anti-polio workers were killed by gunshots, which led the United Nations to decide against the continuation of the eradication program in that zone of conflict. Approximately 2 weeks after this unfortunate incident, other 7 more workers, assigned to do community development work, were killed only because they were associated with the anti-polio work carried out by their colleagues. In February 2013, this time in Nigeria, members of an Islamist group killed 9 other healthcare workers. Since 2012, a shocking 60 healthcare workers dealing with anti-polio vaccinations have been killed, threatening a polio “renaissance”.

The same issue applies in terms of non-infectious chronic diseases. Because of this “militarization of healthcare”, many refugees are more predisposed towards overcharging and exploitation since they are not in their home country. Adjacently, the surge in non-infectious chronic diseases in war zones is something to keep an eye on since they are progressively in the foreground. Proof gathered from both natural disasters and warfare points out to the excess in mortality and morbidity as caused by non-infectious diseases such as diabetes, hypertension and cancer. Moreover, not being able to access basic medical care leads to a propensity towards outbreaks of cholera, dysentery, typhoid or hepatitis.  All those seemingly routine blood tests needed for chronic diseases, such as the thyroid stimulating hormone or different types of medications like an asthma inhaler become unavailable when violence against healthcare buildings, ambulances or stores occurs. Maternal deaths are another reason why the lack of international healthcare or the lack of access to it is so sharply felt. These deaths – that can otherwise be considered preventable – happen because of mishandled home deliveries, all the missed abortions which in many cases led to sepsis and all the conflict-related impediments that constrain both patients and physicians’ access to one another.

Since many doctors are being considered “enemies of the regime” for treating protestors, for instance, they are constantly targeted which makes hospitals unsafe places to seek treatment in. That leads to an increase in the setting up of alternative places to practice “medicine” such as makeshift hospitals, underground networks of healthcare workers or, in some cases, somebody’s living room.  People choose to be treated in these parallel healthcare establishments for fear of being arrested or, even worse, tortured by their ethnic group for entrusting their health to these medical practitioners that are viewed as foes. However, these places have unsustainable and disjointed care.

Non-measured, non-existent…

“What we are surprised about is how much these incidents almost go unnoticed” said Yves Daccord, the Director-General of the ICRC. This is probably due to the fact that all of these repercussions brought by violence on the healthcare system are equally tough to measure. As Rudi Coninx from the Emergency Risk Management and Humanitarian Response department at the World Health Organization stated, “If you ask someone at WHO, ‘What is the extent of the problem?’, if they were honest, they would say, ‘I don’t know’, as nobody collects these data in a systematic way”.

Legal Provisions 

A year after the creation of the ICRC, the Geneva Convention of the 1864 set the legal basis for the neutrality and protection of medical personnel, hospitals and ambulances against violence during active combat (ICCR, 1864). However, the Geneva Conventions that are currently serving as the legal frameworks for the carrying of medical activities in armed conflicts were negotiated in 1949. They were subsequently amended with the inclusion of the Additional Protocols that were meant to take into consideration newer types of conflict. However, these violations of the law go far beyond the principles enshrined in the Geneva Protocols. According to the Special Representative of the Secretary-General for Children and Armed Conflict, Leila Zerrougui, the aftermath of conflict affects children’s right to healthcare, in terms of their ability to access healthcare services during wars and the difficulties encountered by the healthcare personnel in providing for their most basic needs. That happens in spite of the legal framework constructed by the United Nations Security Council in which the protection of children in conflict zones is rendered a priority. The denial of humanitarian access to healthcare services is situated among the other six violations classified by the UNSC as gravely affecting the wellbeing of the children. Another violation is represented by the attacks on hospitals and schools. The main idea is that all of these violations are inadequately covered in the current legal framework meant to protect healthcare in conflict zones.

Refashioning the System                              

Steps towards the remodelling of the healthcare system have already been taken starting with the mere acknowledgement of the problems posed by the violence against healthcare. For instance, in May 2011, at the World Health Assembly, the government expressed avid interest towards the matter by simply admitting violence against healthcare does happen; more than that, it is pervasive and something needs to be done about it.

