July 24th, 2015 by Claudio Schuftan
Food for a possible historic (re)thought
Human Rights Reader 366
“It is impossible that it is impossible to change our history” (Graffiti in the Darío Salas Highschool, Santiago, Chile).
- All my life I have been an impertinent person; is this why history interests me? I have for long maintained that traditional historiography, i.e., mainstream history, has not paid attention to human rights (HR) thus generating the wrong impression that, with counted exceptions, common people have overwhelmingly been incapable to ‘make’ history. Such a deficit has distorted people’s image and is an unacceptable interpretation.
To me, the silence of the defeated and the downtrodden is like ‘the holes in the cheese of history’, but the holes are not enough for cheese to stop being cheese* (Roberto Ampuero)
*: I will not here mention the holes in the cheese of history regarding the history of Asia and Africa, holes that most of you readers never got to study at school, i.e., the ethnocentric aspects of history which would make for a whole new Reader.
Historians not only record the past, but also record that which worries them about the present.
- History has been a discipline largely indifferent to suffering, injustice and appalling HR violations; it is told primarily by the victors. Is history, therefore, reliable? Does it convey reality? If not, what then is history if it can-be and not-be a true reflection of reality? Does this mean that, in this realm, we have to talk about anti-history when the tale is recounted from the perspective of the defeated and downtrodden? (If so, this new anti-history is not to be considered a subversive version of history!). The past belongs to humanity as a whole: Yes, but have we been made accomplices, victims and/or survivors of how it has been and is being recorded? Are we loosing important collective memory –and thus suffer from selective amnesia– as a result? We can indeed accuse mainstream historians of not recounting history as it really was. In each era, history may have been received as novel and revealing –until somebody unveils its imposture.
- Which conquerors in the history of the world did not burn the history of the conquered to impose their own version of happenings? They aimed-at becoming, and de-facto became, the medium (artifice) of the actual frequent rewriting of history. Take the evangelization process: Was it only an ideological thrust aimed at hiding the real interests that seduced and inspired the conquistadores and colonists? At the heart of evangelization was the silencing of the historic past of those conquered. It has particularly been wars of conquest that silence those who want a new narrative to prevail over the recounting of facts by mainstream historians.
It is more; there are holes in the conscious part of our collective memory (Johan Galtung)
- Carl Jung, the Swiss psychiatrist said (and the Chinese before him) that the shadows of history are long and dark; that trying to jump over them does not help; they follow us. We cannot get away with the misdeeds of the past hoping people will forget. At their worst, these misdeeds have been nothing short of HR calamities –not only for the victims, but also for the perpetrators now standing accused. Slavery, for example, was forced labor with chains and whips; genocide is often only whispered by mainstream historians, as is ethnic cleansing. One day, these shadows do to us what we did to them, making our worse fears self-fulfilling… The darkest shadows never really leave the inside of our collective subconscious. The feeling of being on the wrong side of history, not only losing wars or an empire, is now more-and-more coming to many. It is a feeling of having been led to slide downhill; indeed an uneasy feeling. Leaders try to find somebody ‘outside’ to blame, but the shadow follows the victors and the oppressors faithfully. Yes, people are reacting. How? (How does one process dark shadows with dire negative HR impacts in history?) By confronting them! Submitting them to International Truth Commissions (on slavery; on White against Red and White against Black, on Brahmins against Dalits and on Haves against the Have-been-deprived).**
**: The refusal to accept setting up such international commissions/tribunals is itself self-incriminating, isn’t it?
- Explanations must be found, because a strategy without understanding the whys is liable to bring about violence and is empty (like one-time street protests). Make no mistake, there is no way the world forgets the past; it stays in the deep culture, brooding collective nightmares; more so if people are barely surviving and are being politically repressed. In confronting the truth, the 3Cs, Confession-Contrition-Compensation, would help; it would help to heal the tortured, those whose rights have been trampled for generations… It would do well to both sides, all sides, and the cost is little. No! to distancing ourselves from the misdeeds of the past. Bring them to the open. The track record of the past is too dark to simply gloss over it. People’s movements must take the initiative; bring the ball to their court and play it. Many groups have already started, many more must follow.
Mainstream historians are actually collectors of big-events’-memories (are they therefore ‘memorialists’?)
- We have said these historians have too often failed to reflect the history of the downtrodden, namely failed to chronicle the fate of the ‘anonymous-or-no-names in history’. Somehow, they vanish in the fog of history as officially recounted. (E. Galeano) Actually, at best, they recount what prompted the bravery of an exceptional hero who rebelled against power and against abject HR violations and launched the building of a better society… and this is often only found in the small print of mainstream history.*** (J.R. Ribeyro)
***: The Vietnamese General Vo Nguyen Giap who defeated the French frowned at the many glorified headlines glistening under the pens of Western writers such as “The Victor or Mastermind of Dien Bien Phu” or “The most feared enemy of the French and the Americans”. He was not speaking from false modesty. He was convinced that mighty upheavals in world history are born from the interplay between various objective factors in the relations between haves and have-nots; it is the capacity of great leaders of the people to exploit this, given the right circumstances. (A. Ruscio)
- Until the middle of the 20th century what we had was a positivist history. It was not based on the downtrodden. It was based on kings, generals and important politicians –and that is not what history now ought to be. Now, history is to be more social, for instance, including oral history complemented with other social sources. (V. Navarro-Rosenblatt)
- Yes, chronicling about the fates and fortunes of the poor sectors in society is too often missed. For instance, the history of the influences of various happenings on food shortages is familiar, but the consequent impacts on the health and survival of the oppressed are much less well told, as are the historical ravages of infectious disease outbreaks and interconnections between food crises, epidemics, social disorder, wars and conflict. The structural causal processes affecting health outcomes seldom reflect the historical facts behind appalling social conditions, the violation of HR, despotic governance, militarism the resulting demographic stresses. Up to three millennia of evidence of impacts on food shortages, famines, starvation and deaths can be found in textbooks, but little is found about their social and political causes. The truth is that historians of the time provided assessment clues of poor quality. Generic words such as ‘plagues’ and ‘poxes’ are evitably obscure. In summary, the broad health-risk categories of under-nutrition and starvation, infectious disease outbreaks, and conflict and their relation to, for instance, warfare, are insufficiently accessible for historical study. One simply has to question the quality of the evidence reported in historical accounts. Bottom line, during much of the 20th century, and before, there was an energetic debate over the inclusion of socio-political consequences on the marginalized in historical analysis: you can only guess which position mainstream historians took. (T. Mc Michael)
- There is an unexplained mystery in the history of ideas: an idea may be right and true….sometimes for centuries…without impinging on the public debate or collective consciousness. The idea remains unacceptable until that mysterious moment the Greeks call kairos (‘the right time’) comes. I ask: Has kairos arrived?
Claudio Schuftan, Ho Chi Minh City
-“History is a memory that people use for their needs. As life needs change, they revisit history; what they choose to remember thus changes too”. (Rudolph Dreikurs the Adlerian psychiatrist as cited by Shula Koenig) Bishop Tutu, actually went further in his famous: “If you are neutral in situations of injustice, you have chosen the side of the oppressor: If an elephant has its foot on the tail of a mouse, and you say that you are neutral, the mouse will not appreciate your neutrality.”
-Mainstream history is a walking paradox. It is contradictions that power its legs. Maybe this is why its silences tell us more than what the narrative tells us because, frequently, by lying, the narrative reveals to the inquisitive person the real truth. In short, what it is is that mainstream history’s snapshots do not tell us about the real human adventure in this world from the perspective of those-that-did-not-make-it-into-the-picture. (Eduardo Galeano)
July 5th, 2015 by Claudio Schuftan
Food for a non-divine thought
Human Rights Reader 365
-Late capitalism has been brilliant at righting itself. Communism was poor at this. The problem is that capitalism usually only does so after mega crises or wars. (T. Lang)
-It was painstaking research into the life cycle of the HIV virus that revealed how it functioned and thus how it must be attacked; many lives have been saved as a result. Capitalism is a far more complex pathogen; it cannot be tamed without a commensurate effort. (M. Anderson)
- We are skilled at that combination of complacency and despair that assumes things cannot change and that we, the people, do not have the power to change them. Yet you have to be abysmally ignorant of history, as well as of current events, not to see that our world has always been changing; the world is actually in the midst of great and worrisome changes –not least in the human rights (HR) sphere. Occasionally, changes have been and are made through the power of the popular will with claim holders (although they may not know they are such) organized in social movements. It is hard to see how we will get to more of such bottom-up changes from here on, but more and more we see HR activists –together with citizens with higher political consciousness– claiming and exercising their rights and demanding changes from duty bearers. If we look at the prospects of this, the future seems tremendously exciting. Many people do not understand what HR activists are up against, because they do not grasp that it is the lack of credible counterbalances that keeps the still resilient, unfair capitalist system going. For most people, none of this is real or vivid or visceral or even visible. The question then is: Is everything coming together while everything is falling apart? (J. Henn)
- Of course, those wielding the power will not yield it without a fight –the very fight HR activists are already engaged-in on many fronts. If everyone who is passionate about HR –who gets it that we are living in a moment in which the fate of the planet and of humanity is actually being decided– found their place in organized social movements, amazing things could happen. What is happening now is already remarkable enough, just not yet commensurate with the magnitude of the current crises. The intransigence or inertia of bureaucracies is still a remarkable force to beat. The HR framework has become a more frequent public and hotly debated issue, as well as the subject of demonstrations in dozens of locations. The HR movement has proved to be bigger and more effective than it looks, because most people do not see it as a single movement. If they look hard, what they usually see is a wildly diverse mix of groups facing global issues on the one hand and a host of local ones on the other.
