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South Asia

South Asia’s Weakening Resilience in the State of Pandemic

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Authors: Shanjida Shahab Uddin and Fahd Mannan*

Before Covid-19, the Spanish flu was the deadliest pandemic that hit the world, including the South Asian countries. It was estimated that around 18 million people died in this region due to that pandemic in 1920. A century later, the world is again hit by a deadly virus,Covid-19. The South Asian region detected its first conformed Covid-19 case in Nepal on January 24. Till date, this virus has spread in all of the South Asian countries infecting and causing the death of hundreds of thousands of people. Several challenges have already emerged during efforts to curb the spread of Covid-19 in almost all South Asian countries, which were already mired in age-old challenges, including disunity and procrastination in the adoption of political decisions, poor healthcare systems, high population density, poor infrastructure and poverty. Although all these challenges are common in almost all eight South Asian countries, country like Bhutan exemplified how to overcome these challenges and outshine in curbing the transmission of Covid-19. Other countries such as India, Pakistan and Bangladesh are still struggling hard to curb the transmission of this deadly virus.

Lack of Unity in Regional Politics

Political disunity in South Asian countries once again appeared as a major obstacle in fighting Covid-19. However, positive moves had been witnessed immediately after all South Asian countries were found to have been affected by this virus. Indian Prime Minister Narendra Modi called a video conference under the platform of the South Asian Association for Regional Cooperation (SAARC)which was joined by all the South Asian leaders, except Pakistani Prime Minister Imran Khan, to share their views regarding curbing this virus. On behalf of Imran Khan, his Special Assistant on Health Affairs, Zafar Mirza, participated in that video conference. A Covid-19 Emergency Fund was also created in the hope of collectively fighting against this pandemic. Although it is an encouraging and constructive move, Pakistan did not agree to contribute to this emergency fund based on the argument that this fund should be managed by the SAARC Secretariat General in Nepal, not India. Despite Pakistan’s absence in the initiative, all other South Asian countries have immediately contributed to this fund. Pakistan’s abstention from this recent move under the platform of SAARC proves that Pakistan will not support or facilitate any kind of initiative under the leadership of India. This kind of act proves that the political disunity still prevails between the major countries – India and Pakistan — and it strongly persists even amidst a common dire need in a time of crisis.

Poor Healthcare, Low Testing

Once known as the “sub-continent” of South Asia, India, Pakistan and Bangladesh were already dealing with a fragile healthcare system before Covid-19 hit. The healthcare system for billions of people in these three countries can best be summed up as inefficient while that for women and children is close to nil. Together with high population densities, low literacy rate and lack of awareness about basic hygiene made the overall healthcare system insubstantial against the deadly Covid-­­19. An insufficient number of hospitals, lack of doctors, scarcity of healthcare equipment and paucity of funds made dealing with Covid-19 a challenging task. And due to fast transmission of this virus, hospitals are being flooded with a surge in patients. This situation is making the already distressed healthcare system more convoluted and resulting in a shortage of ventilators, medicine and doctors, and most importantly masks, gloves and personal protection equipment (PPE). And the low testing rate of this virus in South Asian countries worsens the situation. For example, Bangladesh is the third country to be the most affected in South Asia after India and Pakistan with a total of 202,066 confirmed cases as of 18 July 2020. With a population of 165 million people, the country conducted 1,020,674 tests so far since 8 March and currently testing 6,195 of every million people as of 18 July 2020. In contrast, the Maldives, Bhutan and Nepal outshined in terms of the number of people tested per million (the Maldives 43,758 as of 22 May, Bhutan 25,375 as of 5 June and Nepal 21, 419 as of 14 July). Being large countries, India and Pakistan are also struggling with poor testing rates. For instance, India is currently testing only 9,736 people from every million as of 18 July. Bangladesh has an even more shocking obstacle: getting tested costs a minimum of $2.36 to a maximum of $5.86. No South Asian country is placing any charge on Covid-19 tests, something Bangladesh imposed recently. This will largely limit poor people’s access to getting tested.