Nonetheless, this is not the stage at which things should be stopped. Appropriate measures to advance the delivery of healthcare by enhancing security need to be taken both within the health community itself and in the arenas of politics, law by creating standard operating procedures within the military and enhancing humanitarian dialogue. For example, in the realm of politics, the obstruction in the manufacture and trade of light weapons and small arms could lead to less civilian deaths in active combat. Another solution to protect healthcare workers is to establish a special protection force. Furthermore, something that is already being done with leaders of rebel groups such as Charles Taylor is the prosecution of attack perpetrators on healthcare personnel at the International Criminal Court.

“One of the first victims of war is the healthcare system itself”, as Marco Balden interestingly stated. Some even believe that the legal framework is not as relevant anymore due to the urgency and importance of the matter. For instance, Paul Christopher Webster, an award-winning documentary film director who has reported from 20 countries since 1992, sustained the idea that “we need to focus on the consequences and not get bogged down in legalistic debates”. He then went on to say that “this issue [violence against healthcare] is very real and very important for huge numbers of patients”.   Regardless of differing opinions, what needs to be borne in mind is that the sick and the wounded are being denied healthcare that can make a difference between life and death when healthcare workers and killed, injured or threatened and when ambulances and hospitals are rendered non-functional.

Alina Toporas is a recent Master of Science graduate in Global Crime, Justice and Security at the University of Edinburgh Law School. She has previously worked for the European Commission Representation in Scotland, the International Anti-Corruption Academy (IACA), the Romanian Embassy in Croatia and Hagar International (the Vietnamese branch). She is currently serving as a Communications Assistant of the British Embassy in Romania. Her research interests are mainly targeted at the EU-UK cooperation in Justice and Home Affairs (JHA) post-Brexit. Alina is also the author of various pieces on transnational crimes (namely, human trafficking and illicit trade) with a geographical focus on South-East Asia.

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International Law

What Effect Will the Coronavirus Pandemic Have on Migration Issues?

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Labour migration in Russia has suffered the shocks of the pandemic and the coming economic crisis, bringing about major changes to its present and future. Even today, many migrants find themselves in the difficult position of having to wait for the restrictive measures to be lifted, and their prospects of going home are vague (due to the borders being temporarily closed, as well as the fact that their home countries suffer from unemployment). Additionally, the access of migrants to the Russian labour market is shrinking rapidly. But do the massive changes that have taken place in 2020 constitute a turning point? How significant will their impact on the future of labour migration in Russia be? How will the situation in Russia be affected (and how much has it already been affected) by the changes in the Eurasian and global migration systems that have been brought about by barriers to migration that have only appeared recently? [1]

The Global Context

The “perfect storm” that has combined the coronavirus pandemic, a dramatic drop in oil prices, the unfolding economic crisis (that is worse than the crises of the last decades), the closing of borders between states (including borders within regional unions such as the EU and the EAEU), the sharp restrictions in international trade, the long-term demand for political populism in most host countries stemming from playing the “migrant card,” the drought expected in Europe and the United States, and the unprecedented plague of locusts in Africa, Asia and the Middle East, will all make it far more difficult to manage migration flows throughout the world.

The consequences of this “perfect storm” that is unfolding before our eyes are so significant that they have prompted a series of negative forecasts, ranging from doubling the scale of the expected famine (according to the United Nations World Food Programme, or WFP, over 265 million people across the globe may face acute food shortages by the end of 2020, which is 130 million more than predicted in 2019) to predicting a revision of the outcomes of globalization, partially abolishing the global division of labour and gradually drifting towards the principle of the self-sufficiency of national economies (if governments fail to take control of the crisis within a year). All these forecasts focus on factors that will ultimately affect migration processes, from prompting new refugee flows out of Africa to the increased vulnerability of migrant workers in most host countries.

New Changes and Changes Long Underway

Rapid changes taking place all over the world in 2020 have altered the challenges involved in controlling migration.

Over the past few decades, Russia has seen major changes in external migration, including differentiation of inbound flows (an increase in the share of families migrating, more migrant women and children, and greater age diversity); growing numbers of migrants from small towns and rural areas; falling education and income levels, as well as greater cultural diversity (including languages and faiths), among newly arriving migrants; and a change in the structure of migration flows, with migrants from Central Asia dominating.

