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NTDs Getting a Little Less Neglected

The World Health Organization just published their first report on Neglected Tropical Diseases (NTDs). It’s a great view into the impact of these diseases, which affect over a billion people every year. The NTDs are a set of 17 diseases and disease groups that affect the poorest of the poor, primarily in sub-Saharan Africa. They have cures, in many cases, or effective treatments. But people aren’t getting the treatments, and drug companies aren’t working to develop more. The WHO report shows us how much progress we’ve made, and how far we still have to go.

The wins: Drug donations from pharmaceutical companies have expanded access to treatments for NTDs, in particular helminthes (hookworms). Preventative chemotherapy is breaking the cycle of infection for entire at risk populations, and research into new cures and treatments has begun to expand.  By the end of 2008, 670 million people had been reached by preventative chemotherapy. If those efforts continue to scale up, several NTDs could actually be eliminated.

What’s left to do:  NTDs are endemic in 149 countries, many of which have more than one endemic NTD. 30 of those countries have 6 or more endemic NTDs. Dengue fever has begun to reclaim territory in Latin America because of malaria control failures. In 2008, only 8% of people with schistosomiasis had access to high quality medicines.

The most vital part of the report, I think, was this: NTDs are a proxy for poverty, pure and simple. They are  right along with malnutrition, lack of infrastructure, and other diseases. Fighting poverty is vital to fighting NTDs, and it always will be.

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an apt metaphor. UNMIS troops extinguish a fire  credit: UN Photo/Tim McKulka

Is the US Calling for More Peacekeepers in South Sudan? UPDATE

Interesting to read that an unnamed US official is suggesting giving the UN Mission in South Sudan, UNMIS, a boost.  Specifically, the official would like to see the “augmenting of Unnmis in certain hotspots along the border where a buffer presence could be established.”

“Nobody thinks it is realistic to put Unmis, even if we had masses more troops, along the north-south border in a country that large,” the US official told reporters, speaking on condition of anonymity.

“One thing I think we can and should consider if the (UN special representative) and the (UN) secretariat come forward with such a proposal is looking at augmenting Unmis in certain hotspots along the border where a buffer presence could be established,” the official added.

This is a good idea. But can it be accomplished?  It is unlikely that UNMIS will be able to change its mandate or boost troop levels before the referendum. At least until independence, South Sudan is a part of Sudan.  Any new troop levels would require the consent of Khartoum.    Theoretically, troops could be re-assigned within South Sudan. But keep in mind that there are only 10,600 uniformed personnel in UNMIS.   Deployment to any of these “hotspots” would be have to be limited.   The question is: would relatively small detachments of moderately armed peacekeepers successfully deter cross border attacks?  Would peacekeepers become targets?

I don’t know the answers. But if you are president of one of the countries that has troops deployed to UNMIS, would you be willing to put your troops in this position?  If so, you better be sure that countries calling for this augmentation will have your back if things get tough.

In the meantime, I will be interested to see how the Secretariat and UN peacekeeping respond to this “request” for contingency planning.

UPDATE:  From a press stakeout earlier today:

REPORTER:  Ambassador thank you.  You raised in your public remarks in the Security Council this idea of repositioning UNMIS troops in some sort of way, buffer zone, hot spots, whatever.  How seriously is the U.S. going to be pushing this; have you actively considered, what do you consider about the practicality of it given the force now, what kind of response are you getting from Security Council members on that possibility?

AMBASSADOR RICE:  This was an idea that we originally heard from the Government of the South.  We haven’t yet heard from the North and Khartoum on how they view this concept.  I think most Council Members are skeptical, to say the least, of the feasibility of a force that could line the entirety of the border.  The troops don’t exist; it couldn’t be constituted quickly enough.  But there is serious discussion of alternative models that might focus on those areas along the border that are most vulnerable or at high risk of violence and where civilians may be most at risk.  So we will await the recommendations from the Secretariat, from UNIMIS on this, but we’re having a preliminary discussion of impressions, and I think there is an openness to this idea that’s one that we would need to see fleshed out, know the views of all the parties, and discuss further.

So there you have it.

UPDATE II: I just spoke with someone who I can only identify as a “close observer” to the situation in South Sudan who called the idea of repositioning UNMIS “benign but naive.” His basic point was this: unless the Americans are willing to either deploy their own troops (unlikely) or convince their European allies to pony up troops (unlikely) and then push that plan through the Security Council in the next month (very unlikely) it is unreasonable to expect that re-positioning a limited number of UNMIS troops will make a dent in the security situation of South Sudan.

The best way the Americans can help, this person said, is to “play big cards” with Khartoum and Juba.  This means, in practice, to make some costly concessions to China in order to leverage China’s influence over Khartoum.  “If you really want to help, find out where the various pressure points are and then engage there, even if that engagement is politically expensive,” he said.

I find this line of reasoning convincing.   It is probably too late to change UNMIS’s mandate and infuse it with new troops before January. (And for the record, groups like Refugees International have been warning about UMMIS’s lack of capacity to adequately protect civilians for a long time.)