Economic Fallout

Covid-19 swept the globe with periodic lockdowns, a state of quarantine and the idea of social distancing. The South Asian countries will also have to follow these stringent measures to curb the fast transmission rate of this virus. However, such stern steps to contain this pandemic largely disrupted market supply chains and caused sudden drops in demand. Due to the need to maintain lockdowns and social distancing, most of the countries in South Asia, which are densely populated, decided for continuing the state of emergency. Under this situation, educational institutions, offices, restaurants, shopping malls and other public places went under complete or limited lockdowns. If we see the case of Bangladesh, the country imposed temporary bans on commercial goods import and international passenger flights for almost two months. Following the sweeping measures to curb this virus, the country also went for a nationwide full lockdown, imposed travel restrictions in and out of the country and sealed borders with immediate neighbours. These had a large impact on the country’s economy. Experts are assuming that the country might be in for both external trade shocks and internal demand shocks. The impact on the inflow of remittances in the country might also be largely affected since the major remittance generating countries are still following complete to limited lockdowns shutting most of their businesses. These have already left thousands of migrant workers without a job. Apart from remittance, the country’s garments industry is the biggest contributor to the economy. However, this industry is also facing debacles since major clients in the US, UK, Germany, France and Italy shut their stores and modified their orders in tune with people limiting their spending. Almost all other countries are also facing more or less the same economic losses due to the restrictions coming with Covid-19. Therefore, it is predicted that the South Asian region may experience its worst economic fallout in 40 years followed by spiralling recessions.

Amidst all the grim scenarios in every aspect of these major nations, small countries like Bhutan have excelled in managing this pandemic. Of the eight countries of South Asia, Bhutan has still managed to maintain a zero death rate during this passing of this deadly virus. Bhutan has also managed to keep the number of confirmed cases low compared to other South Asian countries. Bhutan started its fight against this virus with a minimal amount of testing kits provided by World Health Organization (WHO) and a shortage of healthcare workers and essentials. The country took this situation very seriously and once it confirmed its first two cases, it immediately started tracing and testing people who had symptoms or came into contact with confirmed cases. Through the dedication of both the government and the masses, Bhutan successfully implemented its national preparedness and response plan with a commitment to regularly carry out testing. Therefore, there are lessons to learn from small countries like Bhutan to overcome the grim resilience situation prevailing in other South Asian countries. And major countries need to take collective short and long term steps by putting their disunities aside to gear up the region’s resilience against this pandemic.

*Fahd Mannan is Sub-Editor at The Daily Star, Bangladesh. He can be reached at zoahebman[at]gmail.com.

Shanjida Shahab Uddin is Research Officer at Bangladesh Institute of International and Strategic Studies (BIISS). She can reached at shanjidashahabuddin[at]gmail.com

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South Asia

Promoting Projects and Practices in Community Health in India

Prof. Pankaj Jha

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Street scene in India, August 2020. © UNICEF/Vinay Panjwani

One of the most populated countries in the world, India has been facing problems with regard to well-being of its citizens while sustaining their developmental needs. The need for better health facilities, and developing antidotes for new kinds of pathogens and viruses have made the task more challenging. The respective governments, pharma companies, and testing labs are trying to develop safe trial mechanisms and developing safeguards for protecting the lives of vulnerable sections of society. Within India, the community health programme involves the non-governmental sector, healthcare professionals, economics aspects and social interaction through people and voluntary workers. While the health ecosystem exists, the problem has been finance, support and critical knowledge repository. India did well to address issues such as polio vaccination and creating community awareness for regular medication against tuberculosis. There is a mounting impact of chronic diseases in economic and social sectors, need for quality health services in the wake of changing demographics, and increasing life expectancy have made matters more complex.

In terms of understanding the requirements for building better resilient and health-conscious societies, it is important that the vaccines, lifesaving drugs, and medicines should be developed with certain generalised regulations which can improve the health of the society and address problems faced by people living across regions. While India is a subcontinent comprising of all geographical features, it is also a cauldron of different ethnic communities, and physical features which provides exceptional opportunities for testing and developing medicines which can cater to different physical and pathological profiles of people. Within India, one can find people with different levels of immunity. As the eating and food habits have been different, there is higher incidence of diabetes, hyper tension and cardio diseases in a cross-section of people. It has also been seen that people who are above 40-70 years of age have been more vulnerable to pandemics, and other communicable diseases. A sizeable mortality profile of people suggests that.

In this context it becomes very important that medicines which should be developed should have a better shelf life and give results which can be corroborated with testing facility, with a cross-section of people. The results have usually varied with regard to people with different eating habits and also nutrition factor. Pandemics such as COVID-19 have brought to the fore that India has better resistance mechanisms which has helped in relatively less mortality rate when these people have been infected with COVID-19. The duration of sickness because of COVID -19 has varied from five days to more than three weeks. In such certain times, it has been found that because of lack of any effective medicine or any sure shot diagnostic mechanisms the treatment has prolonged and the recovery has been slow. In terms of legal and other regulatory mechanisms, it has been found that most of the clinical trials which are done in India enroll the vulnerable  and poor people and human trials are conducted. There is a grey area of medical compensation and addressing post-tests complications from legal point of view.