- “If these are the values of our society, then I want to be an outlaw in that society”, an activist recently said. The movement has grown in size, in power, and in sophistication, but it is still nowhere near where it needs to be. The coming year –with the launch of the not-really HR-based SDGs– will very likely be decisive. So this is the time to find your place in the growing HR movement –if you have not yet. This is the big picture, so there is a role for everyone, and it should be everyone’s most important work right now, even though so many other important matters press on all of us. Human rights are at the core of world and planetary issues.
- Many people believe that personal acts in their private life are what matters to eventually address these global crises. These acts may be good deeds, but not the key thing(s) to do. Such personal gestures can and do offer a false sense that you are not part of the problem. Joining organized groups to mobilize actions is what is called for. You are not just a consumer; you are a citizen, a claim holder, and your responsibility is not private, but public; not individual, but social. The race is on. The real pressure for global change comes more from within nations than from nations pressuring one another. We have a particular responsibility to push hard.
- Pressure works. How will we get to where we need to be, you may ask? I am not sure, but I do know that we must keep moving in the direction of making HR the linchpin of the Post 205 Development Agenda, of transforming the economy, of escaping from the tyranny of HR violators. This is the key vision of a world in which everything is connected. The story of the coming years is ours to write and it could be a story of the HR revolution when popular resistance changed the fundamentals –as much as the people of France changed their world (and ours) more than 200 years ago. “Any human power can be resisted and changed by human beings,” Ursula K. Le Guin tells us. And she is right, even if it is the hardest challenge we have to embark on. Now, everything depends on it. (R. Solnit)
- About 150 years ago, Marx indicated that capitalism was the most efficient economic system humanity had ever invented to produce goods and services. But Marx also pointed out the price being paid by adherence to this system: The destructiveness of the very bases of its wealth-generating principles, the destruction of nature and the unrelenting exploitation of the labor force (HR did not exist as such then…). But today, we have no other reality of the development of the productive forces than the capitalist vision that claims short-term efficiency and lineal progress in a planet assumed to have non-exhaustible natural resources. Certainly, the ‘fight against poverty’ has been adopted by most governments in the world, as well as by the UN –be it using a humanitarian justification (social democratic regimes) or a market-expansion/trickle down justification (neoliberal regimes). (F. Houtart) The contrast of these justifications with what the HR framework is all about should, by now, be clear and stark for you the reader.
- As an aside, what Latin-Americans call ‘asitencialismo’ is the capitalist plan to give the masses restricted access to personal benefits (bonuses, subsidized credit, handouts, subsidized schooling, health care, other subsidies, etc.). So far, HR activists have been unable to counter this by launching massive HR Learning processes centered on HR with the subsequent political organization and mobilization. Assistencialism mostly secures popular electoral support and is not linked to actions fostering a true alternate political project as an alternative to capitalism; in this approach, benefits are distributed widely without bringing about new expectations for structural change. As access to consumer goods is promoted, few activists are fostering masses of new social and political actors needed for that change. What is most worrisome is that all this happens without consciousness being raised that ‘consumerism’ values the consumer and not the citizen in us!
- The best symbol of this ‘post-neoliberal consumer frenzy’ is the cellphone. This gadget brings with it the false idea of a democratization process being under way by making people believe they are ascending or belong to the middle class. The cellphone makes people feel they are acting as active participants in the market. At the same time, credit cards that give access to benefits and credit are aggressively promoted –with people not realizing the usurary interests they are being charged and how their debts rise.
- Therefore, the challenge we face cannot be put on the laps of governments only. The challenge very much concerns social movements and progressive political parties that must urgently embark in politicizing the debate about the advances, penetration, contradictions and dangers of the raw market economy. They must all widen the scope of their actions to literally promote the liberation of the people trapped in the system, as well as to build a truly emancipatory post-capitalist model of society. (F. Betto)
The proponents of the neoliberal model try to convince us that changing our refrigerators, our television sets, our cars and our electrodomestic gear is the way of being patriotic.
Neoliberalism is very good at manipulating the meaning of words, e.g., in calling ‘poverty reduction’ what really should be ‘changing the socioeconomic paradigm’; in calling ‘social protection’ what really is a failed poverty reduction policy; in calling ‘participation in social innovation’ what really reflects the demise of the welfare state. We know it. It is nothing new. But we should act upon it. (F. Mestrum)
- Every political message that seeks hegemony –as neoliberalism does– also needs good promises such as poverty reduction, employment creation, social protection, a veneer of respect of HR (?)… so that it is accepted by people. But by the time people find out the promises are not met, it is too late: the hegemony has already taken stronghold. It is, therefore, important to carefully analyze the new discourses being proposed because, indeed, what is being put on the table is not necessarily about social protection, about the fulfillment of HR, about employment creation… but is rather an ‘improved’ version of poverty reduction –at the service of markets!* Discovering what the proposed discourse is ultimately about is what will help us to organize resistance –better late than never. We should not wait. We already know the risks, and we should react to them –now. (F. Mestrum)
*: Poverty reduction is totally compatible with neoliberal policies, which have nothing to do with a ‘correction’ of the overall negative consequences of such policies! A narrow preoccupation with poverty actually works against the broad and long-term efforts required to achieve what is really important, namely disparity reduction. The idea of social protection has been quickly buried with the emergence of the neoliberal poverty discourse. (Global Health Watch 4, People’s Health Movement)
- As has become patent in the last few years, austerity policies are part and parcel of the neoliberal program that has aimed, and succeeded, to reform the state and to introduce a social paradigm that has weakened trade unions and the welfare state, instead focusing efforts on poverty-reduction-at the-service-of-the-market. Neoliberalism, we should never forget, is not about directly weakening states, but rather about reforming the state and making it strong within a limited scope that suits neoliberalism’s intentions. And this is happening right now. So yes, the real macroeconomic goals of austerity may be being met (are they really?), but with HR as a victim. Add to this the growing influence of multinational corporations over the state, as well as their lobbying and aggressive promotion of international trade and investment agreements**, and we see the further emergence of ‘captive states’ whose goal is no longer to care for the HR and welfare of their people, but to help and promote their ‘corporate citizens partners’. (F. Mestrum) [Keep in mind that free trade does not imply a free-market and, more often than not, it means poor people go hungry while profits of rich landowners, of financiers and of corporations***, especially in the agro-industrial sector, increase. (V. Shiva)].
**: A pertinent question here is: Are trade agreements, in general and by definition, as well as in practice, to be considered crimes against humanity…? (E. Shaffer)
***: In all fairness, it also should be said that not all corporations (even some of the larger ones) are wedded to the current system. Many of the younger CEOs are fully aware of the challenges ahead and are trying to make their companies genuinely sustainable, moving from the old “take, make, waste” manufacturing paradigm to a circular one which minimizes or eliminates waste and mimics nature. (W.van Marle)
- For decades, capitalism and socialism were adversaries. Since 1945, they worked simultaneously in the Western world. But with ‘the threat of communism’ gone, financial capitalism, as part of the neoliberal ideology, stopped being compatible with the democratic values and hopes of the majority of people who are losing faith in democracy as relates to its capacity to improve their living conditions. (Albino Gomez)
- Most people do not condone the excesses of neoliberalism. True. But they remain in a state of constant ‘forgetfulness’. Ours seems to be a society of deliberate blindness about these matters. We live in a culture of the perpetual present, one that not only deliberately severs itself from the past that brought us where we are, but also from the future we are shaping with our actions or inactions. (N. Klein)
- Yes, neoliberalism is in crisis. It is actually in the intensive care unit; it does not generate growth for all, it only survives creating ever more debt as it makes inequality grow…HR are not in its horizon. (A. Gomez)
- Bottom line, we are sick of hearing about and technological triumphalism in a model that is actually characterized by ‘the three exs’, namely exploitation, exclusion and extinction …not forgetting HR violations!
Are Public-Private Partnerships financing development or developing finance?
Originally, public-private partnerships (PPPs) are the result of a contract between government and a private company under which:
- A private company finances, builds, and operates some element of a public service; and
- The private company gets paid over a number of years, either through charges paid by users, or by payments from the public authority, or a
combination of both.
But PPPs of another sort are now being promoted worldwide by global institutions and consultants. Development banks, national governments, the EU and donor agencies are providing subsidized public finance specifically for PPPs. Countries subject to IMF regimes, as well as other developing countries, are being subjected to political pressures and marketing campaigns to join. But experience over the last 15 years shows that PPPs are an expensive and inefficient way of financing projects and divert government spending away from other public services. They conceal public borrowing, while providing long-term state guarantees for profits to private companies.
- In this context, and as an aside, I have to say more about Public-Private Partnerships (PPPs). In PPPs, the profit making motive is never really too much in the background. In them, the private sector literally captures the policy decision-making process.**** The defining feature of PPPs is that they establish legally binding contractual clauses to the public flow of funding. PPPs thus can be and have been transformed to become vehicles for coming-up with multiple novel means of extracting private profit –too often at the expense of HR. In PPPs, the public sector tends to carry all the financial risks by providing cash subsidies or guarantees while PPPs are not about building and/or providing support to public services; they are about building assets for the private partners, therefore eventually yielding them financial and/or other returns. In sum: PPPs are less about financing development than about developing finance. (Corner House)
****: In the policy making of PPPs, agreement is mostly reached on setting technocratic targets, (i.e. targets that are power-neutral, are measurable and mostly rely on capital transfers to developing countries) whereas targets that necessarily imply shifts in the power balance or challenge the influence of developed countries on global issues are quite systematically avoided. PPPs thus dodge the bullet of having to reconsider their social accountability. [Let us not forget: Targets get achieved by processes set in motion. The mistake of PPPs (and of UN agencies) focusing too much on targets has been proven in the MDGs. Given that processes advance at difference speeds, targets need to be set participatorily year by year from the launch-on and then throughout the evolving processes agreed upon after their participatory assessment; this, with the aim to amend them as needed. PPPs could not be further away from this concept].
