Africa

By Jomo Kwame Sundaram
KUALA LUMPUR, Malaysia, Dec 17 2024 (IPS)

The new geopolitics after the first Cold War undermines peace, sustainability, and human development. Hegemonic priorities continue to threaten humanity’s well-being and prospects for progress.

Jomo Kwame Sundaram

End of first Cold War
The end of the first Cold War has been interpreted in various ways, most commonly as a US triumph. Francis Fukuyama famously proclaimed the ‘end of history’ with the victory of capitalism and liberal democracy.

With the collapse of the Soviet Union and allied regimes, the US seemed unchallenged and unchallengeable in the new ‘unipolar’ world. The influential US journal Foreign Affairs termed ensuing US foreign policy ‘sovereigntist’.

But the new order also triggered fresh discontent. Caricaturing cultural differences, Samuel Huntington blamed a ‘clash of civilisations’. His contrived cultural categories serve a new ‘divide-and-rule’ strategy.

Today’s geopolitics often associates geographic and cultural differences with supposed ideological, systemic and other political divides. Such purported fault lines have also fed ‘identity politics’.

The new Cold War is hot and bloody in parts of the world, sometimes spreading quickly. As bellicosity is increasingly normalised, hostilities have grown dangerously.

Economic liberalisation, including globalisation, has been unevenly reversed since the turn of the century. Meanwhile, financialization has undermined the real economy, especially industry.

The G20 finance ministers, representing the world’s twenty largest economies, including several from the Global South, began meeting after the 1997 Asian financial crisis.

The G20 began meeting at the heads of government level following the 2008 global financial crisis, which was seen as a G7 failure. However, the G20’s relevance has declined again as the North reasserted G7 centrality with the new Cold War.

NATO rules
The ostensible raison d’être of the North Atlantic Treaty Organization (NATO) has gone with the end of the first Cold War and the Soviet Union.

The faces of Western powers have also changed. For example, the G5 grew to become the G7 in 1976. US infatuation with the post-Soviet Russia of Boris Yeltsin and Vladimir Putin even brought it into the G8 for some years!

Following the illegal US invasion of Iraq in 2003, the sovereigntist Wolfowitz doctrine of 2007 redefined its foreign policy priorities to strengthen NATO and start a new Cold War. NATO mobilisation of Europe – behind the US against Russia – now supports Israel targeting China, Iran and others.

Violating the UN Charter, the 2022 Russian invasion of eastern Ukraine united and strengthened NATO and Europe behind the US. Despite earlier tensions across the north Atlantic, Europe rallied behind Biden against Russia despite its high costs.

International law has also not stopped NATO expansion east to the Russian border. The US unilaterally defines new international norms, often ignoring others, even allies. But Trump’s re-election has raised ‘centrist’ European apprehensions.

Developing countries were often forced to take sides in the first Cold War, ostensibly waged on political and ideological grounds. With mixed economies now ubiquitous, the new Cold War is certainly not over capitalism.

Instead, rivalrous capitalist variants shape the new geoeconomics as state variations underlie geopolitics. Authoritarianism, communist parties and other liberal dirty words are often invoked for effect.

New Europe
Despite her controversial track record during her first term as the European Commission (EC) president, Ursula von der Leyen is now more powerful and belligerent in her second term.

She quickly replaced Joseph Borrell, her previous EC Vice President and High Representative in charge of international relations. Borrell described Europe as a garden that the Global South, the surrounding jungle, wants to invade.

For Borrell, Europe cannot wait for the jungle to invade. Instead, it must pre-emptively attack the jungle to contain the threat. Since the first Cold War, NATO has made more, mainly illegal military interventions, increasingly outside Europe!

The US, UK, German, French and Australian navies are now in the South China Sea despite the 1973 ASEAN (Association of South-East Asian Nations) commitment to a ZOPFAN (zone of peace, freedom and neutrality) and no request from any government in the region.

Cold War nostalgia
The first Cold War also saw bloody wars involving alleged ‘proxies’ in southwestern Africa, Central America, and elsewhere. Yet, despite often severe Cold War hostilities, there were also rare instances of cooperation.

In 1979, the Soviet Union challenged the US to eradicate smallpox within a decade. US President Jimmy Carter accepted the challenge. In less than ten years, smallpox was eradicated worldwide, underscoring the benefits of cooperation.