On the other hand, the main incentives for migration to the Russian Federation have not changed: Russia has the best economic situation within the Eurasian migration system; it has an aging population and thus needs a labour force, including unskilled workers. Demand for unskilled labour is evidenced by a stable inbound flow of migrant workers who are mostly employed in unskilled, physically demanding and low-paying (as seen from the calculations of person-hours) jobs.

Migrant workers have essentially become an integral part of Russia’s labour market, and the changes that have taken place in labour migration over recent decades, coupled with the emergence and growth of a “parallel community” with “migrant” services and infrastructure, make their rapid and large-scale return home less likely. For many of them, Russia has already become a second home, and their principal hope for a better future. Nevertheless, some migrant workers will go home in 2020 (let us not forget that many of them are natives of small towns and rural areas who will be able to sustain themselves through their small farmsteads), although the contributing countries have very limited opportunities for supporting their returning citizens. For instance, experts propose giving away land in rural areas and decreasing the tax burden.

Recent expert reviews analyzing the effects that the coronavirus pandemic has had on labour migration mostly focus on the short term, while predictions of falling labour migration into Russia use the 2008 and 2014 crises as points of reference. However, the 2020 economic crisis in Russia has its own specifics: the economic situation has deteriorated sharply, and the pandemic has only added to its woes; there has been a sharp drop in oil prices; international sanctions have continued; borders have been closed and economic activities suspended. Another important factor is the social anxiety that the people of Russia have increasingly experienced over the past several years, which has been exacerbated by the negative socio-economic consequences that can already be observed (small and medium-sized businesses closing, large numbers of Russian citizens being laid off and having difficulties paying their mortgages, the vulnerability of mass medical services that has been highlighted by the pandemic, etc.). The state’s mitigating response has been slow in coming, even though it involves minimal costs. Consequently, we can predict an unstable socio-economic (and even political) situation, which will lead to issues of managing migration flows being relegated to the background, while homebound migrant flows will be greater than during previous crises.

The difficult situation today is fraught with unpleasant consequences both for migrant workers themselves and for the Russian labour market. In the coming months, migrant workers will be partially pushed out from the niches of Russia’s legal labour market in big cities. We know this from past experience (the crises of 2008–2010 and 2014–2016). However, purchasing power, which has been limited by the economic crisis, will work major changes in the shadow sector as well, curtailing the number of jobs even in those businesses that do not pay taxes (or do not pay them in full) and minimize their expenditures by way of the super-exploitation of labour. The shadow sector of the labour market is expected to grow. Foreign workers will compete with Russian citizens, and migrants will have certain advantages here, such as a willingness to work for lower hourly wages and in hazardous conditions, including those that are detrimental to their health. Today, the expected drop in quality of life in contributing countries (due, in part, to smaller money transfers from Russia) makes migrant workers a group that easily offers itself up for super-exploitation.

The changes that have taken place on the Russian labour market as a result of the pandemic (increased numbers of delivery persons, greater numbers of white-collar employees switching to online work, etc.) mean that jobs in delivery services that unemployed Russian citizens typically take as stop-gap solutions until they find a more permanent position will go to foreign workers in the medium term. The caregiving services (domestic workers) will continue to grow due to the aging of the Russian population, which will open up new opportunities for foreign citizens. In the medium term, agriculture will also offer more jobs to foreigners.

Two opposing trends will develop: the state will strive to collect more taxes, and entrepreneurs will strive to minimize their expenditures by hiring more foreigners, sometimes semi-legally and sometimes entirely illegally.

Obviously, in both the short and medium term, at greater or lesser pace, migration legislation will continue to be liberalized and the management of migration flows will become more flexible. For instance, during the pandemic, the President issued an executive order that eased the situation of migrants. In addition, a law was passed allowing those who wish to become Russian citizens to keep their previous citizenship, temporary residence permits were abolished and categories for obtaining Russian citizenship were introduced. These developments appear to be links in the chain of this gradual liberalization, no matter how slow it might be.