- The myriad green lights being given these days to PPPs, private sector financing and partnerships ‘for sustainable development’, without any specific language on their needed evaluation, accountability, transparency and overall governance checks, is deeply worrying. It is imperative to re-consider the term PPP in its original meaning and not allow the term to be used for any not-thoroughly-assessed partnership with the private sector.*****
*****: Private sector investors do not necessarily need HR to operate profitably. They depend much more on property rights and mainly want to make sure that contracts and laws that favor them are enforced. (A. Konishi, ADB. D+C Vol 41 Dec.2014)
- ‘Multi-stakeholder’ partnerships –that go hand-in hand with PPPs– must also be reviewed using UN-led governance guidelines that incorporate absence of conflicts of interest and accountability checks, ex-ante assessment criteria (such as having demonstrated sustainable development results), transparent reporting, as well as independent monitoring and evaluation mechanisms. (International Council for Adult Education)
Claudio Schuftan, Ho Chi Minh City
-Among academics, somebody said, we find a lot of ‘deep socialism buried in savage capitalism’. (R. Ampuero)
-The bourgeois class system of justice is like a fishing net that allows the hungry sharks to escape only catching the small sardines. (Rosa Luxemburg)
June 21st, 2015 by Claudio Schuftan
Food for a sharp observer’s thought
Human Rights Reader 364
- In sink with the title, and with no intention to glorify human rights (HR) activists, I would like to start this Reader with some assorted aphorisms I have picked up here and there:
- The only struggle HR activists lose is the one they never undertake or the one they abandon.
- They are constantly challenged; so they must thus pick their battles wisely. (To them, compromise often can and does bare fruits).* (adapted from J. Koenig)
- They do not abandon themselves (as many of us do) to that false happiness that comes from routine. (J. R. Ribeyro)
- As opposed to intellectuals who are rather redundant and often dilettanti, activists are passionate about their social and HR ideals and, therefore, delve into the real, unfair world we live-in with their head and feet. (M. Vargas Llosa)
- Activists cannot become the new protagonists if they are still under the spell of old narratives. (R. Ampuero)
- They see the difference between what can be foreseen and what is predestined. [Do they turn out to have a better crystal ball than most among us…?].
- HR activists stay away from ‘romantic illusions’ in the face of messy problems. (J. Mackenbach)
- They find-what-they-look-for as they know the answers lie in the questions they actually ask and pose to duty bearers.
- They do not indulge in too many explanations, because their friends do not need them, their enemies do not believe them and the uncritical followers of trends do not understand them. (Albino Gomez)
- They see their role as making-exceptions-becoming-a-new-normal. (So, as the years press-on, they do not let their motivation wane or weaken).
- Activists make it a point to understand others, their intentions, their interests, their hopes, their difficulties, their tragedies. (adapted from R. Kapuscinski)
- They do not ‘hope’. Instead, they work hard to get where the HR movement needs to go to: Today, tomorrow, every day. (Aung San Suu Kyi)
- They see it as their function to delegitimize what is being deceitfully passed as rightful.
- For them, activism is not about mechanistic thought and manipulated facts; it is about creativity and seeing key connections. (V. Shiva)
- Above all, HR activists have to be a good person, because bad persons cannot be good HR activists.** (But in the name of the good, they must not fight so much against evil that they become evil themselves…!).
*: One can be more revolutionary by simply not accepting or complying with certain ‘norms’ than openly challenging them. Perhaps this is the difference between an act of disobedience and a revolutionary act. (A. Gomez)
**: There are wo/men who fight one day and they are good. There are other who fight for a year and are better. There are those who fight for many years, and they are very good. But there are those who struggle their whole life; those are the indispensable ones. (Bertolt Brecht)
One is old when one has more memories than projects in the soul.
-Never forget: There is no worse remorse for our activism than to have had the key to the solution in front of our noses and not have drawn the simplest of conclusions and have acted accordingly. (It is not always about premeditated actions, but about a series of small actions and gestures that add up towards an intimately hoped-for outcome). (P. Simonetti)
-Learning from listening is activism’s birthplace. (J. Koenig)
- It is fitting here to start with a caveat. It goes like this: Flesh decomposes faster than intelligence. It is a characteristic of the old age syndrome to think that nobody can do things like one does oneself, that one is irreplaceable and absolutely needed. We must deal with the fact that the world goes on functioning perfectly when we are buried two meters below. We must be aware and fear that, as years go by, we enjoy more deviating from our ideals than carrying-on with the tasks we really stand-for and believe-in. [How many years have you let go by…?]***
***: We all have our fears; they make us screen endless unpalatable information which we eventually forget (an internal conflict technically known as ‘cognitive dissonance’). True? (You may not even notice that you have turned your attention elsewhere and have now forgotten what you just read). Your fear may prevent you from adequately analyzing the evidence and/or responding intelligently to it. So, if you are one of the people still reading this Reader, you are probably less frightened than most people. The others may have given up before they got to this paragraph. The primary problem with such fear is that it distorts not only our mental focus, but also our capacity for analysis and, worse, it distorts the behavior of national elites, i.e., corporate executives and their political, military, media, bureaucratic, academic and judicial acolytes. Fear will drive dysfunctional corporate activity irrespective of its HR, environmental and other costs. And corporate executives will ensure that their political and other acolytes do not get in their way, because the fear that drives profit-maximizing behavior is deep-rooted and far outweighs any fears in relation to HR or the environment. Arguments, no matter how sensible or evidential, do not work (look at the climate negotiations… Rich nations who give climate financing for poor nations do not do so additionally, but put the same as part of their existing foreign aid portfolios –and this does not help…) The question is: Do we have the courage to fight fear? There is no downside in trying. But we need to fight strategically so that we defeat both elite fear and our own fear. (R. Burrowes) [How long will it take for you to overcome your fears and join the HR activists’ fight?].
- If we do not act, life as a journey becomes a useless illusion; there is no journey; the world goes nowhere. If we stay put at home or in our offices, the world around us keeps its course in a race to the bottom. (V. Nabokov)
- There is an important difference between the cost of action and the cost of inaction: The costs of inaction are primarily borne by those who are the most vulnerable: You know that the worst consequences will be suffered by those who live in poor countries, especially women, children, young people and the elderly. (J. Martens)
The only choice I now see for you is between being a human rights advocate or a human rights activist.
-You may have experienced many disillusions and may want to get away of it all. But do not hide from your ideals. Dare. (P. Simonetti)
-The times do not call for procrastination or despair, but call for action.
- There always come times for those concerned with public policy generally or, for instance public health policy, when conscience compels commitment. That time has come for us now. It came quite some while ago, but has not yet been heeded. We must all be responsible citizens now –in our everyday, as well as professional lives.**** In doing so, we need to humbly accept that immiserated and oppressed people and populations whose HR are being systematically and chronically neglected have a better sense of what is going on in their world and what is or is not in store for them than do those of us whose material lives are comfortable. Ultimately, it is aggrieved claim holders who have to stand up for their own rights, to shape what they are fighting for, and to finally work towards a just society. This means that we have to be prepared to put our careers on the line; that mentoring and inspiring young colleagues and natural leaders is for us a sacred duty and that, when our grandchildren listen to our story they can say they are proud of us. (Fabio Gomez)
****: To use a metaphor from Franz Kafka: For many of our colleagues it is not the lack of oxygen, but the lack of capacity of their lungs…
- It is thus time that we all stopped being primarily self-centered, making our own generation and ourselves the focus of our thoughts and of our work. Further, it is time that we no longer put humans first, for the sake of our own species, but do so as well for the sake of all other species and for the natural world and the biosphere. Bottom line here is that the overall concern of what-is-seen-as-an-unacceptable-state-of-affairs prompts colleagues to reflect upon overcoming the still prevalent widespread avoidance of uncomfortable truths, staying in a state of mind that perpetuates the assumption that impoverished and disadvantaged populations need aid in the form of money, handouts, goods or interventions of types that, by their nature, are not sustainable or, worse, mystify or deadlock the people they are supposed to help. (World Nutrition editorial, September 2014)
- So, to end, here is what a HR activists’ motto could be: Let’s be more than ‘progressive’! Never give up your sense of duty. Duty is the echo of our being. Being more radical is our duty today; this is actually no more than keeping loyal to what our common sense tells us. Therefore, being beyond progressive is to grasp what is humanly fair and just. We cannot assume that what is humanly unfair and unjust is ‘natural’. Let’s be radical, i. e., let’s listen to our common sense. What is natural, we assume; what is humanly right and fair, we need to deeply comprehend. Yes, duty is the echo of our being. (L.Weinstein)
Claudio Schuftan, Ho Chi Minh City
-Character assassination (of HR activists, for example) has always been a tool used by those who cannot successfully defend their message. Although they think such slander will destroy people’s career, they do not understand that the attacked often gave up a ‘career’ for a life of service. The spirit of service inspired by the truth, conscience and compassion cannot be stopped by threats or media attacks. Applying science has always been about service, not servitude. (V. Shiva)
-Every person shines with her/his very own light. There are no identical inner fires. There are big fire and small fire people; other have fires of all colors. There are people with serene fires and those with wild fires that fill the air with sparks. Some fires are dull; they do neither shine nor burn. But yet other fires burn life with such determination that you cannot look at them without blinking –and whoever comes near them gets her/his light turned on. (Eduardo Galeano)
-The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift. (Albert Einstein)
-It is attributed to Winston Churchill to have said that an optimist sees an opportunity even in a calamity as opposed to a pessimist who considers all our opportunities a calamity. [Also consider: Does having just a few options make our decision-making easier…or doesn’t it? (A. Gomez)].
June 8th, 2015 by Claudio Schuftan
Food for contesting a thought
Human Rights Reader 363
Human rights principles and standards are to be used by activists in social movements to contest neoliberalism’s myriad violations of human rights. (adapted from P. Clayes)
The challenge to be addressed in contesting human rights violations is to leave the ever-present statistical approach behind and to insist on claim holders de-facto exercising their sovereignty.