Official development assistance (ODA) currently amounts to around 0.3% of rich countries’ national incomes. This is less than half the 0.7% promised by wealthy nations at the UN in 1970.

The end of the first Cold War led to ODA cuts. Levels now are below those after Thatcher and Reagan were in power in the 1980s. Trump’s views and famed ‘transactional approach’ to international relations are expected to cut aid further.

The economic case against the second Cold War is clear. Instead of devoting more to sustainable development, scarce resources go to military spending and related ‘strategic’ priorities.

IPS UN Bureau

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');   Related Articles

• The Global South in the New Cold War
• South Suffering Due to Powerful Nations’ Policies
• IMF Urges Non-alignment in Second Cold War
• Imperialism, Globalisation and Its Discontents*
• North Ignores ‘Perfect Storm’ in Global South
• Aid for Power in New Cold War
• Weaponizing Free Trade Agreements

The daughter of Angola's former president was described by the UK government as a "notorious kleptocrat".

Nigeria's Ademola Lookman and Zambia's Barbra Banda are crowned Africa's best footballers at the Caf Awards in Marrakesh.

By Anis Chowdhury
SYDNEY, Dec 16 2024 (IPS)

This piece is not about the crisis or the chaos that the country is now facing after successfully toppling the autocratic regime of Sheikh Hasina. Rather, it is about the crisis of confidence and social capital or trust — interlinked, nonetheless.

Anis Chowdhury

The thread that binds a nation together is trust or social capital. There could be many factors that contribute to social capital, but one that stands out is equity or fairness. Social capital or trust is low in a country where income and wealth gaps are high, and the general people feel unfairly treated or deprived.

The fallen autocratic regime prided itself on rapid economic growth, averaging approximately 6 per cent a year. However, the regime’s kleptocratic system of ruling by plunder and favour to its cronies has contributed to accelerated wealth and income gaps as well as relative deprivation; thus, it has caused fissures in the social fabric.

Rising relative deprivation

Income and wealth gaps have yawned wide, turning a reasonably equitable society at the time of independence into one of the most unequal societies. The Gini coefficient, a common measure of income inequality, has increased from 0.36 in 1973 to 0.499 in 2022, according to the latest (2022) Household Income and Expenditure Survey (HIES) of the Bangladesh Bureau of Statistics.

The Gini coefficient was 0.39 in 1990–1991, marginally above the 1973 value (0.36), accelerating to 0.46 in 2010. Income inequality in Bangladesh has deepened since 2016. The 2022 survey reveals that about 30 per cent of the income generated in the country is concentrated within the top 5 per cent of household. This proportion was 27.82 per cent in the 2016 Household Income and Expenditure Survey.

Furthermore, the top 10 per cent of the wealthiest households in Bangladesh hold about 41 per cent of total income. This proportion was about 38 per cent in 2016. Concurrently, the income share for the bottom 50 per cent of households decreased to about 19 per cent in 2022 from 20.23 per cent in 2016.

Disturbingly, there has been a secular transfer of income from the lowest quintile of the households to the highest quintile. The average annual loss of the bottom 1st quintile’s share in the national income has been -0.71 per cent as opposed to the average annual gain of 0.46 per cent for the highest (top) quintile during 1973–2010. The middle-class also lost; income shares of 2nd, 3rd and 4th quintiles declined since 1973.

This does not augur well for our democracy. Nor can we celebrate this development in a country where one of the founding principles is socialism.

Suppression of democracy driving growing disparities

PROFESSOR MG Quibria of Morgan State University and ADB’s former Senior Advisor pointed out, ‘possession of political capital opens up myriad economic opportunities, including preferential access to finance and business, restructuring and loan default options, lucrative employment, access to privileged information, tax evasion or even outright corruption’.

The link between corruption and economic growth could be debated, but it is a method of plunder and primitive capital accumulation by the lumpen bourgeoisie that exacerbates inequality of wealth.

An environment conducive to unchecked corruption emerges when democracy is suppressed and the institutions that ensure accountability, transparency and the separation of powers between various branches of the government are weakened. Where democratic institutions are weak, political capital is a powerful instrument for advancing one’s economic and social position.

Unfortunately, suppression of democracy in Bangladesh began as soon as it emerged as an independent nation with the rigging of its first parliamentary elections in 1973. It is ironic that a country, where democracy is one of its founding principles, turned into a one-party state in 1975 within four years of its independence, shutting down most of the news media and allowing only state-run ones.