The events of 2020 will increase the number of foreign citizens willing to obtain a Russian residence permit or Russian citizenship, particularly among migrant workers who have years of experience living and working in Russia. Given the increasing competition with Russian citizens, migrant workers who want to reduce their outgoings will strive to improve their employability, and acquiring a more protected status will help them minimize risks in terms of finding employment and a place to live.

In the short term, when the restrictive measures imposed in response to the coronavirus pandemic are lifted, emigration of Russian citizens, including skilled workers, might increase against the background of the economic crisis. Educational migration from post-Soviet states (states contributing to Russia-bound migration) will increase, and the number of migrants studying at Russian vocational educational institutions whose graduates have good employment prospects in Russia will noticeably increase.

Many experts expect an uptick in Russia political activity among the Russian people after the pandemic. This may lead to populist parties enjoying more influence in political life, using xenophobic and migrant-phobic myths to boost their popularity.

Migration Challenges for Russia

The changes that have already taken place and are taking place now have brought the issue of modernizing migration challenges in Russia to the foreground.

Crime and Terrorism

Foreigners have never accounted for more than 3–4 per cent of all crimes committed in Russia, as attested by the official data of the Ministry of Internal Affairs of the Russian Federation. Even given the difficult circumstances that migrant workers have found themselves in over the past few months, we can confidently say that crime is unlikely to surge among them. Their long-term plans are geared towards working in Russia, and Russia has strict rules in place that involve deportation after two offenses (including administrative offenses), followed by a lengthy ban on entering the country. These two factors are a powerful deterrent against any illegal activities. Migrant workers typically find themselves breaking the law when it is difficult for them to overcome the barriers to their acquiring legal status in a lawful manner, and when it is cheaper to solve their immigration issues through illegal means. We are talking about buying fake registrations cards and/or employment contracts, not felonies that involve harm to life or health. However, such situations raise more questions about the height of the hurdles that migrants must overcome in order to obtain legal status than about the migrants themselves.

In both the short and medium term, mass migration into Russia is unlikely to generate an increased terrorist threat. However, terrorism challenges will become more relevant in the long term if the state withdraws the previous funding for integratory measures aimed at migrants of all categories, including the integration of foreign-born Russian citizens, particularly children of naturalized migrants. Additionally, given the possible increase in nationalistic sentiments and the growing numbers of terrorist attacks and right-wing crimes, targeting migrants will become a serious long-term challenge.

Healthcare

The risk of the coronavirus and other infectious diseases quickly spreading among migrants is rather high: studies show that migrants tend to live in overcrowded conditions, have limited resources for purchasing protective equipment and medication, are poorly aware of the recommended preventive measures, and generally do not have medical coverage as the price of even the most medical insurance that would include semi-regular check-ups is prohibitively high for them [2]. Consequently, healthcare for migrants is the gravest challenge of all. Migrants fall under the most vulnerable categories during pandemics throughout the world, not just in Russia. International organizations have already voiced this problem.

Growing Xenophobia and Migrant-Phobia

It is possible that xenophobia and migrant-phobia in Russia may grow, and with Russian citizens losing jobs in large numbers, the possibility will only increase. In times of economic crisis, migrants are traditionally seen as competition for Russian citizens who work in menial jobs, which is only fair if heavily qualified, yet this idea is actively explored by populist politicians. Migrant- and xenophobia are unlikely to lead to serious ethnically motivated conflicts in the near future, but it will certainly increase the popularity of political parties and movements that use anti-migrant rhetoric.

Closed Borders

The situation of foreign migrants has already deteriorated significantly due to the restrictions on inbound, outbound and domestic travel imposed during the pandemic. These restrictions apply equally to Russian citizens and the citizens of the EAEU states. Travel barriers being lifted gradually will hardly result in a quick and full recovery of the migration opportunities that existed before the pandemic. This is also a major challenge, since restrictions on the free movement of labour curtail both regional and international economic growth pace.

Increased Job Competition

The upsurge in unemployment in Russia that began in March–April 2020 and is expected to continue in the coming months will increase the competition between Russian citizens and migrant workers somewhat in the short term. In the medium term, the decrease in the size of the working-age population will weaken this competition. However, if the negative scenario materializes (see below), domestic migration will push job competition between Russian citizens and migrants in large cities to higher levels than before the pandemic.