- La Via Campesina has succeeded in using human rights (HR) thanks to its innovative use of staking demands. The advantages they see in using HR to frame peasants claims are numerous. Human rights are used by their activists to redefine the boundaries between what-is-just-and-fair and what-is-unjust-and-unfair. For them, HR grievances turn claims into universal and legitimate demands, and allow any social movement to frame their claims in a way that de-emphasizes just sectoral solutions. Human rights allow the integration of more than one ideology and help share claims among movements with divergent ideological, political, or cultural references. These advantages help explain why HR have been made center stage in a great number of social struggles and its language having been gaining ground. The shift from demanding-decision-makers-to-make-good-on-their-promises to reminding-decision-makers-of-their-solemn-duties strengthens social solidarity, i.e., HR help claim holders imagine and fight for a different common future.
- All these factors combined support the rebellious potential of HR, because the HR framework connects individuals to a collective in a way that reintroduces equality and self-determination as central themes in people’s struggles –and this attracts ever new movements to actively participate.
- On the other hand, applying the HR framework injects a new meaning to the very idea of ‘participation’ which activists do not limit to ‘the right to participate in development’, but see the challenge rather being ‘to demand a break in the monopoly of the government’ in defining public interest. When necessary, this means challenging the state as the only legitimate source of law making and of applying laws. Having an internal dimension, i.e., the right of people to choose their own political, economic, and social system, this ultimately emphasizes much greater democratic control. It calls for integrating all participating movements in a far-reaching, wide variety of struggles at the local and national level.
- Activists in these movements are thus called upon to put in place HR practices that represent concrete and feasible alternatives in the here and now. Fewer efforts are sunk into elaborating on the kind of regulatory institutions and measures that would be needed to enable these practices to flourish under the existing system. So, here we have a veritable anti-reformist position where activists rather demand deeper systemic changes and not mere ‘cosmetic reforms’. This notwithstanding, in this emerging struggle, efforts to institutionalize recognized HR are certainly not abandoned.
- In all fairness though, the HR struggle has not yet acquired strong mobilizing qualities: HR do not yet constitute a true unifying and mobilizing movement. The HR framework remains perhaps more than somewhat disconnected from natural grassroots leaders. The mobilizing potential of the HR framework will indeed be considerably greater if it manages to reinforce the collective identity of different existing movements. We badly need to search for new ways to build links among diverse memberships. [As can be guessed, a renewed unambiguous call for massive HR learning is pertinent here].
- Moreover, consider that rather than directing our HR praxis at the grassroots, it unfortunately tends to be organized around and oriented towards institutionalized structures of power. This can and does seriously endanger the emancipatory thrust of HR.
- The level of expertise being used to spread HR arguments is such that, more often than not, the latter have been defended by HR lawyers and not by average citizens. As a result, conflicts framed in HR terms have tended to be solved in specialized arenas and run the risk of undermining social movements’ efforts to organize and mobilize de-facto claim holders around HR issues that affect them. Experience with UN-led processes aiming at creating new and respecting existing HR standards shows that, to be successful in the longer term, those involved in standard setting need to build a broader and more inclusive base and thus reach out not only to governments, but also to public interest civil society organizations, experts, victims and beneficiaries, as well as to other UN agencies. Among other things, this means that, to secure compliance with international HR norms and principles, inevitable adjustments need to be made to many national standards. But, be it as it may, the ultimate aim is to localize HR. i.e., making them meaningful to more and more local constituencies and contexts.
- Only by revitalizing the ‘HR project’ with true rebellious dimensions* will we succeed achieving recognition of its global validity and local legitimacy. This also points to the importance of the political mobilization needed for the success of rights-based strategies, at the same time finding an adequate balance between institutional and non-institutional movement building.
*: When injustice becomes the law, rebellion becomes a duty. (Thomas Jefferson)
Is it not true that to talk about duty bearers is to talk about ideology? (adapted from Michel Foucault)
- The homogenizing tendencies of the global regime have to be fought. For that, an incontrovertible distinction must be made between the different logics and interests of claim holders and duty bearers**. In the end, what will make the difference for HR movements is building links between the global political space and local realities, that is, ‘bringing home’ the outcomes of global negotiations with, on the other hand, local and national mobilization efforts providing the needed popular energy required for global political work. National accountability backed by political mobilization is thus the indispensible complement for globally negotiated guidance on HR. (N. McKeon and People’s Health Movement)
**: For many HR thinkers, duty bearers are, themselves, not, strictly talking, duty bearers; they often are claim holders to other duty bearers. [I have to confess here that, in the Readers, I talk about claim holders and duty bearers as two categories of people or classes. That is not correct. Claim holders and duty bearers are roles into which individuals, groups of individuals, non-state actors and state actors enter depending on the situation. Most of them enter into the role of both claim holder and duty bearer, but in relation to different specific human rights (ergo claim holder/duty bearer) relationships. We cannot forget that even the individual claim holders who live in poverty have a number of important duties! (reminded to me, as often my mistakes or omissions, by U. Jonsson)].
States must be provided with greater guidance and deadlines to fulfill their duty to progressively realize the different human rights so as to counter the misperception that they have embarked in such progressive realization when they are actually indefinitely delaying taking key actions.
- Since 1948, the modern international HR law system has rapidly evolved
producing nine core human rights treaties, many related UN institutions and at least a hundred HR declarations, resolutions, conferences, and programs of action. Regional analogs of the international HR law system have developed in Africa, the Americas, and Europe. The speed of these developments has seen international HR law become the fastest growing field in international law.
- The progressive realization of HR requires states to take immediate action towards realizing all rights including immediately guaranteeing the non-discriminatory exercise of all HR***. Governments thus must take deliberate, concrete, and targeted steps (even if long-term) towards full realization. This means that while states can justify some deficiencies in their social services, they cannot justify the failure to work towards rectifying them. The importance of distinguishing between non-compliance arising from unwillingness rather than inability must be emphasized when determining whether particular actions constitute violations of any of the HR.
***: Let us examine discrimination –of which class prejudice is a central element: We have actually moved from simplicity to ambiguity and this makes me angry. Angry, because stories of injustice that have been passed down for generations seem to be continuing before our very eyes. I am offended, because of the insulting comments I keep hearing and reading about. I am introspective, because I most often want to take sides on this issue. Let me use an example: The nature of racism has changed. There has been a migration away from prejudice based on genetics to prejudice based on class. ‘Proper’ people have both a disgust and a fascination for those who live in the untouchable realms. Fascination is responsible for a sort of ‘poverty tourism’. Let’s face it, we have a sharp social divide between people who live in the ‘respectable’ meritocracy and those who live beyond it. In one world, people can control their destiny; in the other, no matter how hard they try, they cannot. Widening class distances produces class prejudice, classism on visceral attitudes about competence. People in the ‘respectable’ class have meritocratic virtues –and this view metastasizes into a vicious, intellectually lazy stereotype. Classism combines with latent and historic racism to create a particularly malicious brew. People are assigned a whole range of supposedly underclass traits based on a single glimpse at skin color. The distinction between civil, economic and social rights has now been obliterated. But every civil rights issue is also an economic and social issue! Classism intertwines with racism. We need a common project: a HR project. (D. Brooks)
Remember: General Comments go a long way in clarifying the entitlements and duties under the different human rights and their progressive realization.
- General Comments resolve some of the vagueness of formulations and arguments in the respective HR covenants and provide policy-makers and courts with clearer guidance for overseeing the realization of each right. This is not to suggest, however, that General Comments are sufficient to resolve all remaining questions about scope and context, including in particular the content of the HR Minimum Core Obligations, e.g., non-discrimination, non-retrogression.
- Furthermore, the application of HR covenants and of General Comments also implies the need for a democratic allocation of the limited resources available. There are indeed important downstream legal consequences for countries that have ratified the different HR treaties, particularly in cases where individuals and social actors can now access independent judiciaries willing to enforce these rights ordering governments to comply.
- Despite this, we see growing recognition that General Comments and law alone are insufficient mechanisms to advance transformative HR changes. It is social action that is key to such outcomes!****
****: Social action can involve state reporting and/or individual complaints. Both are primary mechanisms within the international HR Treaty System for monitoring and encouraging state accountability for their compliance with ratified treaties. Each of three regional HR systems offers mechanisms to deal with individual complaints of violations of the different rights. (Note that states agree to submit regular reports that update the respective UN Treaty Monitoring Committee on the state’s progress in complying with its obligations; additionally, individual complaints alleging the violation of treaty rights must be lodged against states at the relevant treaty committee –thus the importance of ‘shadow reports’ submitted by public interest civil society organizations). (L. Forman)
Some people’s idea about human rights is so perverse that it can forever spoil good judgment. (P. Simonetti)
- Many colleagues seem to have assumed that there are no real issues in HR, or else, that the issues they may be aware-of as citizens are genuine HR issues, but are not their problem. And this can spread maliciously: We all know colleagues rich in opinions and poor in true dedication… Yes, in tranquil times, HR principles could be implied rather than pursued. But in tumultuous times, such as now, they need to be specified and vigorously pursued (G. Cannon) –hence these Readers. So, if we are going to make any progress, we have got to go all out for it. But, mind you, a technical only focus on progress is counter-productive, because it weakens the drive for a more radical, structural reorganization. (John Waterlow)
Claudio Schuftan, Ho Chi Minh City
Economic, social and cultural rights can also be framed as ‘Equality Rights’ (email exchange with Paul Hunt former UN Special Rapporteur for the Right to Health)
PH: I hesitated a long time before framing economic, social and cultural rights (ESCR) as Equality Rights but think that, on balance, it is okay to try to locate them within egalitarian political (not economic!) liberalism (i.e., not only within socialism).