The most effective way to prevent violence is by using America’s special relationship with South Sudan to convince the southern Sudanese to keep their guns holstered and have China ask the same of Khartoum. All the while, both the Chinese and Americans can help convince the North and South to make certain concessions on oil revenue sharing and border demarcation that is required for a lasting solution to this conflict.

UNMIS can help facilitate the implementation of these new agreements. But peacekeepers cannot be expected to prevent the outbreak of conflict between two countries that are determined to go to war.

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Security Council debates peacebuilding, authorizes ISAF, SG’s Panel on the Referenda travels to Sudan

Security Council: this morning, the Security Council held an open debate on peacebuilding.  The SG told the Council that success requires patient, long-term commitments and the involvement of a wide range of actors working together. He noted that the UN is making progress in countries like Burundi, Haiti, Nepal, and Sierra Leone. In order to improve peacebuilding efforts, he said predictable financing, effective partnerships and putting women at the heart of efforts are key.  In her remarks, Ambassador Rice said the Peacebuilding Commission (PBC) must do more to link the work in NY to the field and better coordinate efforts with other international institutions and a range of actors including academia, NGOs and BWIs.  She also spoke of the need for better recruitment of civilian peacebuilding experts (an issue likely to be addressed in the 2011 PBC Review), the incorporation of women throughout the process and strengthening the capacity of local leaders and communities to build sustainable peace.  On a separate note, the SC voted unanimously to extend its authorization of the International Security Assistance Force (ISAF) in Afghanistan for a year.

Sudan: today, the SG’s newly formed Panel on the Referenda in Sudan met with Salva Kiir, the President of the Government of Southern Sudan, and the First VP of Sudan in Juba.  They discussed issues such as how to make the referenda process as free and fair as possible and security arrangement during the campaign, as well as post-referenda challenges.  The Panel’s chair, former Tanzanian President Benjamin Mkapa, said that he believes a credible result can be achieved by January 9, 2011.

Fistula in the Third Committee: earlier this week in the GA’s Third Committee (tasked with social, humanitarian and cultural issues), a Report of the SG on “Supporting efforts to end obstetric fistula” was introduced.  The Report makes several recommendations to States, among them: addressing underlying social, cultural and economic determinants of maternal death and disability; addressing inequalities of care in rural areas and urban poor; implementing national maternal health and obstetric fistula programs; making services geographically and financially accessible and culturally acceptable; mobilizing communities so they are empowered with respect to maternal health needs and strengthening interventions to keep adolescent girls in school and stop child marriages.  Partnerships are also highlighted to address the “multifaceted determinants of maternal mortality and morbidity”.  Specifically, the Report estimates $1.2 billion is needed for family planning and $6 billion for maternal health care per year to support priority countries in the achievement of MDG 5.  Additionally, between now and 2015 an estimated $750 million is needed to treat existing and new cases of fistula.

Flood Relief in Pakistan: Rauf Engin Soysal, the SG’s new Special Envoy for Assistance to Pakistan, visited Sindh today and met with families and local authorities, stressing the continued urgency of the humanitarian situation: “Seeing the devastation firsthand and speaking with flood affected families confirmed the astonishing reality of a continuing emergency for millions of people, and even two months on, the world must not forget those in Pakistan still in urgent need of humanitarian assistance.”

International Day for Disaster Reduction: to mark the International Day today, the SG issued a message underlining that the poorest are the most vulnerable to natural disasters and urging preparedness.

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ICC Nabs Another Suspect

From the ICC:

11 October 2010, Mr. Callixte Mbarushimana, a leader of the Forces Démocratiques pour la Libération du Rwanda (FDLR), was arrested today, in Paris, by the French authorities following a sealed arrest warrant issued by the International Criminal Court.

ICC Prosecutor Luis Moreno-Ocampo thanked France for a smooth and efficient operation. He described the arrest of Mr. Mbarushimana as a “crucial step in efforts to prosecute the massive sexual crimes committed in the DRC”where over 15,000 cases of sexual violence were reported in 2009 alone. 

And another one bites the dust…except, there are far more suspects at large than there are behind bars.  In fact, it is a small miracle anytime the International Criminal Court is able to nab a suspect.

There are currently ten cases before the court involving fifteen suspects.  Only six of these suspects are currently in custody. The rest remain at large.

Some of the suspects evade arrest by staying far outside of any jurisdiction capable of arresting them, no matter how much governments would like to do so. This includes Joseph Kony and other leaders of the Lord’s Resistance Army who are located somewhere in the lawless borderlands of the DRC, Central African Republic and Sudan.

Most of the wanted suspects, however, are hiding in plain sight.  Ahmed Haroun, wanted for crimes in Darfur, is a governor of South Kordofan province in Sudan.   Omar al-Bashir, wanted for Genocide, is, well, the president.   Unless these suspects turn themselves in, the only practical way to secure their transfer to The Hague is if the state somehow complies.  When the state dutifully protects a suspect, there is little chance he’ll find his way to a cell in Scheveningen.