For India it has become imperative to develop projects and conduct feasibility studies through government mechanisms rather than through medical companies. While projects have been undertaken to study different kind of diseases that school children and adults will be facing in the next two decades, it has been found that most of the complications will be related to teeth, eyesight, anxiety and mental well-being. However, in the case of pandemics and community health programmes it has been encouraging signs that initiatives such as creating awareness with regard to AIDS, mental well-being, depression and anxiety disorders have been fruitful and rewarding with institutionalising counselling and telephone helplines. Most of the programs have been done and supported by NGOs as well as a few voluntary organisations.

The projects and programmes which can be initiated in India should address core issues. Firstly, the incidence of non-curable diseases, depression, immunity disorders, other issues related to community transmission, and the development of proper safeguards and awareness with regard to pandemics and life-threatening diseases. Secondly, the COVID-19 has opened a Pandora’s box with regard to the incidence of diseases which impact community, and thereby also affect government health budget. Lastly, it is necessary that India will have to create medical soldiers and inform voluntary workers so that the community transmission and community health well-being should be addressed on a priority level.

As the COVID vaccine is in different trial stages, many countries are looking for testing facility in India and also conduct human trials, as legal structure in medicinal trials is still in infancy. India needs to address the issue of IPR on developing vaccines and medical history should be addressed jointly as it has been found that many western countries have been purchasing medical history of the patients living in developing Asia, providing vaccines through great testing mechanisms and subsequently using copyright laws to deny cheap medicines to the larger community.

 In this regard it is important that India should conduct research on immunity vectors of its population and develop generic drugs which can help in protecting communities from most transmissions. It is also pertinent to note that in terms of the temperature variance across India it provides unique testing opportunities in different conditions. However, there is a need for a holistic approach and therefore it is important that training and sensitisation of the personnel working in this field is of paramount importance. Initiatives related to preventive and therapeutic services is critical. Also, looking for quick alternatives would save the lives of personnel.

Just like any emergency, there is a need for rapid action medical force which can provide immediate assistance and better cognitive abilities track critical illnesses and the reasons thereof. It has been seen in the case of midwifery and associated postnatal diseases that it has worked wonders with a better equipped and knowledgeable person existing in each society for better assistance and awareness.

The critical importance of voluntary workers is that with sufficient technical assistance (which might come from government and state units) gives them confidence and also strengthens their application of knowledge for better informed public health practices and policies. Technical assistance and quick action through centralised control centre has to create the first line of defence in case of a pandemic. 

The institutes which have been working in this field are Public Health Foundation of India, Indian Institutes of Public Health and All India Institute of Hygiene & Public Health, which have been disseminating information through online workshops, seminars, and social media. They have created affiliates and sister agencies working in the field all across India. Networking of public health institutions in medical education need to address issues such as environmental health and countering new kind of diseases which are dominating.

This clearly highlights the fact there is a need for understanding pandemics, developing awareness among communities about public health, and stress on hygienic environment, conducting long term  research on emerging diseases and promoting research in tropical medicine.

India need to allocate separate fund for public health initiatives and promote exchange of medical workers with third world countries for better understanding the nuances of medical and health research. In fact, in most of the think tank meetings, public health and awareness is not listed as topics whenever Track II dialogues are held. There is also a need for better practices in public health, education, and developing health demonstration projects, barefoot nurses and doctors, strengthening an eco-system of education, training, and scholarship. Developing traditional medicine and making it easily accessible should be the bulwark against diseases. Restructuring Community Medicine/ Preventive and Social Medicine colleges which impart this kind of education in developing countries is required as the number is relatively less. Across developing world scholarship in community medicine and hospital administration is low and needs structural financial support. The data collection and diagnostics apparatus need micro management to create better response chain. COVID-19 has provided the reason for public health to be taken as a national initiative.

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South Asia

Sino-India Himalayan Chess Game: Breakthrough or Stalemate?

Vineet Malik

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The continuous geopolitical blame game between India and China hasn’t witnessed any positive development with respect to either sides pulling back their respective troops, dragging the recent skirmish even further till winter.