CS: This framing will then eventually make the HR framework more attractive to (some) liberals, right? So it would be more than okay trying to go this way? Is this realistic though? (no harm trying, but…) Does this respond to the question why so many liberals have not yet espoused HR? Isn’t this mainly ideological? (this is why you say: ‘not only within socialism’). I fathom it is also their ignorance about HR, no? As opposed to conservatives, liberals, to me, have an ambiguous agenda (or ideology?) They thus are and are not with us HR activists –depending on from where the wind blows to quickly pay lip service when called for without meaning it: Tough challenge for us. It will thus be interesting to see responses by egalitarian liberals to your proposal on this. But then, liberals, in my experience, do not react much, much less in writing, when challenged…
PH: Frankly, I see ESCR as being integral to democratic socialism. But it occurs to me that it is also integral to egalitarian progressive political liberalism. So, if their ideology is serious about equality, it should be serious about ESCR –and ESCR need all the allies they can muster! It is easier to sell ESCR as part of egalitarian progressive political liberalism than it is to sell ESCR as part of socialism. I think we need to try both; hence my proposed framing.
May 28th, 2015 by Matthew Anderson
The 2015 Left Forum will take place on the weekend of May 29-May 31, 2015 at John Jay College in the Bronx. Readers of the Social Medicine Portal readers may be interested in the Health Track. (LF 2015 Health Track Flyer). We have a special reason to celebrate as the New York Assembly has just voted in favor of a Single Payer plan for New York State. This is a small but significant victory.
Please come to our session on Faultlines in the Medical Industrial Complex on Saturday at noon.
Matt Anderson, MD
May 26th, 2015 by Claudio Schuftan
Food for an ignorant’s thought
Human Rights Reader 362
In some agencies, selectivity and hypocrisy surround human rights. (I. Saiz)
- Human rights language in the successive post 2015 development agenda drafts still fails to move beyond aspirations and to address the real global determinants of underdevelopment with its human rights violations*: There is a tendency there to address human rights (HR) in purely aspirational terms (which objectives, which indicators, etc.). While these are important, the discussion at this level sometimes becomes a smokescreen to avoid addressing the fundamental above-mentioned global determinants, the ones that hinder strong local and sovereign expression of claim holders’ grievances. A critical shift of the conversation is needed at this level rather than the purely aspirational one being used. (S. Prato)
*: Beware: Underdevelopment is not a phase on the road towards development. Underdevelopment is the historical result of somebody else’s development. (Eduardo Galeano)
- Moreover, besides high-flying rhetoric, the post 2015 agenda continues to be an agenda that pretends to regulate and prescribe for the local much more than for the global. As soon as one gets close to the big elephants of the global agenda (international HR law, trade, finance, the environment and migration), a hierarchy is immediately invoked to suggest that the HR agenda cannot enter those domains as they are addressed elsewhere in existing on-going processes. I believe this needs to be challenged. If the international community is serious in pursuing the ambitious objectives it is currently discussing, there needs to be a strong call for a clear change of locus cum-accountability-demands in the post 2015 agenda. (S. Prato)
- On the other hand, HR have provided a common language to peasants’ and small-scale farmers’ organizations and movements, as well as other that are politically, culturally, and ideologically committed to HR on an increasing scale. (P. Clayes)
Human rights are at the heart of the emancipation of those denied dignity. (adapted from R. Luxemburg)
- It is impossible to defend social rights in general if workers rights are not respected. Neoliberal policies constantly produce more poverty –precisely because workers’ rights are not respected. This is why, ‘at-the-end-of-the-pipeline’, social assistance cannot solve all the problems when there are limitations to social rights. Looking at it the other way around: workers rights cannot be defended if the rights of poor people are not respected. With growing poverty and poor people willing to accept any job at any wage (Marx’s Lumpenproletariat), if there is no decent social assistance, workers’ rights are directly undermined. This means that social rights, in general, and workers rights, in particular, have to be combined and be promoted and defended together in a comprehensive way. Separating the rights of poor people from workers’ rights is precisely what neoliberalism wants. There is a neoliberal willingness to ‘help the poor’ (that is the ‘deserving poor’, those able and willing to work). But, at the same time, the aim is to disregard workers’ rights and definitely weaken trade unions. What progressive forces have to work-at is a platform to fight the fragmentation of HR. In the end, by necessity, we have to fight together to re-dynamize and re-politicize our societies, away from neoliberalism. (F. Mestrum)
- As this Reader has often said, all too often, economic ‘freedom’ boils down to the ‘freedom’ of business interests to trample on the weak in the name of greater profits, or, conversely, the ‘freedom’ of a worker to sell his or her labor for less than a subsistence wage.** Many on the left have rightly turned to HR as a way of articulating claims for social justice and equality. (S.Wilson)
**: Think of it: freedom of choice is a bourgeois prejudice. Think further: Freedom of expression: What good is it if the other does not listen? (A. Gomez)
- The political left’s greatest contribution to the theory of HR is this: if political rights are to be worth anything, they entail recognition of the means necessary to exercise them. It clearly requires the redistribution of wealth and of economic power to the extent necessary to ensure that everyone has more or less equal access to the means of self-realization and ultimately of dignity. Ergo, redistribution (disparity reduction) does matter to HR. But existing laws are too weak or too compromised to deliver any meaningful form of change in the direction of social rights and redistribution. It is no good asking an elite judge, through elite lawyers, to do something truly egalitarian. His (and it is still usually his and not her) class and other social prejudices do interfere. This is why even narrow legal victories can help catalyze positive social, labor and HR changes. The corollary is that, if legal decisions are not the subject of popular political mobilization and follow-up action, they will wither and die. Once they are upheld through active mobilization, they can create opportunities for truly transformative political action. It is not necessary to be legally recognized in unions or other social movements to have political force! Indeed, leaving HR only to lawyers and courts forgoes much of their potential. To make a HR claim is to expand the bounds of the legally and politically possible. It is often also to challenge those in power to make good on their political promises, let alone commitments, and/or to expose the contradictions in those commitments. (S.Wilson)
- Speaking about power, from their origins, philosophy and HR are disciplines that cannot function by paying obedience to power. Sustaining the existing order and not criticizing what exists is tantamount to a negation of HR. (A. Badiou)
- So, HR cannot thus be negated. They are the defining issue of our age so that, to be really effective, HR work must be carried out on a global scale, and it must be radical in the exact sense of the word, i.e., it must go to the roots of the matter. (G. Cannon) Human rights are perhaps our greatest collective problem demanding collective, global action the likes of which humanity has never actually accomplished. Therefore, what is needed in HR work falls in the realm of big politics; it is not about better administering what we have, but to rebuild what has been and is mismanaged –starting from what has never been respected. (A. Posse) Key, then, is to address the failed governance that is responsible for so many HR violations.***
***: Note for accuracy: States violate ratified HR; other powerful actors, like TNCs, ‘abuse’ HR.
The emerging human rights paradigm: There are no nations! There is only humanity. (Isaac Asimov)
Human rights are meant to hold fast to that which is good, and to identify and alter what is bad; they require universal awareness so that a majority pays attention to what is right and what is wrong. (Therein lies the challenge of the needed massive HR learning). The over-riding responsibility of HR is to work towards passing-on to present and future generations an improved quality of human life in society. (G. Cannon)
- The wealth of HR cannot be measured the way we measure the value of goods or the balance in our checking account. Its value is in the qualitative realm and in the territory of the many divergencies about what humanity and human values are or are not. If there is consensus, it is that the respect for others is a positive dimension in life, an inherent wealth, a common good, a part of the movement of change towards another paradigm. (L. Weinstein)
- The rapidly emerging social movements like feminism, ecologism, indigenism, pacifism, ecumenism and holistic medicine increasingly value and apply HR and popular education, they validate direct democracy and they struggle non-violently. These new, in good part, spiritual streams are all part of an emerging culture that in some way questions the ruling and dominant paradigm, as well as announces a new possible post-crisis society that upholds human needs, human rights and human capabilities. These are all spaces of hope. (L. Weinstein) [The latter, Despite the fact that Aung San Suu Kyi tells us: “I do not ‘hope’. I work hard to get where we need to get with our movement.”].
- In the sense Thomas Kuhn gave them, these movements are spontaneous manifestations already operating outside the dominant paradigm anticipating and showcasing the emergence of the new basic, holistic integrated, cultural and political paradigm. The prevailing development model proposes to us ‘doing’ over ‘being’; individuality over an integrated vision of human beings in nature.**** The prevailing power is rightly seen as one of domination, of using pressure and force, authority and seduction; its mood is one of control, of instrumentalizing, of neutralizing (of distancing us from one another). We end up living with a fake certainty, avoiding to seriously questioning our many doubts, our ambiguities, our ambivalences and our contradictions. (L. Weinstein)
****: Caring for your fellow human beings is a mood to fit into your own nature, not one to be used to fit-in with the nature of the rest of the people. Caring must be seen as ethics and as part of our human rights culture. (L. Boff)
- The alternative path to be used by the-new-way-of-being-political is to use the new spaces these emerging movements (pacifists, feminists, HR… and all the above) are opening to launch the new ‘concrete utopia’ being forged. In this context, HR activists are here to remind us of our identity as human beings, of our species in relation to others in the planet, of our infinite diversity; these activists are pushing the possible and the necessary, they are going to the roots, encouraging a new needed political thrust. Yes, they represent a new form of doing politics. (L.Weinstein)
- More and more, social movements, public interest civil society organizations and human rights organizations are not accepting that the lives of their members, their dignity and their struggles, be fragmented. Representing their people, they do not want to see their rights reduced by unacceptable policies that only offer unacceptable minima commensurate with charity. People are no longer willing to exchange their self-determination for safety nets, their territories for meager cash transfers that carry conditionalities, and their healthy and culturally adequate meals, eaten in family and/or in community for ‘ultra-processed micronutrient-enriched’ products or genetically-modified organisms (GMOs). People further reject the public space being governed by private corporate interests. (F. Valente)
- So, to recap: The overall principles that guide HR are ethical in nature*****. They are concerned with our humanity and the values of human conduct; not with description, but with judgment; not with ‘is’, but with ‘should be’. Ethical issues are ‘transcendent’ and so are HR issues. They may be well grounded in evidence, but by nature, they are above and beyond experiment. Ethical questions are usually not addressed by the exact sciences but, in reality, scientists cannot justify or sustain a value-free attitude. (G. Cannon)
*****: HR may be elusive, but they unavoidably challenge many right and wrong assumptions; HR thrive best when actually practiced.