Sadly, instead of trust — built through accountability and transparency — election manipulations became the norm for all political parties to gain power and then retain it. Therefore, each successive government became more repressive, more lacking in accountability and more vigorous in election rigging.

However, such regimes suffer from legitimacy deficits — both legal and moral; they can only survive by allowing corruption and distributing favour. Thus, a vicious circle develops — a regime that resorts to more election manipulations becomes more beholden to its cronies, allowing them to plunder the state.

Undoubtedly, this process reached its zenith during Sheikh Hasina’s rule. Unchecked corruption, tax evasions and financial crimes such as defrauding bank loans enabled Bangladesh to become the global leader in wealth growth during 2010–2019. New York-based research firm Wealth-X, reported a remarkable 14.3 per cent annual increase in the number of individuals with a net worth exceeding $5 million, surpassing Vietnam, which ranked second with a 13.2 per cent growth rate.

Neoliberalism and the demise of democracy

BANGLADESH is not alone in witnessing widening income and wealth gaps and consequently democratic backslides. This is a global phenomenon coincided with the embrace of the neoliberal economic philosophy of privatisation, liberalisation, deregulation and globalisation dictated by the interests of the corporate power.

In the process of multinational corporations-driven globalisation, the civil society simply became apolitical NGOs, happy to receive crumbs from the donors to engage in so-called development activities. Citizens became ‘stake-holders’ together with the large corporations and donors, instead of ‘right-holders’.

Bereft of rights and no longer an end itself of development, citizens are now ‘human resources’, an epitaph cleverly designed to hide that they are simply fodder for the profit machines of corporations. In a deregulated economy, workers are dehumanised, constrained to socialise and participate in political activities.

Should one be surprised in the falling share of wages in the national income, stagnating or falling real wages and tragedies like the ‘Rana Plaza incident’?

Under the corporate globalisation, schools and universities — both public and private — are no longer places of learning where youths are transformed into enlightened citizens and agents of change, and where visionary future social-political leaders are produced. They are simply factories for mass-producing so-called ‘job-ready’ certificate or diploma holders, apathetic to social, economic and political issues.

An additional boost to accelerating inequality in Bangladesh comes from a three-stream education system (Bengali-medium national curriculum, traditional religious curriculum and English-medium overseas curriculum). It perpetuates inter-generational inequality.

Which way out?

ONE can get some cue in AK Sen’s observation that ‘a country becomes fit through democracy,’ and democracy versus development is a false dichotomy. Sen defines development as freedom — freedom from hunger and poverty; freedom from fear and persecution; and freedom to express, associate and participate. In sum, freedom to enhance one’s capabilities to attain one’s full potential as a human being.

Sen insists that political and civil rights are ends in themselves. Their denial cannot be acceptable even if it promotes economic growth and some well-being as such a development path is not sustainable. Suppression of political and civil rights results in growing income and wealth inequalities, where obnoxious, luxurious living by the few coexists with a large populous struggling to survive. This fuels a sense of relative deprivation contributing to violent social conflict.

Therefore, the first step is strengthening democratic institutions or consolidation of democracy. This requires the depoliticisation of administration and civic associations.

There exists a large volume of research findings showing that the politicisation of administration and the organisation of civic associations along party lines not only boost corruption but also accelerate social cleavage.

Civic associations where members hold different political views help build trust among political parties. They can agree on critical national issues while still disagreeing on details.

A depoliticised public administration serves a wider citizenry. In the process, the government, even though led by the winning party, governs for all and becomes inclusive, thus strengthening the trust between the state and the governed.

As for the political parties, they need to practise democracy themselves. That is, all party posts should be open for contest and there should be transparent rules for elections. As the primary organisational vehicles of electoral democracy, political parties are themselves judged in terms of their democratic character.

The most engaging models of internal party democracy are inclusive, participatory, deliberative and accountable and include fair distribution of power. It involves non-discriminatory open memberships and the inclusion of all party members in decision-making processes, leadership selection, policy formulation, as well as ensuring accountability of party leadership to its members. In short, internal rules of political parties should be guided by inclusiveness, clarity, transparency, accountability and independence. Their interaction with society should be based on dialogue, interdependence and cooperation.

In the economic arena, there is an urgency for reorienting to pursue strategies for growth with equity. This is an imperative if Bangladesh is serious about its state principle of socialism. The state has to recapture its lost leverage over the corporate sector to protect the interest of the wider community and to ensure decent jobs and a fair living wage.