In 45 years, India for the first time has witnessed a conflict-like situation vis-a vis China which witnessed the martyrdom of 20 troops on June 15thand rounds of shot firing in the LAC where the Indian Foreign Affairs Ministry confirmed about the PLA first initiating the firing ,after which the two sides have constantly held each other responsible for increased tensions whereas India has tremendously shown goodwill, hopefulness and looking at many factors to keep the ties stable.The year 2020 was supposed to be the 70th Anniversary of Sino-India Cultural ties where unfortunately, the celebrations were overshadowed with this recent border mishap.

The Himalayan Chess- Game

The Chinese Foreign Ministry’s scepticism on the territorial claims and debate on Aksai Chin are not new, which has its roots to the abrogation of article 370, the recentlychanged rule declaringLadakhas an integral portion of the Indian Union was unfavourable to the Chinese side, reiterating about India getting into a strategic misadventure by violating their own territorial sovereignty and national interest and the former justifying on those and trying to flex its muscles in the Pangong Tso, Galwan Valley, Gogra, Kongka La, Depsang.

Border infrastructure is becoming a new method for these two aspiring Asian powers to assert their economic cum political interests with respect to further claiming of territories leading to the road towards being victorious, where the Indian side has further increased its focus viewing the strategic ramifications in the neighbourhood .by providing 8 bridge infrastructure projects each  in Arunachal Pradesh and Ladakh , which India requires to ensure easy connectivity in harsher terrains, promote tourism, distance reduction in order to reduce time for movement of goods to ensure welfare and safety for troops and natives residing in high terrains which again China suspiciously looked at in its counter statement, blatantly opposing any infrastructure in disputed boundary.

Notabledefence experts, Victor Gao and PremShankharJha, opined that China is aiming at a strategic bargain and believe that this move of the Indian side developing infrastructure in Ladakhcould be a counter to the Chinese G219 highway , covering a distance of 179 km connecting Xinjiang and Tibet which is in close proximity with Daulat Beg Oldi, where a 450 metre bridge over the Shlyok river was constructed last year which was only accessible by air before the construction of this project .

Amidst this prolonged crisis, 7 rounds of the India China Military Commander Meetings were held on a frequent basis at the Line Of Actual Control, in order to maintain tranquillity, peace, further enhancement of mutual understandings and deterrence to reduce the chances of an armed conflict, nevertheless there has been no proper agreement and the troops aren’t stepping out from their current positions either side.

Also, even the recent Moscow visits of Defence Minister Rajnath Singh and Foreign Minister, Mr. S Jaishankarin September for meeting their respective counterparts, haven’t been completely fruitful where they have also held discussions on showing respect towards each other on territorial claims and not cause these ties to deteriorate towards an upper trend which means that no country wants to compromise on its territorial claims and any change in status quo, which has led to unprecedented uncertainty in the relations as of now.

CCP Apprehensions of an Alliance

Chinese scholar, Fu Xiaoqiang , in his article, stated about India creating unnecessary tensions in the border leading to further straining of relations which are motivated by selfish political agendas. He also felt that India is being persuaded by the US to join an alliance like structure such as the Quadrilateral Initiative and set preferences with respect to choosing friendships with countries such as Japan and Australia, which have a common perception likewise India, regarding China as a potential competitor in the region.

Currently, China is fearing any conflict or alliance like structure with respect to its role in spreading the pandemic for which it was hiding its strategy, due to which these justifications are being used by Xi Jinping to protect his own image in the masses so that no crisis or dissent arises which could put the Communist Party’s survival and reputation at stake at a time where he is being questioned about the corruption and internal party pressure. There is a reason behind why China is involved in scapegoating on this conflict to show an innocent and a positive image by blaming Indian politiciansusing nationalism to mobilise the public, narrating their growth story, ideology, rich historical as well as cultural heritage, where the same goes for the dragon’s promotion of their nationalism  as well.

Alliances are important for India but they will take time to come in support if any mishap takes place in the neighbourhood, keeping India under uncertainty with regards to its strategic autonomy, it was following for many decades.  These alliances can be useful only to deter an enemy organising territorial strikes and put the latter on check creating some amount of fear and introspection.

Recently, steps have been undertaken by the Indian government to ban Chinese products and apps due to surveillance plus information threats in security. It is looking towards making itself self-reliant (aatmanirbhar) to reduce any more dependence on countries which have their own interests which could change anytime, if it doesn’t suit them which could be seen through India’s past experiences, where the same mistakes can’t be repeated againlike 1962 or 1975, at a time when the multipolar world is moving towards Asian multi-polarity where China is currently at an edge.