Depopulation of Russian Provinces

One challenge that has invited little discussion is domestic migration, including seasonal work, i.e. Russian citizens from economically depressed regions travelling for seasonal work to regions that are the strongest economically. Crisis phenomena will spur on domestic migration, especially after the peak of the pandemic has been passed, and this will lead to the faster depopulation of Siberia and the Russian Far East. This is a long-term challenge.

The “Brain Drain”

The emigration of skilled workers from Russia will continue to be partially offset by the influx of talented and educated professionals, primarily young persons, from post-Soviet states. This includes educational migration. A small uptick in the “brain drain” from Russia can be expected in the short term, mostly due to the narrowing windows of opportunity for the young generation due to the socio-economic crisis in Russia, and inbound migration will not entirely offset Russia’s “brain drain.”

Prospects and Conclusions

As of right now, in May 2020, it is difficult to make any accurate estimates about the migration consequences of the “perfect storm” that we are currently experiencing. Not until the pandemic ends and the socio-economic crisis that is brewing becomes clearer. Nevertheless, some consequences for the global community, as well as for Russia, can be seen quite clearly even now.

The International Situation

In the coming years, migrants around the world will experience greater labour exploitation and become increasingly vulnerable. This will be due, among other things, to the growing poverty in countries that contribute to the workforce, as well as to the growing need for migrants to transfer money back home.

Against the background of tightened restrictions and greater obstacles to legal migration, both undocumented (illegal) migration and human trafficking will increase.

Famine and social unrest (including armed conflicts) stemming from unresolved problems with food supplies in Africa, Asia and the Middle East will increase the risks of new refugee flows.

If deglobalization does not lead to outright border closures and integration associations shutting themselves off (for instance, the European Union closing its borders), then it may, to a greater or lesser degree, result in new restrictions on migration. Having said that, the triumph of globalization is that it has been interfering with or even destroying the self-sufficiency of most countries for decades, increasing their dependence on the international division of labour, tourism, and trade. The cutting of international ties during the pandemic has worsened the situation in all states that depend on international supply chains. Consequently, a new upsurge in industrialization and reindustrialization in both developed and developing countries appears quite realistic. In the medium and long term, this development will bolster the demand for both skilled and unskilled workers and result in the obstacles to migration flows being somewhat relaxed.

Russia

Russia fits into most of the global trends outlined above.

In the short term, the EAEU partnership will take on more pragmatic, or perhaps stricter, forms. However, migration flows will not shrink. Instead, they will change their format: shadow labour relations will increase, as will the number of human rights violations; labour protection standards will deteriorate, and human trafficking will be on the rise. Thus far, the negative consequences of these changes are hard to assess, but in the medium term (the next three to four years), Russia can expect to see the following scenarios, all of which directly depend on the socio-economic measures the government adopts in the short term.

1. The optimistic scenario.

Once the restrictive measures are lifted, the Government of the Russian Federation will launch intensive purchasing power support by pouring money into the economy and helping it emerge from the “slowdown,” with special attention being paid to small- and medium-sized businesses [3]. Demand for migrant labour (both skilled and unskilled) will gradually increase, and in the medium term, those migrant workers who had gone into the shadow economy immediately after the restrictive measures were lifted and those who had temporarily returned home will have more opportunities for legal employment.

Centripetal trends in domestic migration (people moving to Central Russia) will remain in place, but there will be no major increases in seasonal workforce. Educational migration in Russia will continue at the same pace and will gradually become differentiated due to the influx of foreign students into Russian vocational educational institutions. Migration legislation will be further liberalized, thus stimulating the legal employment of Migrant workers. Considerable attention will be paid to the influx of skilled labour and to curtailing the “brain drain.”

This scenario implies migration flows returning to their previous levels in the short term and gradually increasing in the medium term.