It has to give priority to citizens’ well-being over balancing the budget and be bold enough to use its fiscal power to redistribute the growing wealth by using progressive taxation and widening public provisions of basic services, such as healthcare, education, housing and universal social protection. There is ample evidence of a close negative association between the tax-GDP ratio and inequality as well as between public social expenditure and inequality, clearly indicating the redistributive role of the government.

State actions are needed to smoothen the rough edges of the market forces that manifest in exclusion and inequality, which are found to fuel social and political unrest harming growth in the long run. Equity of access, opportunities and outcomes are fundamental aspects of socialism. They enhance both economic and political freedom, essential for rights-based development that empowers citizens and expands their capabilities.

Weakened democratic institutions and rising inequality create a vicious circle that leads to diminished trust — among citizens and between the state and citizens — which chips away social capital, the glue that binds society.

Bangladesh has to find the solution to its woes in its founding principles — a democratic polity and a socialist economic construct. Both are critical in rebuilding trust and social capital, needed to overcome the current national crisis.

Anis Chowdhury is emeritus professor, Western Sydney University, Australia. He held senior United Nations positions (economic and Social affairs) in New York and Bangkok.

IPS UN Bureau

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');  

A scientist analyses a sapling in a lab.

By Ousmane Badiane
DAKAR, Senegal, Dec 16 2024 (IPS)

From increased pests and diseases to lower crop yields and extreme weather events, the adverse impacts of climate change on agriculture in Africa cannot be overstated.

Climate shocks will present major roadblocks to the continent’s rapidly growing population, especially if global temperatures remain on their upward trajectory. Urgent and effective action is therefore needed to mitigate these threats to food security and livelihoods.

Despite the growing stresses on Africa’s agrifood systems, the bioeconomy offers opportunities to improve food security, tackle climate change, and support development goals. The solution lies in sustainably leveraging Africa’s natural resources.

While the continent is highly vulnerable to climate change, its rich biodiversity offers tangible opportunities to address multiple challenges simultaneously. New evidence shows that Africa can leverage a much broader and more systemic approach to addressing the impacts of climate change on agrifood systems and beyond through its bioeconomy.

Characterized by sustainable production and use of biological resources to create innovative products, processes, and services for all economic sectors, bioeconomy involves the use of scientific knowledge to add social and economic value to biological resources in an environmentally sustainable way.

The latest ReSAKSS Annual Trends and Outlook Report (ATOR) makes a case for converging the two pressing agendas of climate change and the bioeconomy toward building resilient agrifood systems in Africa. Harnessing Africa’s ecological wealth and investing in the continent’s bioeconomy can yield multiple development benefits across various sectors while contributing to climate resilience, sustainable agriculture, and economic growth.

Science and technology offer a viable pathway for the development of bioeconomy solutions. African countries will benefit from establishing robust science, research, and technology systems to leverage opportunities offered by the bioeconomy. Research initiatives to develop climate-resilient tools for farmers can go a long way in protecting food security and livelihoods from climate shocks.

A successful example is the redesign of Uganda’s research system through the National Agricultural Advisory Services program. This program focused on rebuilding relationships across the country’s agrifood system value chain, from the farm level all the way to regional chiefs, district coordinators, and private or semi-private service delivery companies.

Through this approach, farmers defined demand and had their research and innovation needs addressed through a national coordination network combined with the private sector. This has improved the availability and quality of advisory services provided to farmers and promoted the adoption and use of modern production technologies and practices.

Furthermore, Africa’s bioeconomy can create rural and agriculture-adjacent jobs for its youthful population while enabling economic diversification and growth. Leveraging Africa’s vast untapped potential will open up new industries and value chains that can drive job creation and livelihoods across the continent, especially for rural youth and other marginalized groups.

Emerging innovations like biological waste conversion using black soldier flies (BSF), and earthworms have opened up new markets and, consequently, new job opportunities. At the same time, these circular solutions benefit natural ecosystems, in turn supporting better conditions for crop and livestock production systems.

Domestic and cross-border trade also plays a vital role in facilitating economic growth through the bioeconomy. Increasing food demand can drive specialization and intensification of the agrifood sector and bioeconomy, ultimately incentivizing productivity, supply, and income increases. Existing policy tools such as the AfCFTA can reduce trade barriers across the continent’s bioeconomy and deliver better economic outcomes.