- All this leads me to say something about science: The widely-held view of science as a set of specialized, highly technical methods for revealing ‘the truth’ about the natural and the social world is a major obstacle to HR. Modern reductionistic science, now entrenched in the heartland of Western culture, makes it harder for us to imagine with humility and awe how we as humans are interdependent among ourselves and with nature. The task we face in HR work ranges well beyond the classical and supposedly secure scientific paradigm of data collection and data analysis. Classical rigor may be appropriate enough if we are carrying out research to find out how the world and societies work normally. Scientists have been doing that for many years. But when the research question is more urgent, when the world has stopped working normally, and the repercussions are flagrant HR violations, then, step-by-step empirical hypothesis-testing rigor may be an unaffordable luxury, i.e., number-crunching has its place, but as a servant! Directly grasping the context and the views from those affected, in our case by HR violations, is essential. Decisions and actions in the public interest depend on circumstances, and must be guided by down-to-earth judgments. The task is to find the relevant evidence that is most likely to be of value (as directly felt by claim holders) to take remedial actions that literally impose fairness and compensation. (adapted from T. McMichael and G. Cannon)
The UN and its three pillars
- Human rights are regularly described as one of the three pillars of the United Nations (along with development and peace and security). That makes for a short pillar and a badly aligned roof. UN member states should make sure that, as one of its core and mandated activities, HR are properly funded. Human Rights cannot be promoted and protected on a mere voluntary basis. Voluntary, and particularly earmarked contributions are often not the solution, but rather part of the problem. Earmarking funds –as we see when funds come from public-private-partnerships– tends to turn UN agencies, funds and programs into contractors for bilateral or public-private projects that erode the multilateral character of the system and undermines democratic governance. Member states simply must revert their austerity policy towards the United Nations and increase their contributions!******
******: Actually, governments treat the United Nations like firefighters. They call them to put out a fire, but do not give them the water to do so and then blame the firefighters for what is their failure. (J. Martens and R. Pomi)
- Furthermore, voluntary guidelines, (too) often promoted and trusted (too much) by UN agencies, are unfortunately only as powerful as the General Comments adopted by the Committee on ESCR. Being non-binding, they are less frequently used by those they call upon to act. At the eleventh hour, signatories find them ‘over-prescriptive’. (O. de Schutter) So, then, what…?
- Human rights are indeed not voluntary. Their progressive realization means that it is not acceptable for a UN member states to remain passive. No single part of government can avoid being called to account for failing to take the measures it is expected to take. Therefore, independent monitoring by public interest civil society organizations must result in sanctions associated with non-compliance for the processes and timelines that have been set or not been set for a progressive realization.*******
*******: We all know there are major actors who are able to block change as a result of the dominant position they have acquired in the political system. The democratization of the HR discourse thus is a necessary condition to affect change. To exercise democracy, people need to own the systems on which they depend –and for that, those systems need to be radically and democratically redesigned. (O. de Schutter) Yet another renewed call for massive HR learning here.
Claudio Schuftan, Ho Chi Minh City
May 11th, 2015 by Claudio Schuftan
Food for a here-is-why thought
Human Rights Reader 361
The realization of human rights is a prerequisite for the achievement of the other three.
- The application of the human rights-based framework must be seen in the larger UN perspective. In order to fully understand and appreciate the potentially powerful role of human rights (HR), the relationships between HR and the other ‘pillars’ of the United Nations (peace, justice and democracy) need to be understood. The relationship between justice and human rights is of particular importance. Two things must be recognized: (i) the centrality of applying and integrating justice and HR in development policy, and (ii) the need to include democratic development and respect for HR as indispensable to achieve sustainable development at all levels.
- A careful reading of the United Nations Charter helps us understanding the relationships among these universal aspirations. The UN Charter is actually based on the ‘four pillars’ of Peace, Justice, Freedom (Democracy) and Human Rights. The Universal Declaration of Human Rights further explains that HR form the foundation for the other three:
“The recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice, and peace in the world.”
- This suggests that the realization of HR is a prerequisite for the achievement of the other three and what this means is that the Human Rights-Based Approach to Development (HRBA) represents the broadest and most fundamental development strategy.
So, if it is a prerequisite, what does it entail?: A recapitulation for latecomers (U. Jonsson)
- Any specific issue affecting human beings is a right only if it has been codified in an International Human Rights Treaty (Covenant or Convention). This means that all human beings have such a right –they are right-holders. If a country (State Party) has ratified that treaty, individuals move from being just right-holders to being claim-holders with valid claims on others who then become the correlative duty-bearers. This forms a ‘claim-duty pattern’ in society in which the State most often is the ultimate duty-bearer. Increasingly though, ‘non-state duty-bearers’ are being recognized.
- A Human Rights Standard represents a desirable goal or an outcome of the realization of a specific HR. These standards are codified in HR treaties, for example the rights to health, to education, to food, to adequate housing, etc. There are many different ways of achieving a desirable outcome, or more precisely, there are different processes that can be used to reach a certain outcome. In the Human Rights-Based Framework the processes should meet the criteria of Human Rights Principles (i.e., universality and inalienability, indivisibility, interdependence and interrelatedness, equality* and non-discrimination, participation and inclusion, and accountability and rule of law).
*: A common misuse of equity and equality interchangeably, originally introduced by the World Bank, who defined equity as equal opportunities, forgetting that equality of opportunity does not automatically result in equality of results. A high degree of equality of opportunity may be desirable, but is seldom a sufficient condition for equality of results! (See HR Readers 228, 285, 289 and 307-308).
- The United Nations HR work focuses on the development of the capacities of duty-bearers to meet their obligations and/or of rights-holders to claim their rights. Any HR work must focus on the Progressive Realization of HR [which includes setting (annual) benchmarks that will show processes have (progressively) been set in motion, all pointing towards the full realization of that right]. While most development approaches focus on outcomes only, in the HR-based framework ‘development’ is understood as processes that lead to outcomes. This facilitates both the identification of priority actions and is helpful in monitoring. It must be noted that the HR relationship between claim-holders and a duty-bearers, more often than not, reflects unequal power relations.
Human Rights Approaches to Development: Action or no action (U. Jonsson)
- Consider five scenarios:
(i) There is a lack of any significant reference to human rights, i.e., no significant or explicit reference is made to HR, or it is assumed that HR that are not codified in national law are not ‘real human rights’.
(ii) Misuse of human rights, i.e., HR are misused by using normative ‘human rights-like’ positions that are not recognized as part of International Human Rights Law thus not being real HR; for example, ‘youth rights’ and some parts of ‘property rights’.
(iii) Rhetorical repackaging, i.e., a desire to refer to HR is in these cases expressed, but without any serious effort to ‘integrate’ HR or taking a truly serious ‘HR perspective’. The reason of this is often a desire to show a ‘high moral ground’ by referring to HR, and the incorporation of HR terminology into an otherwise traditional development discourse without any significant discussion of its operationalization.
(iv) Human rights as a cross-cutting issue, i.e., although the term has been used by many agencies, no agency has so far managed to define ‘cross-cutting’ HR work in clear operational terms –which in many cases has just reflected a ‘high moral ground’ approach (see iii above)
(v) Human rights mainstreaming, i.e., here the aim is to ensure that HR are ‘integrated’ into all sectors/aspects of existing development interventions (e.g., water, education, etc.). ‘Mainstreaming’ and ‘integrating’ are often used interchangeably, although very seldom clearly defined.
- As understood today, sustainable development, and the realization of HR are, to a large extent, dialectically related. Neither sustainable development, nor the realization of HR can be fully understood or achieved without an understanding and achievement of the other one. Three of the four components of sustainable development primarily reflect specific groups of HR: Sustainable Social Development (social and cultural rights); Sustainable Economic Development (economic rights); and Sustainable Political Development (political rights), while Sustainable Environmental Development does not yet have a clear group of ‘environmental rights’, although some rights in the International Covenant of Economic, Social and Cultural Rights (ESCR) and the International Covenant of Civil and Political Rights do relate to the environment.
- Bottom line, the realization of human rights is a pre-condition for the achievement of democracy, freedom, justice, sustainable development and peace in the world –and here we explored why this is so… [How badly this needs to be remembered in the final stages of the negotiations of the Post 2015 Development Agenda…].