2. The pessimistic scenario.

The Russian economy is slow to recover. Solvent demand is low. Real unemployment is growing. Jobs in economic niches that had been traditionally occupied by migrants are moving into the shadow economy. Migration-related corruption does not drop, or even grows and becomes a part of everyday life, making it more difficult for the authorities to manage the migration system. Business owners, particularly small business owners, prefer to hire migrant workers off the books. Super-exploitation of migrants continues or even increases. Non-payment of wages and other elements of human trafficking are not suppressed effectively and become more widespread. Foreign workers (including workers from Central Asia) are partially re-oriented to other labour markets. The “brain drain” and emigration from Russia continue, mainly in the form of young people.

Domestic migration into Central Russia is on the rise, as is seasonal work. Educational migration to Russia shows little growth, but Russian vocational educational institutions attract more foreign students. The liberalization of migration legislation slows down.

In this scenario, the migration flow will recover within the next one to three years.

Just which scenario will appear depends directly on the socio-economic situation in Russia and on the stability of its political development. Right now, the second (pessimistic) scenario appears more realistic.

[1]Ivakhniuk I.V. The Eurasian Migration System: Theory and Policies. Moscow: MAKS Press, 2008 (in Russian).

[2] Poletaev D. V. and Y. F. Florinskaya. Migrant Awareness of Tuberculosis and HIV. Moscow: Krasny Krest, 2015.

[3] When Does Russia’s Economy Pass the Point of No Return? Working Paper. April 2020. Institute of Economic Forecasting of the Russian Academy of Sciences. Institute for the Economy of Growth. http://stolypin.institute/institute/kogda-budet-proydena-tochka-nevozvrata-dlya-rossiyskoy-ekonomiki/

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International Law

The Dawn of New Chaos

Shahzada Rahim

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Before the ongoing crisis, no one has ever imagined that there could be a close relationship between politics and biology. Although, the discourse of the twenty-first century warfare has attempted to define the new dynamics of politics and warfare in hybrid context that establishes a close relationship between social sciences and natural sciences. For instance, the ontological discourse of the Hybrid warfare is characterized by the kinetic, non-Kinetic, biological, psychological and physical weaponry for producing a new kind of destruction and chaos. 

As an illustration, in the recent years, the characteristics of the modern counter-insurgency adds to the increasing prominent role of the life sciences in determining the politics of international security and peace. However, with the sudden eruption and rapture of the coronavirus pandemic expresses a new kind of natural destruction. Some people call it a man-made conspiracy to optimize the global population ratio, some call it as God’s curse and some call it as the beginning of World War-Z type apocalypse.

Perhaps, this kind of utter psychological paradox reminds me of Albert Einstein’s famous words “I know not, with what weapon World War III will be fought, but World War IV will be fought with sticks and Stones”. Here, the sudden resurgence of the coronavirus pandemic slightly indicates Albert Einstein’s weapon-X, despite the fact that it is not easy to justify this logic. Nonetheless, the metaphorical jargons such as bio-warfare, bio-politics, and genetic warfare and race wars are extremely popular across the public circles—a phenomenological dilemma.

On the contrary, the fact cannot be denied that the dawn of the 21st century is marked by the dominant discourse over the phenomenological concepts such as post-modernism, post-truth, post-logic and post-humanity. Perhaps, the latter discourse was briefly explained by Michel Foucault in his famous lecture series ‘Race wars’ at College de France, in which he made a significant illustration about the bio-politics by establishing a link between two moral queries; what must live and what must die.

Consequently, the paradox of living signifies an emerging irrational discourse about the new type of wars, which are beyond the human comprehension. What famous German war strategist and tactician Carl Von Clausewitz once said; ‘war is not the action of living force upon the lifeless mass but the collusion of two living forces’. In contrast, the ongoing ‘Covid-19’ has ravaged the global politics, society and economy. Perhaps, as per media speculation, it seems that the world is on the brink of socio-political and economic catastrophe.

This can be seen in the detail report published by the United Nations Conference on Trade and Development (UNCTAD)entitled ‘The coronavirus shock: A story of another global crisis foretold and what policy makers should be doing about it’. In the very first topic ‘A year of living dangerously’, the opening sentence goes like this ‘the coronavirus is the first and foremost a public health threat, but, it is also an increasingly economic threat’—a completely foretold apocalyptic scenario. Another report by the Organization of the Economic Cooperation and Development (OECD) interim economic assessment report entitled ‘Coronavirus: the world economy is at risk’ briefly summarizes about the global economic conditions resulted from the pandemic. The report recapitulates the health of global economy in four major points.