Recent research argues for a nutrition-sensitive circular bioeconomy that can be adopted to drive food security and nutrition outcomes while tackling waste management. For example, converting biowaste to vermicompost, biofertilizers, and biopesticides can reduce the costs and environmental burdens of synthetic chemicals while simultaneously improving agricultural productivity and food availability.

Strengthening the bioscience environment across sectors is critical. Under the Advanced Agriculture and Food cluster, South Africa’s Council for Scientific and Industrial Research (CSIR) aims to increase the output of high-value foods, cosmetics, nutraceuticals, and traditional African medical products. The Biomanufacturing Industry Development Centre (BIDC) has advanced over 100 bioproducts in cosmetics, nutrition, and biotechnology. A key success story from this case study is VIDA Pharmaceuticals, which produces accessible and affordable nutritious food products from baobab and maize.

In the wake of COP29, channeling more climate finance toward Africa’s bioeconomy is critical. Increasing investments in innovative financing models such as blended finance – which leverages concessional capital from public and philanthropic sources to de-risk private investments – can support climate goals in Africa’s agrifood systems.

There is political momentum for Africa’s converging climate change and bioeconomy agendas. South Africa was the first African country to develop a dedicated bioeconomy strategy in 2013, followed by Namibia, which published its national bioeconomy strategy in 2024. The East African Community (EAC) is the first regional economic bloc to develop a dedicated regional bioeconomy strategy in 2022.

The global shift toward sustainability and the green economy presents new opportunities for Africa to position itself as a leader in the bioeconomy. Policy action to embrace an African bioeconomy would entail the ability to deploy tailored and contextualized interventions to tackle climate change, biodiversity loss, and food insecurity while advancing sustainable growth.

Increased investments in Africa’s resilience and green growth agendas from the continent’s leaders, private sectors, and other stakeholders are the first steps towards realizing this potential. The promise of a robust bioeconomy offers a viable growth and development pathway that can contribute to lower carbon emissions, better preservation of biodiversity, and greater prospects for decent jobs and livelihoods.

Dr. Ousmane Badiane, Executive Chairperson, AKADEMIYA2063

IPS UN Bureau

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');  

IPS UN Bureau

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');  

Credit: Antonio Jaén Osuna

By Eric O'Flynn
DUBLIN, Ireland, Dec 16 2024 (IPS)

For decades, preventable deaths, lifelong disabilities, and disfigurements presented devastating consequences for over 90% of the population in Africa, where surgical care remains largely out of reach.

Simple, affordable procedures like skin grafts for burns, bone fracture repair, and hernia procedures routinely go untreated, causing needless suffering and often driving families into abject poverty due to loss of livelihood.

Consider a young man in his 20s in rural Zambia, electrocuted by a low-hanging power cable while riding on the back of a lorry, whose exposed skull and severely damaged scalp were repaired during a 16-hour procedure, allowing him to make a full recovery; a 19-year-old woman with a deep-seated tumor that caused her to lose her sight and whose surgery was made possible by a resourceful clinician using magnifying glasses in the absence of a microscope, removing the tumor in full and allowing her to regain her vision; a 32-year-old mother of two in rural Zambia, run over by a truck and left with devastating injuries who underwent eight months of intensive treatment and rehabilitation putting her on a path to recovery.

Cases like these are the everyday reality faced by surgeons Dr. Peter Mushenya from Zambia and Dr. Nathalie Umugwaneza from Rwanda, both recent graduates of the College of Surgeons of East, Central, and Southern Africa (COSECSA), which celebrates its 25th anniversary this December.

Since its founding, COSECSA has grown from graduating just six surgeons in 2010 to an impressive 152 in 2023. This growth reflects the organization’s commitment to equipping surgeons with the skills to meet the urgent needs of communities across the region. Over the course of their careers, COSECSA-trained surgeons are projected to perform nearly 9.5 million surgeries, a stunning demonstration of the impact of successful surgical training programmes.

Qualified just a year, Dr Mushenya is a specialist neurosurgeon working at Maxcare hospital in Lusaka, where patients often travel over 1000 kilometres to receive care from the only neurosurgical team in the country.

On average, he and his team perform 70 surgeries a month. He describes challenges such as a shortage of surgical supplies, long waiting lists and needless complications arising from untreated simple infections that worsen due to a delay in care. Common, he explains, are untreated coughs in children that escalate into meningitis and later abnormal swelling of the head due to excess fluid on the brain.