Concluding Points

The Chinese feel that the ball is in India’s game to choose between the have’s or have not’s while looking at the opportunity costs involved .The dragon is basically assessing the elephant’s capability and coping strategies in the winter, leading the standoff to be extended even further for which it is crucial for India to enhance its capacity in order to build up on its equipment, give support to the troops and further focus towards economic development in the borders.

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South Asia

Immediate broad-based Reforms needed in the Political system of Pakistan

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Image source: Pakistan PM’s website

Opposition parties have launched a comprehensive campaign to de-seat the PTI Government by its grand show of power on 16 October 29020 at Gujranwala. All major opposition parties attended the Jalsa, and opposition leaders delivered speeches, criticizing the PTI government and even the military.

In a democratic country, it is common practice for that opposition to criticize the ruling party. Pakistan, with no exception, has a long history of agitations, protests, strikes, criticizing, rallies, blames on the ruling party, from opposition parties. Even PTI also played a very aggressive role as the opposition party in 2014, against the Government of PML-N. It was the longest Dharna in the history of Pakistan, and the first time protesters entered into Parliament house, PTV, Pak. Secretariate and sensitive areas, etc.

But the current behavior of opposition since 16 October is even more severe and blame on Pakistan Military is rather unacceptable. However, PTI ministers are also giving irresponsible statements. The ruling party must maintain political temperature under control. The opposition wanted to create chaos and confrontation, but the ruling party should mild-down the conflicts and manage the situation to complete its tenure. Either the ruling party’s ministers, spokespersons, advisors are unaware of consequences or lacking the understanding of the real issue.

Till this moment, the masses of Pakistan are not convinced with the narrative projected by the opposition parties, but neither happy with the ruling party. The common man is concerned with the issue he faces daily – inflation, price-hike, jobs, health care, education, social justice, and welfare. The ruling party failed to deliver, and the common man kept suffering.

Indeed, the masses do not love opposition, but neither the ruling party. It is their sufferings, which might help the opposition to convince them to stand the Government.

The majority of people are still admiring PM Imran Khan and believe that he is honest and a man of integrity. Yet, he failed to recover the economy or provide any relief to the common man. He was unable to recover to looted money from corrupt politicians of past governments. He also failed to punish the national criminals too. However, the people of Pakistan acknowledges his contribution toward foreign policy, Kashmir issue, and International relations, where Pakistan’s narrative was projected appropriately and improved the county’s image.

The people of Pakistan think that all wrongdoings by the ruling party are due to his wrong cabinet,  nothing to do with PM Imran Khan himself. His economic team, imported and landed by helicopter, are failed to revive the national economy. Although the oil prices in the international market have dropped to record low levels, even minus yet, Pakistan could not improve its economy. Even due to the Pandemic, Global Financial Institutions have extended a helping hand, yet, Pakistan could not improve its economy. The Sugar crisis or Wheat crises are traced back to the ruling elite, and responsible is sitting on the right and left side of PM.

The intellectuals of the nations think that PM Imran Khan might be a pious person. Still, he is responsible for selecting his team – consisting of foreign nationals, dual nationals, elect-ables, corrupts, and incompetents ministers and advisors. It was his choice, and he could have refused to take anyone into his team if he was not satisfied fully. If there were some pressures from certain quarters, he should stand against such pressure. He should have judged the person before admitted into his team. He knows the importance of merit, and he has announced on several occasions the importance of merit. Even though if he misjudged anyone and admitted into his team, but it is never too late; as soon as he understands the person and found unsatisfactory, he can change immediately.

The country is passing through a very critical era, the geopolitics are changing too rapidly, challenges are enormous, and time is too short. Pakistan can not afford the luxury of any mistake anymore. The nation needs unity, the right policies, appropriate reforms, legislations, merit, and consistent hard-work. Attention may not be diverted and struggle with a clear focus and pre-set goals. Divide, intolerance, extremism, corruption, incompetency are the curse for a nation, must be averted.

Although PM Imran Khan is a visionary leader and has all the leadership qualities to lead the nation, but alone may not be able to achieve anything. A strong team, equipped with knowledge, wisdom, patriotism, honesty, and integrity, needs the time. Reforms based on proven successful experience, addressing the futuristic issues are required urgently. The nation has the potential to revive its past glories.

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