This brings us to  one of the more vexing at-large suspects wanted by the ICC: the Congolese warlord Bosco Ntaganda.  His warrant was unsealed in 2008, but so far he has eluded capture by endearing himself to the Congolese government.  He is, in fact, a currently serving general in the Congolese National Army– a position he earned by signing a peace deal with the state.  In exchange, the Congolese government promised to ignore the ICC warrant.

Ntaganda may have changed uniforms, but he did not cease being a war criminal.  In fact, just today Human Rights Watch released a report implementing Ntaganda in a series of political assassinations since January.

Since January 2010, Ntaganda has been implicated in the assassination of at least eight people, arbitrary arrests of another seven, and the abduction and disappearance of at least one more. Some of these incidents occurred in eastern Congo, others in neighboring Rwanda.

Ntaganda, who lives and moves about openly in Goma, in eastern Congo, has also directly or indirectly threatened more than two dozen people whom he perceives as opposing him.

The ICC depends on states’ cooperation to arrest and transfer war crimes suspects. French police demonstrated the ideal by executing a sealed arrest warrant against a suspect living in France.  Unfortunately, that kind of cooperation with the court seems to be the exception rather than the rule. Unless the international community raises the political costs for states that evade their obligations to the ICC, the court’s value in preventing and punishing war crimes will remain limited.

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Who Knew Global Health Could be So funny? (Video)

This was about the funniest talk to occur during UN Week.  Thailand’s “Mr. Condom,” Mechai Viravaidya discusses his country’s very successful public health campaign around condom usage during the TedXChange event.  Penile Puns and vaguely inappropriate language are tucked into a very serious discussion about family planning and public health.


Who knew public health could be so funny?

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Photo credit CIVIC. "Children in North Waziristan with debris from drone missile"

More Civilian Casualties of War in Pakistan than Afghanistan

At what point do we stop calling it the “Afghanistan War?”

The Campaign for Innocent Victims in Armed Conflict (CIVIC), released a new study of civilian casualties in Pakistan. They find, among other things:  “In 2009, an estimated 2,300 civilians were killed in terror attacks alone with many more injured. Counting losses from Pakistani military operations and U.S. drone strikes, civilian casualties in Pakistan likely exceed in number those in neighboring Afghanistan.” [emphasis mine].

The majority of casualties are the victims of terror attacks and extrajudicial killings by the Taliban — but that is what you expect from a group like the Taliban.  Still, a not insignificant number of civilian non-combatant casualties are from Pakistani military action and U.S. drone strikes.   On the latter, the report provides strong evidence that the number of the civilian casualties from drone strikes are significantly higher than the United States admits.

The report draws on some existing surveys of US drone strikes and finds that approximately 120 drone strikes killed between 804 and 1367 people in 2009. The United States claims only 20 of those killed were civilians.  CIVIC investigated only 9 out of 120 attacks and found at least 30 alleged civilian deaths. In June, one attack alone took the lives of 45 to 60 people, up to 18 of whom were believed to be civilians.

What is most remarkable about this report is that CIVIC speaks directly to individual victims of drone attacks:

Daud Khan, from North Waziristan, was at his home with his 10 year-old son when a drone missile struck. He says, “The day before some Taliban had come to the house and asked for lunch. I feared them and was unable to stop them because all the local people must offer them food. They stayed for about one hour and then left. The very next day our house was hit… My only son Khaliq was killed. I saw his body, completely burned.” He said that while the drone strikes were effective against the Taliban, “they wander about the towns and villages and create problems for all the other people… they are violent and cruel actions.” Without the money to rebuild their home, Daud Khan and his family were forced to leave their village in North Waziristan.


In June 2010, Shakeel Khan was sitting in his home in North Waziristan with his family when a drone missile struck: “I was resting with my parents in one room when it happened. God saved my parents and I, but my brother, his wife, and children were all killed.” The children were 5 and 3 years old. Khan says, “I must support my aged parents now but I earn a very little amount which can hardly meet our expenses. We don’t have enough to reconstruct our house and fear that the drones will strike us again.”

As an organization, CIVIC lobbies for compensation for innocent victims in conflict. Their founder, Marla Ruzika was killed in Iraq in 2005 on a mission to document  civilian casualties.  As a result of her organization’s work, the United States now has a process to pay compensation to civilians harmed by American military action in Iraq and Afghanistan.

The report shows that there is a haphazard mechanism by which local provincial officials compensate innocent Pakistani’s for damages incurred from wrongful attacks by the Pakistan military. Pakistani victims of American drone strikes, though, do not qualify for this kind of compensation. Neither are Pakistani victims given access to the same compensation mechanisms in place in Afghanistan and Iraq.

If, as the report says, the brunt of civilian casualties are now being incurred on the Pakistani side of the border, it would make moral sense (and likely benefit the counter-insurgency effort) to extend the same kind of compensation to innocent victims of U.S. military strikes in Pakistan.  An innocent victim is an innocent victim, no matter what the geography.

Photo credit CIVIC. “Children in North Waziristan with debris from drone missile”

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