“Many patients are two years down the line without a CT scan and come to us in critical condition in need of urgent surgical attention. In many cases, we often have to use our own money to buy drills, sutures, shunts – not just the expensive equipment like microscopes, but even the little things are not there. Instead, we rely on well-wishers. A lot of the conditions we see are simple to treat, yet we don’t get the support we need,” says Dr Mushenya.

It is an all too familiar scene in Rwanda, according to Dr. Umugwaneza, who counts road traffic accidents and falls among her most common surgeries, “Patients often wait up to six months for surgeries that are not considered acute, resulting in improperly consolidated fractures that cause life-long disability.” She emphasizes the need to strengthen the entire surgical system, from training surgeons to strengthening entire surgical teams across a range of disciplines from nurses to anesthetists.

The situation experienced in Zambia and Rwanda matches the broader challenges faced in the region. In many countries of the Global South, the surgeon-to-patient ratio is alarmingly low, with just one trained surgeon for every 2.5 million people. This neglect persists even though surgically treatable conditions cause more deaths and disabilities than AIDS, tuberculosis, and malaria combined.

Despite a 2015 World Health Assembly (WHA) resolution urging the inclusion of global surgery within primary healthcare as a critical component of Universal Health Coverage (UHC), surgical care remains strikingly absent from policymakers’ agendas.

This lack of priority has contributed to minimal progress in strengthening emergency and essential surgical and anesthesia services. As a result, 16 million people worldwide die annually from conditions that could be treated surgically.

In response to the urgent demand for surgical care, COSECSA, supported by Royal College of Surgeons in Ireland has trained 910 surgeons through its intensive five-year programme, achieving this at an astonishingly low cost of just $600 per surgeon per year. Prof. Juan Carlos Puyana, Chair of Global Surgery at RCSI University of Medicine and Health Sciences in Dublin, has witnessed firsthand the impact of the programme and is a passionate advocate for further investment in global surgery.

An experienced surgeon himself, he worked for decades in low resource settings, and emphasises the scalability and cost-effectiveness of the initiative, underlining the importance of changing perceptions about surgical care: “There’s a misconception that surgical care is prohibitively expensive, but simple procedures don’t require large investments in infrastructure and expensive equipment.

Our approach is grounded in evidence that safe surgery is not an expense but a critical investment in health infrastructure and in promoting economic development.”

Dr Puyana’s views are echoed in the findings of the 2015 Lancet Commission on Global Surgery, which underscored that billions of people lack access to safe surgery. The report highlighted that investing in surgical services is not only affordable but essential to saving lives and securing safe health systems.

Closing the gap to ensure that surgical services are more readily accessible in lower- and middle-income countries, will not only save lives but also restore patients’ ability to work and lead productive lives, generating economic benefits that far outweigh their costs. The programme stands as a powerful testament to how targeted, cost-effective interventions can make a lasting impact.

In recent years, it has broadened its scope beyond surgical training. Recognizing that effective surgical care relies on multidisciplinary teams, it now supports the development of colleges in anesthesiology, obstetrics and gynecology, and nursing across the region.

This expansion builds on a proven model for rapidly scaling up training in the sub-Saharan context that involves a blend of virtual classrooms, mentorship, and a support network for isolated health workers. In some countries like Zambia, Tanzania and Malawi, particularly in rural hospitals, non-specialist and non-physician surgeons also play a key role in delivering essential procedures.

Further, at a time when trained health workers from the Global South are increasingly migrating to the Global North in search of better opportunities, the programme has proven to be a game-changer in stemming the exodus of health workers in the region.

A 2024 study reveals a significant shift, with an impressive 98.5% retention rate of specialist surgeons within Africa, addressing the chronic shortage of skilled health professionals. This shift represents not only a major achievement for the programme, but also an important step toward the sustainability of local healthcare systems.

Addressing the crisis in global surgery demands a fundamental shift in global health priorities: surgery is not a luxury intervention, but an essential component of any functioning health system. This requires policymakers to prioritize investments in training, infrastructure, and system-wide support, ensuring that surgical care is within reach for the millions who still don’t have access.

As the network of skilled practitioners expands, communities are themselves laying the groundwork for resilient health systems. In doing so, surgeons like Dr Mushenya and Dr Umugwaneza are safeguarding future generations from the preventable suffering that has long plagued the world’s poorest regions.

Eric O’Flynn is Programme Director — Education, Training and Advocacy, Institute of Global Surgery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin.