Claudio Schuftan, Ho Chi Minh City
Soliloquy: We cannot but face the apparent contradictions maliciously planted to oppose the HR discourse. It sometimes looks so uphill a battle to me to fight… but not doing so means giving up, which I won’t. We simply have to crack the apparent (and the real) paradoxes. For that, sometimes we have to get into more complex topics, topics that go deeper into the human identity and into what I would say is the current crisis of human evolution. I have variously brainstormed on this but, over and over, I see no other way out than that of concerted political action. Our world today is beyond existential doubts and philosophizing. Our needs are more immediate, urgent and concrete. We have to break with conventionalities, think and act out-of-the-box; we have to avoid falling into rhetoric and empty pronouncements; perhaps accept that the old school of ‘theory and practice united will never be defeated’ may have its limitations. The question is whether new approaches will get more traction with the common people. For the vast majority of the haves, who have the power to change things, reasoning-in-a-planetary-sense has stopped being a preoccupation, much less a practice –not even in their most sublime moments. So what else than to dislodge them from their positions of power? I will be glad to consider other promising alternatives… To be radical in HR implies integrating radical analysis and/with radical action. This is the way many of us see it. But can this view be passed on to claim holders and duty bearers? These Readers think so, not moralizing but focusing on the “we have to” and “what is it that we are doing (or not doing)?” …and “to what avail?” (apparently, so far, to not so much avail…). Much to be done. (adapted from L. Weinstein)
April 24th, 2015 by Claudio Schuftan
Food for a central political thought
Human Rights Reader 360
The centrality of politics
- Do politics matter? We should realize that if the answer to this important question is no, then we –those living in so-called democratic societies–are in deep trouble. Why? Because we know that democracy does not work under primarily technocratic regimes. Do note that the evidence shows that the answer to the question above is a strong YES: politics do indeed matter. Political parties, for example, do shape outcomes –although not always in the direction we would expect or like them to, e.g., having human rights (HR) considerations at the forefront… (V. Navarro). What this Reader has been saying repeatedly is that people need to conquer the right to fight for their rights* –and this is only possible in democracy. (F. Mestrum)
*: Independently of how powerful economic, political or even military institutions are, they persist because they are legitimized and that legitimation rests on the acquiescence of people. But people can legitimize and delegitimize! One of the characteristics of legitimacy is the power of people to change its precepts. History has certainly been a witness. (W. Herman) We are all what we remember, but also what we choose to forget and those of us who do not protest are insensitive to the inequalities in this world. (Albino Gomez)
- Power concedes nothing without a demand. It never did and it never will. (F. Douglas) Take, for instance, patriarchal power. It is embedded in political power and is inimically opposed to dialogue. It places all types of obstacles to dialogue. Patriarchal politicians pass judgment and give explanations as if they were the sole truth. (J. Monsalvo) Greed, hunger for power and patriarchy are congruent desires. (P. Simonetti)
- The belief that it is possible to solve political problems as if they were engineering problems, with rational planning, is a tragic fallacy. Technocrats, politicians and ideologues have abstract technical knowledge and think that that is all there is. Their prefabricated plans come apart, because they simplify reality and do not understand how society works and, importantly, what the rest of the people know intuitively. (M. Oakeshott)
- This is why more of us have to start using honest and punching political language to address the so many current political processes going the wrong way. Capitalism itself is one such exploit. Neoliberal dogma has made honest political terms into dirty words (think equality, disparity reduction, HR….). Capitalism is not a dirty word. It is a dirty system. Ergo, we must use honest and simple political language with people to explain political processes and systems to then take effective political action. No wonder we cannot mobilize ‘the people’ when discussions are unintelligible to most claim holders; the point is they do not have to be unintelligible. Not surprisingly, when politics is explained truthfully, it is perfectly understandable to the vast majority of the population.(A. Katz)
It is not a lack of political will, but rather the accumulation of a political will by the powerful to oppose or stall the implementation of progressive policies that tackle human rights abuses
-Power is omnipresent, but really only shows when there is the will to use it. (paraphrasing Nietzche)
-All we need is political will, but political will is a renewable resource. (Al Gore)
- You are all aware of the classical contradiction between powerful trade regimes and the relatively weak HR regime. When we hear calls for coherence and greater commitment among development actors, it is not clear ‘coherence’ in whose interest? Greater coherence can indeed erode HR accountability by coalescing actors who are party to unfair trade agreements and aggressively impose their financial interests and capture public spaces —in practice working against HR and against greater equality.**
**: Inequality is best understood as a proxy for how effectively an elite has constructed institutions that extract value from the rest of society. (W. Hutton)
- Given the unilateralism imposed by the powerful, “We, the People…” has taken-on a new urgency (A. Fazal), and to respond to this urgency, claim holders need to say no to the fatal flaws of neoliberalism that we witness day-in-day-out informed by the unfair ethics of the market. This is an ethics in which a minority makes most of the profits against the majority literally giving their lives. In other words, those who cannot compete, die. This is a perverse ethics that, in fact, is devoid of ethics.*** (P. Freire)
***: Since when has economics been making itself a moral science? (R. Savio) In the trenches of the opposition, we argue with high morals while those in power use the logic of the market.
Political will is not owned by politicians
-The problem in our world is that fanatics are always sure of themselves while our intellectuals and politicians are always full of doubts. (Bertrand Russell)
-Heads of government all know what to do; they just don’t know how to get re-elected if and when they do it. (J. C. Juncker)
- We are ruled by a class of politicians who know only how to dismantle and starve public institutions just when these most need to be fortified and re-imagined. Theirs is a culture of the perpetual present, one that deliberately severs itself from the past that is responsible for what we are, as well as from the future they are not shaping with their actions. (Naomi Klein)
- It is fitting to remind ourselves of the term ‘doublethink’ coined by the novelist George Orwell. He defined doublethink as “To know and not to know, to be conscious of complete truthfulness while telling carefully constructed lies****… to use logic against logic, to repudiate morality while laying claim to it…”
****: Is it right for politicians to sell their soul in order to acquire power, a power they then use only to purportedly ‘serve the poor’? No, indeed not. (D. Brooks) On the other hand, when politicians strive so hard as to be feared, it takes no time for them to be hated. (Montesquieu)
- We have to vehemently combat the dirty tactics of flimsy politicians such as the one that says: “If there is misery, hunger, corruption, poor health and worse education… don’t let it show!” (A. Grande)
- So, indeed, political will is not ‘owned’ by politicians who usually act only in response to consistent and compelling pressures. For HR activists exerting such a pressure, ‘acting’ means more than thinking, more than writing and/or speaking. It means getting involved in direct action, political action that is often irrevocable, which always involves danger and risk, and changes the lives of those who commit themselves.
- Gandhi’s choice of campaigns was always inspired by knowing what would touch ordinary people in their everyday lives, what would raise their consciousness and thus make them active citizens. In HR affairs there come times when direct action is justified, and where failure to act is wrong. So, has the point now been reached when direct action is needed to improve the state of, for example, public health and nutrition throughout the world? We are thus talking about taking actions in the public interest. In these matters, scientists need to step down from their ivory towers to now become citizens and political activists as well. The HR field is a good place to get them started… All those with special knowledge-of and interest-in their respective field now need to denounce what is happening, nationally and globally, in clear and strong terms, again and again. Being polite and writing notes of concern (or buying a page full of signatures in the New York Times) does not work. All concerted responses that fall short of direct action, and that overlook the need for laws and regulations that protect the public interest, never work. (G. Cannon) But beware: In the eyes of those who hold the power, protests can be as rowdy as they want –as long as they remain ineffective. (B. Moore)
- States are still the dominant actors, but public interest civil society organizations and social movements are increasingly involved in shaping the global agenda, in defining new rules, and in monitoring compliance with international HR obligations. (S. Patrick) Only a united global social movement will force nations to acting in the interest of humanity and of the planet. Herein lies the role of the global HR movement.
Claudio Schuftan Ho Chi Minh City
-Issuing ‘global report cards’ on corporations and on governments naming and shaming their actions adds to the pressure good popular organization can bring about.
-In people’s politics, sticking to positions is not negotiating. There are many many members of public interest civil society organizations and social movements that over-and-over witness how many rich countries stick to their short-term, self-interested positions as they negotiate rather than being flexible when facing humanity’s greatest ever challenges. Over the last 20 years plus, international high level negotiations have sadly become instances of ‘business as usual’ and this trend seems to me is set to continue for another 20 years. The North/South divide in global summits is, by now, a classic. Only a united global social movement will force nations to acting in the interest of humanity and of the planet. Herein lies the role of the global HR movement. (Repeated on purpose).
-The Economist once said: “Of all the ills that kill the poor, none is as central as bad governance”. To this add: The mother of all failures is a governance failure. (A. Fazal) Rulers are what some call ‘macro-responsible’.
-The principles of what is needed in global governance can be summarized into The 3 Rs: redistribution, regulation and rights. I would add social justice and equality.
-What passes for governance in so many countries is thus an ungainly patchwork of formal and informal institutions. (How often would we like to say: This is not policy. This is insanity!).
-This is why governance must be HR centered, participatory, transparent, equitable, guaranteeing access to justice and to the rule of law; it must fight against corruption and, above all, be accountable.
April 11th, 2015 by Claudio Schuftan
Food for an unfortunately powerless thought
Human Rights Reader 359
- Yes, as one of the SDGs says, the problem the world faces is not a problem of food production, but one of underconsumption by those rendered poor. But beware: We do not need to bring in the private sector to build up demand! The SDGs should thus here be asking: Is collaboration with the food industry necessary? Which industry? In the interest of whom? Just remember: ‘Money is not made with potatoes but with potato chips’. (G. Cannon)
- We all claim to know that the conscious and intelligent manipulation of the organized habits and opinions of the public is an important element in the nutrition problems we face. Those who manipulate this less-obviously-seen-mechanism in society de-facto constitute an invisible government. In almost every act of our daily lives, eating and drinking included, we are dominated by the relatively small number of persons who understand the mental processes and social behavioral patterns of consumers. It is they who pull the wires that control the public mind. (Edward Bernays, 1928) So why are the SDGs so weak on tackling this?
- I wonder (and object to) why successive drafts of the SDGs keep focusing on long and short, too often vertically integrated ‘value chains’ in the hegemonic agro-industrial-global-nutrition-system. Should the SDGs not focus more on the causes of the chains of poverty that, for instance, lead us to those who receive 15% of the public sales price for their products? The SDGs need to address food systems as systems that work for us rather than exploit us, something that encourages health rather than undermines it. But do they?
- Moreover, are the SDGs proposing strong enough concrete actions to counter the ecological tyranny of the agro-industrial agriculture model that is nothing short of a disaster in the making?