Firstly, the ongoing corona pandemic is chaotic and the outbreak in other countries will lower the growth by approximately ½ percentage this year. Secondly, the global GDP will drop to 2.4% in 2020. Thirdly, China, a global economic heavy weight is the birthplace of coronavirus (COVID-19), whose growth is expected to slip below 5%. Finally, the longer lasting and speedy outbreak of the COVID-19 pandemic across the Asia-Pacific region, North America (mainly USA), and Europe might make the situation worse. In that scenario, the global economic growth will shrink by more than one and half percent in 2020.

In the light of detailed reports by the two powerful international organizations; it seem that, the international community is again on the brink 1928 type Great Depression, mainly characterized by psychological and social breakdown. The public health dilemma because of the lack of efficiency and the economic recession due to the disruption of the global trade will change the shape of the international system for the decades to come. Likewise, the dynamic link between the pandemic and power structure can be understood by examining the consequence of the ongoing chaos. For instance, the public healthcare fragility will expose the majority of the marginalized population to the outbreak. Likewise, the sudden economic disaster might foment a new wave of civil unrests across different parts of the world.

Consequently, although the ongoing Coronavirus (Covid-19) pandemic may not shift the balance of power but it will mark a permanent spot on the memory of the ordinary for the generation to come. In this respect, those people, who lay much emphasis on the dogmatic opinion instead of the real facts, will put their lives at risk. Because, this new chaos is neither normal nor new normal rather abnormal that counts nothing not even your faith. The best way to understand this chaos is to accept the two big realities; the economic and political realities without flinging into skepticism.

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International Law

Human Organ Trade in Global Perspective

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Human Organ Trade has become a lucrative business in the black market as some medical professionals, Nurses and middlemen are involved in this malpractice putting the lives of vulnerable poor people at risk .

Even some poverty-ridden communities sell their organs to feed their children and cover their domestic costs. The Middlemen sell the organs in millions  of dollars while offering peanuts to the organ sellers.

Though , there are strict restrictions in place on such illegal practices globally, yet the Organ Trafficking continues unabatedly throughout the world especially in Africa, Asia and the countries where poverty ratio is relatively high and the nations hit by political turmoil and instability .

Iran is the only country where organ transplant has state permission and everyone can buy and sell organs as per WHO reports. Iran’s economy has been paralyzed due to strict US economic sanctions. The other reasons of trafficking may be the maximum number of unemployment, bad governance, backwardness, illiteracy and poverty that prompts people to sell their organs such as Liver, kidney etc to support their family and children during hard times. Human Organ trafficking has also been prevented in UN resolutions .

 Some analysts are of the view that there are some organized International groups having networks operating globally who exploit the poor segments to sell their organs by offering huge amounts of money and sell the same in lucrative International markets pocketing millions of dollars in so-called illegal Human organ Trade.

There are bitter facts about these malpractices that some well-known Medical Practitioners and  Hospitals are running this secret business and playing havoc with the precious lives of the  Poor people disregarding the laws in place or Human rights.

The Asian countries such as  India, Iran and  Pakistan have a high level of cases especially related to bonded labour and  Brick Kiln Workers whose wages are withheld by the owners and compelling them to sell their organs to cover their  debts ,daily livelihood and Health costs since no health insurance facility is provided to these poor brick kiln workers.

The  African countries are relatively facing economic challenges, Political upheavals , rampant corruption, poor law and order situation . As a result of such issues , there is a high ratio of  unemployment and lack of business opportunities. 

These vulnerable poor communities are lured and trapped by Organ Trafficking Mafia by offering millions of dollars and depriving them of their organs such as Kidney, Liver etc.

The countries like Nigeria, Egypt, Philippines, Iran, Pakistan, India, Bangladesh have fallen prey to these  Organ Trafficking mafias and despite some restrictions imposed by health Regulatory bodies worldwide including  WHO, the  Organ Trade and Transplantation continue unabated around the world regardless of any ban or legal issues as these mafias enjoy support from strongmen in power corridors and continue their illegal Organ Sale and Purchase business pocketing millions of dollars in black-markets while paying peanuts to organ sellers.