IPS UN Bureau

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');  

The people walk to Saydnaya prison to search for the detainees. Credit: Abdul Karem al-Mohammad/IPS

By Sonia Al Ali
IDLIB, Syria, Dec 16 2024 (IPS)

Detained without trial for over three years for trial for allegedly treating “terrorists” (as opponents of former Syrian President Bashar al-Assad were deemed), Alaa al-Khalil, a 33-year-old nurse from the Syrian city of Hama, recounts the agony of her time in a prison cell she shared with at least 35 women.

She was released from Aydnaya prison on December 8 after the fall of the Assad regime.

Following the fall of Assad’s regime and his escape to Moscow on December 8, armed opposition factions managed to open the doors of prisons, freeing hundreds of detainees who had endured the most horrific forms of torture for opposing Assad’s rule and demanding his removal from power. Many lost their lives within the prisons and were buried in mass graves, while the families of the detainees continue to search for their missing loved ones in the prisons of tyranny.

Years of Torture

“I was arrested at a security checkpoint belonging to the former Syrian regime and transferred to the Political Security Branch in Damascus—my hands were cuffed, and my eyes were blindfolded. In prison, we were 35 women in a small, cramped room with the toilet in the same room, without any privacy,” Khalil told IPS. “The marks of severe torture were clearly visible on some of the women. As for sleep, we would lie on the floor and take turns sleeping due to the very small size of the room. The most painful thing was that there were many pregnant women who gave birth to children who grew up inside the prison.”

The search for survivors in Sednaya prison. Credit: Abdul Karem al-Mohammad/IPS

During that time, she said the prisoners suffered from “hunger, cold, and all forms of torture, including beatings, burning with cigarettes, and nail pulling.”

Many of the female detainees were raped and exposed to sexual violence as a form of punishment. After midnight, the guards would come to the detainees’ room to select the most beautiful girls to take them to the officers’ rooms.

“We preferred torture and even death to rape. When a girl refused to have sex or confess to the charges against her during interrogation, she would be killed by the guards or interrogators, and her body would be thrown into the salt room, which was prepared in advance to preserve the bodies of the dead for as long as possible,” she said, tearfully remembering the daily trauma.

Khalil confirms that prisoners were not allowed to look at the guards, talk, or make any noise, even during torture. They were punished by being deprived of water or forced to sleep naked without covers in the freezing cold. The meals consisted of a few bites of spoilt food, and many people contracted serious infections, diseases, and mental disorders.

Now released, Khalil hopes to enjoy safety, stability, and peace in this country after years of oppression and injustice.

Adnan al-Ibrahim, 46, from the southern Syrian city of Daraa, was also released a few days ago from Adra prison on the outskirts of Damascus after spending over 10 years there on charges of defecting from Bashar al-Assad’s army and seeking asylum in Lebanon.

“I feel like I’m dreaming after being released from prison. They accused me of terrorism, subjected me to torture, and I was never brought before a court during my imprisonment. I’m still traumatized by what I endured,” Ibrahim says.

“We were subjected to the worst treatment imaginable in prisons. All we want now is the right to live a decent life, far from injustice, arbitrary arrests, and the ongoing killing in Syria.”

He is now emaciated and weak—his weight drastically reduced due to malnutrition and poor diet. Most of his fellow inmates suffered from life-threatening illnesses as a result of the torture they endured. Many inmates lost their memory due to being beaten on the head during interrogations, and the bodies of the dead remained for long periods before being removed. Many of these bodies were disposed of by burning.

Burdened by Psychological Prauma

Samah Barakat, a 33-year-old mental health specialist, says the survivors of Syrian detention centres will need help to overcome their traumas.

‘The experience of imprisonment and torture in prisons is painful and traumatic for survivors. Imprisonment is not limited to physical torture; the mental state is also affected. Prisoners were subjected to various forms of torture and oppression, leading to a significant deterioration in their mental health. These effects include a range of psychological disorders such as psychosis, memory loss, and speech impediments, in addition to the spread of diseases due to their deprivation of basic medical care.”

Barakat confirms that some detainees are likely to suffer from physical, psychological, and behavioural effects, accompanied by constant anxiety, depression, and social withdrawal.

She explains that survivors of detention need psychological support, which varies depending on the impact of the detention experience. Some need psychological counseling or therapy sessions with specialists, while others require medication prescribed by a psychiatrist due to depression or other mental illnesses.