- We, right to nutrition activists, are on the whole a clan happiest when breathing our views gently (or not so gently) into official ears. Mainstream public health nutritionists are professionally largely dominated by consultants, advisors and official committee members used to acting in the ‘acceptable shadows’. (J. Rivers). But this is not what we ought to be doing just months before the SDGs fate is sealed! We may not like to admit that we also are among those who are manipulated. But we are.
The food sovereignty can of worms
- Food sovereignty is understood as a precondition to food security. In spite of this, the SDGs act as if food sovereignty did not exist. Food sovereignty specifically rejects food systems in which decisions are made overwhelmingly by corporate/private entities and others removed from the very real and varied local food systems. Food sovereignty includes the right to nutrition, i.e., the right of people to healthy and culturally appropriate food produced through socially-just and ecologically-sensitive methods. It entails peoples’ right to participate in decision making of what to grow and defines their own food, agriculture, livestock and fisheries systems. So why would the SDGs be deaf and blind to this?
- Having the freedom to produce, as well as having access-to and consume a nutritious diet is key to food sovereignty. Hunger, malnutrition, food insecurity and their associated health consequences are not equally distributed across social groups or indeed nations suggesting that not all people have such freedoms. (Amartya Sen) This relates food sovereignty to the empowerment of individuals and communities so they achieve control over their lives, get voice and influence and participate in decision-making processes –very much in line with human rights (HR) principles. Improving food sovereignty means dealing with matters of governance, of national economic priorities, of trade arrangements, of market deregulation and foreign direct investment, of fiscal policy, of climate change mitigation and related adaptation policies. A critical area of policy for food security and healthy diets is traditional local agriculture. While a return to full subsistence farming is unrealistic, policy makers have identified a need to support local production as the core of a food system that improves the capacity of farmers and fishermen to develop sustainable farming and fishing methods. In practice, governments have found this challenging due to international pressure to develop export crops. Export-oriented agriculture does not raise national incomes; it has been demonstrated as not effective in reducing income inequalities. (People’s Health Movement)
- The ‘primary raison d’eˆtre of peasant farming is livelihood and labor, not only food; yields are more closely dependent on social relationships. Here, sovereignty means not only the right to produce, but also to control production. Food sovereignty is a principle and an ethical lifestyle that does not correlate with an academic definition, but arises from a collective, participatory process. (P. McMichael)
- Four key areas can be pointed out to SDG drafters for investments to improve food sovereignty and diet-related health:
- Investment in domestic/traditional agriculture aimed at strengthening infrastructure and markets including now negotiated investments by international aid development agencies.
- Investment in processing and preservation technologies for traditional foods to improve access and convenience of healthy, safe and yearlong food options.
- Community education (including HR learning) and support of programs for traditional food cultures.
- Technical support for policy makers involved in trade negotiations to help ensure social, HR, nutrition and health goals are integrated adequately into trade agreements; includes support for staff from local public interest civil society groups that represent consumers and food producers.
To live a life without malnutrition is a fundamental human right…Nutrition improvements anywhere in the world are not a charity but an individual, household and social right. (R. Uauy)
- There is a continuous risk in the ‘international community’ of reducing the right to food to the right to be free from hunger. Powerful nations and international agencies under their influence promote programs such as food assistance and cash transfers that deal with human rights as minima. These powers get away with bypassing the HR commitments they do not like to recognize that they have made. They want to limit rights to minima thus leaving aside all obligations to respect, protect and fulfill the right to food. (F. Valente)
- The International Convention on Economic and Social and Cultural Rights only mentions access-to-food as the fulfillment of the right to food, whereas the-right-to-produce-food is much more fundamental to fulfilling the right to food. That is, rather than having a market-access-right-to-food, the more fundamental right to produce food requires stabilizing the world’s small-producer population, responsible for 50% of the world’s food at the same time as it constitutes about 50% of the world’s hungry. To reframe the question of rights in this way invariably relates hunger to land grabbing, to the denial of small-producer rights to their land and livelihoods, and links the challenges to be overcome to producer rights and productive capacities (including infrastructural needs). This normative shift is what some activists term ‘new generation’ rights.* (La Via Campesina)
*: New generation rights are significant in political and moral terms, but they lack formal status so far. Local movements have to keep pressuring states with direct action and legal means to slow or regulate land grabbing, because political elites have reason (kickbacks, debt relief and brokerage deals) to resist such pressure. Now, under the cover of foreign aid, and of food security concerns, they cooperate with donors to license large-scale land grabs.
- The current terms of our opposition, therefore, centrally include defending peasants ‘ways of life’ on the land against intruding market forces that have precipitated so many crises (e.g., food surplus dumping).
13. Better late than never, now, peasants must recognize the false claims of the neoliberal ‘food security’ approach. (H. Saragih, La Vıa Campesina)
Claudio Schuftan, Ho Chi Minh City
PS: Note that I have not even mentioned the genetically-modified-foods-can-of-worms which the IMF magazine Finanace&Development called Frankenstein foods. (F+D 50:4, December 2013)
April 3rd, 2015 by joannamae
Volunteers of International Medical Corps (IMC) suiting up in personal protective equipment (photo by J.M. Souers)
MONROVIA, Liberia — Though the Ebola epidemic that put the world on edge may be waning in parts of West Africa, there is much more work to do be done to ensure this underserved region of the world does not continue to suffer from a potentially endemic and devastating disease.
From the start of the Ebola epidemic in West Africa there have been almost 10,000 reported deaths and 14,269 confirmed cases in Sierra Leone, Guinea and Liberia, according to the World Health Organization (WHO). The U.S. Centers for Disease Control and Prevention (CDC) was here in Liberia during the initial outbreak but pulled out in May thinking everything was under control. In August, months after the CDC left, the real Ebola crisis struck Liberia.
In January, I applied to Adventist Health International (AHI) to work as a volunteer physician at SDA Cooper Hospital in Liberia. The hospital is run as a general hospital that has been providing health services during the epidemic to patients that are not suspected of Ebola while screening and referring patients with signs of the illness to Ebola Treatment Units (ETUs).
On February 9, 2015, I arrived at the hospital in the capital city of Liberia. Upon arrival I learned of a confirmed case at our hospital that had been transferred to an Ebola Treatment Unit (ETU) just a few days earlier. The hospital now had to shut down the inpatient services for decontamination and everyone who had contact with the case agreed to be quarantined for 21 days as a precautionary measure. Since I did not have contact with the Ebola patient, I continued working at the hospital in the out-patient department and continuous infection control and prevention training.
The hospital was soon overwhelmed by representatives of the WHO, CDC, Medicins Sans Frontieres (Doctors without Borders), International Medical Corps and the Ministry of Liberia. In a semi-coordinated effort, representatives of the different organizations came to our hospital to offer their advice and services. We were pleased to see that these organizations were finally giving our hospital assistance and aid, but staff was frustrated that the offer had not come earlier during the actual crisis.
The situation in Liberia is now finally starting to stabilize. There was a period of more than 25 days with no confirmed cases, according to sources at the CDC in Monrovia. Though, on March 19th a patient presented to Redemption Hospital in Monrovia and was confirmed positive on March 20th. It is rumored that the patient contracted the illness from Sierra Leone, not unlikely due to the very porous border between the two countries. Another theory is that the patient contracted the disease through sexual transmission from her partner over three months after he had been released from an ETU. This reality does not heed well for the already pronounced stigma towards survivors.
It is concerning that many organizations are already talking about decommissioning the ETUs to redeploy aid and services to Guinea and Sierra Leone, where the situation is much worse. There is no doubt that the epidemic must be further addressed in these countries to ensure the safety of Liberians and all of West Africa, but it is important to continue to support efforts in Liberia to eradicate the illness. The health system still needs major improvement to reduce the risk of an uncontrolled and devastating outbreak in the future.
Community leadership seems to have had the most impact on curbing this disease in Liberia. Recognition of the disease, plus changing traditional practices and customs was more widely accepted and accomplished in Liberia than in Sierra Leone or Guinea. This shows how important it is for healthcare organizations to work directly with community leaders at the local level, educating the general population to cooperate in changing habits and customs (i.e. burial customs, consumption of bush meat, hand washing and sanitation) that propagate such an infectious illness.
Education is critical, which is most apparent when working with hospital staff that has very little basic knowledge of infectious disease prevention and control. This is in part because we are in a country with extremely limited health infrastructure including hospitals without running water, dependable energy sources or proper waste management. What does exist is hardly adequate to provide even some of the most basic health care needs of the population. It is a shame that an epidemic like Ebola was necessary to bring this to international attention. It is even worse that the short-term solutions are almost exhausted and very few long-term solutions have been established.
Volunteer of International Medical Corps (IMC) working in hospital triage at SDA Cooper Hospital in Monrovia, Liberia (photo by J.M. Souers)
Focus has turned towards effectively training health care workers in the hospital setting with the proper equipment and precautions for infection control and prevention. Transitioning care from the ETU setting back to the hospital setting has been aided by the “Keep Safe, Keep Serving” curriculum provided by the Liberian Ministry of Health. Still, there are too few properly established hospital protocols to protect staff and patients from another outbreak. This creates insecurity for the hospital staff. Proper onsite training, triage staff, laboratory testing, contact tracing teams, supply chain availability, international support and local community education are still needed to continue to address this transition.
The international community can help by not allowing this epidemic to be just another news flash. Instead, they should make it their long-term mission to help developing countries create sustainable healthcare reforms and infrastructure for long-term outcomes. Their incentive should be to limit the spread of communicable diseases like Ebola that are no longer confined to remote areas of the world given our new global economy. Unless these diseases are recognized quickly and controlled effectively at their source, they can and may spread rapidly and become an international pandemic that threatens everyone.
Joanna Mae Souers is a medical doctor, native of upstate New York, and graduate of the Latin American School of Medicine in Havana, Cuba.