Despite UN general Assembly Resolutions against Human Organ Trafficking, the practice continues globally putting human rights at risk especially in Asian, African countries where poverty monster is gobbling the poor by compelling them to take an unethical decision that may prove disastrous in the Long run .

The international Health body (WHO)  Study, as well as the related media reports, have revealed shocking facts that most of human organ trafficking cases happened with  African  Migrant  Refugees in  Egypt, Libya, as they were compelled to sell their  Organs for the sake of livelihood as migrants, had limited citizenry rights in Egypt.

 Human Organ trafficking and transplantation cases were reported in great numbers in Egypt as there were 250000 cases and the majority of them were related to migrant  African refugee as reported by WHO report.

The study also revealed that most of the transplantation cases were related to persons with drug addiction, diabetic patients and the rich people who are used to alcoholic drinks that damaged their kidneys and immune system.

These patients were the forerunners in the purchase of notorious human organs to save their lives and feed the huge chunk of the funds to the hospitals conducting transplants in India, Iran, Pakistan, China, Egypt and Other parts of the world. 

According to WHO,  the cost of Transplantation varies from the country to country and region to region but the average cost ranges from  $30000 -$40000 US dollars for Kidney related transplantation. The Organ trade is reported to have touched  $160000 in international markets by so-called middlemen and doctors. 

These facts are very shocking to the extent that even after costly organ Transplantation, 70% to 78% of patients reported health and physical complications in  India, Pakistan, Iran, Egypt and other  African Nations.

India leads in  Transplantation cases in Asia as it has a network of  Organ Transplantation Hospitals serving internal and external citizens. Pakistan has also Organ Transplantation Hospitals both in Public and Private sector the Prominent ones are  SIUT, GIMS, Shifa, AKU, Ziauddin Hospitals. But these hospitals conduct transplants surgeries by authorized family donors for their blood relations.

It is good to step that  Pakistan has established  Human Organ Transplant Authority  (HOTA)to regulate the transplant practices and maintain dignity especially organs donated by deceased people in their will to help people such as visually impaired.

Though UN has adopted various resolutions against  Human organ Trafficking Globally, yet all the member nations must frame laws to regulate  Transplants and ban illegal organ trafficking done by some nefarious Groups and individuals risking the lives of the poor segments of society by exploiting their needs, wants, hardships and compelling them to sell their organs to these unscrupulous people who have no regard for humanity or dignity of people.

These criminals have established well-organized networks, the International Police  (Interpol) may be tasked to burst and break their global network.

The countries such as Sudan, Tanzania, Nigeria and Eritrea are also stalled with Illegal Human Organ trafficking as transplants were executed in Egypt.

Back in 2018, Egyptian criminal court had sentenced over 37 persons including Doctors, nurses Medical Staff and Middlemen involved in the illegal trade of Human Organs. They were captured in the raid on a tip-off and millions of dollars were retrieved from them. The investigation heralds serious revelations that how these malafide groups operate globally having no regard for humanity.

The news reports confirm that Egypt is reportedly a big market for organ sale as people sell their body organs to wealthy foreigners for illegal riches and perks offered to them and the middlemen facilitate such deals thwarting  International law and human rights.

The Human organ trafficking is a global issue and all the countries should be united to frame strict laws and put strict restrictions on those concerned with health systems such as doctors, nurses and medical professionals to stop such illegal practices by awarding exemplary hard punishments who are found involved in such inhuman and illegal organ trade.

 There is a great need to establish A global Body of  UN to control, Contain and Prevent Illegal Human Organ trade to save the vulnerable communities falling prey to these wealthy Foreigners who risk the lives of poor communities by luring them with some hard cash and play with their precious lives.

 Some organ sellers shared sad stories that how their organs were stolen from their body without their consent on free treatment offers. Illegal Organ trade has been a global issue and the timely steps of UN and member states can help contain this menace and protect underprivileged people from the grip of these nefarious people.

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