An Unknown Fate

For some, the uncertainty of the fates of their loved ones means the trauma of the Asad regime lives on.

Alaa al-Omar, 52, from the northern Syrian city of Idlib, went to Saydnaya prison and the Palestine Branch in Damascus after the fall of the Assad regime, hoping to find his son, who had disappeared in the prison’s depths.

“I went to the prison with great longing, but I found no trace of my son. I think he died as a result of torture.”

Omar affirms that his son was arrested by the Assad regime forces in 2015 while studying at a university in Aleppo, accused of participating in demonstrations, carrying weapons, and joining the opposition factions.

Omar indicates he heard nothing from his son or about his son since his arrest, and his fate remains unknown even now.

Human Rights Violations

Human rights activist Salim Al-Najjar (41), from Aleppo, speaks about the suffering of survivors of detention and told IPS that the history of building prisons and expanding detention centers in Syria dated back to the rule of Hafez al-Assad, whose regime in the 1980s exercised excessive force against its opponents, turning the country into a “large slaughterhouse.”

“In the regime’s prisons, lives are as equal as stones in the hands of a sculptor, killed and discarded without regard or importance. In them, a person becomes a mere number, with their history, feelings, and even dreams that haunted them until the last moment of their lives ignored,” Najjar says.

Al-Najjar confirms the existence of many prisons in Syria, but the Saydnaya prison, located north of the Syrian capital Damascus, is known as the most prominent political detention center in Syria and was notorious for its horrific reputation as a site of torture and mass executions, especially after the outbreak of the Syrian revolution in 2011. Saydnaya prison was where Assad’s detained opponents or defectors from his army or those who rejected his “killing policy.”

He points out that few detainees were released through family connections or bribes, while the detainees were left to die from their untreated wounds and diseases in “dirty, overcrowded” cells.

He notes that many detainees emerged from behind bars suffering from a loss of their mental faculties, unable to remember their names or identify themselves, and due to the severe changes caused by malnutrition and brutal torture, their features had changed to the point that their families did not recognize them at first.

Najjar hopes to achieve justice for the victims by presenting evidence and documents to international courts and holding Assad and all perpetrators of violations in Syria accountable.

The Syrian Network for Human Rights said in a statement on December 11 that Assad is accused of killing at least 202,000 Syrian civilians, including 15,000 killed under torture, the disappearance of 96,000 others, and the forced displacement of nearly 13 million Syrian citizens, as well as other heinous violations, including the use of chemical weapons.

“Syrian detention centers and torture chambers symbolize the agony, oppression, and suffering that Syrians have endured for decades. Survivors of detention continue to heal their wounds and strive to return to their normal lives and reintegrate into society. Sadly, a significant number of them have perished under torture.”

IPS UN Bureau Report

 

Follow @IPSNewsUNBureau
!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+'://platform.twitter.com/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');   Related Articles

• Syrian Displaced Children Go Hungry, Stunting Their Growth
• Conflict Deprives Children of Education in Northern Syrian IDP Camps
• Absence of Reproductive Care Haunts Syrian Displaced Women

BBC Africa speaks exclusively to a man from Ghana who was held captive by insurgents in Burkina Faso.

BBC Africa speaks exclusively to a man from Ghana who was held captive by insurgents in Burkina Faso.

BBC Africa speaks exclusively to a man from Ghana who was held captive by insurgents in Burkina Faso.

MOTD2 pundit Danny Murphy explains how Manchester United's match-winner Amad Diallo was the only player to have freedom and fearlessness in Sunday's Manchester derby.

MOTD2 pundit Danny Murphy explains how Manchester United's match-winner Amad Diallo was the only player to have freedom and fearlessness in Sunday's Manchester derby.

Video footage shows the devastation wrought by the strongest storm in decades to strike the French territory.

Hundreds are feared dead after extreme winds hit the French Indian Ocean island territory.

Burkina Faso, Mali and Niger say they will allow free movement, as regional bloc meets to discuss their withdrawal.

The road could breathe new life into West Africa's regional bloc, Ecowas.

The road from Abidjan to Lagos could breathe new life into West Africa's regional bloc, Ecowas.

Through her work, Dola Posh shares her story to help other new mothers deal with complex feelings.

Through her work, Dola Posh shares her story to help other new mothers deal with complex feelings.

Through her work, Dola Posh shares her story to help other new mothers deal with complex feelings.