Eurasia

Part I: Summary of Human Rights Watch- World Report 2010

Human Rights Watch recently released their latest Human Rights Watch Report  for 2010.

As I read through the list of countries profiled in the report, I found myself disappointed that Canada, the UK, Australia or any Western European countries had not made the list. I have read reports of almost all of these governments committing human rights violations  or allowing their companies to do so and the populations of these nations do still experience routine violations against human rights. In fact, considering these countries have signed numerous conventions and incorporated human rights laws more thoroughly into domestic laws than most of the rest of the world, their breach of them is all the more abhorrent and worthy of reporting. I thoroughly respect the work that organizations like Human Rights Watch do and I understand that Human Rights Watch is limited in their scope and resources as indicated in the end of the first report; so in no way do I mean to undermine the work that has been done to compile this report. I simply wish that it would cover the entire world and not just pieces of it.

The main violations of concern in the report this year are described in four sections followed by individual country reports. These sections are as follows:

1) The Abusers’ Reaction: Intensifying Attacks on Human Rights Defenders, Organizations and Institutions

2) Civilian Protection and Middle East Armed Groups: In Search of Authoritative Local Voices

3) Abusing Patients: Health Providers’ Complicity in Torture and Cruel, Inhuman or Degrading Treatment

4) In the Migration Trap: Unaccompanied Migrant Children in Europe.

I will cover the details of the report over the next little while in a series of posts. The first post will address the first section of the report.

Intensifying Attacks on Human Rights Defenders, Organizations and Institutions.

Putting a spotlight on human rights violations can be risky, and often those who defend human rights face extreme abuse, imprisonment, harassment, intense intimidation and even death. Organizations fighting this fight have been suppressed, denied funding, shut down and worse. Russia received a great deal of attention for its attacks on human rights defenders. Many victims reported cases of arson, arbitrary detention, disappearances of loved ones, torture, and brutal executions in Chechnya and other parts of the country. Also specifically mentioned in this section was Kenya, Burundi, Sri Lanka, Afghanistan, Malaysia, India, and Uzbekistan. Several states were also listed as completely closed or restricted for activism. At the top of this list are Eritrea, North Korea, and Turkmenistan. Burma and Iran bar international human rights groups completely. Saudi Arabia will not acknowledge NGO supporting human rights promotion and clamps down tightly on any who speak out. Danger in Somalia makes human rights monitoring essentially impossible. Libya allows international visits but completely suppresses any independent civil society. Syria will not license any human rights groups and prosecutes those who push for registration. Indonesia prohibits international human rights groups to visit to certain areas of the country, as has Israel into the Gaza strip. Uzbekistan, Turkmenistan and Vietnam all refuse to allow access to UN special procedures, including on torture and human rights defenders. As does Egypt, Eritrea, Ethiopia, Pakistan and Saudi Arabia. Zimbabwe and Russia have also prevented the special rapporteur on torture from entering their respective countries. Sudan has shut down human rights organizations and expelled several international humanitarian NGOs working in Darfur. China closed the Open Constitution Initiative (a legal aid organization) because of controversy over Tibetan protests and melamine-poisoned milk that sickened hundreds of thousands of children.

Other governments have been accused of openly harassing, detaining or attacking human rights defenders including Cuba, Vietnam, Iran, Saudi Arabia, Cambodia, Syria, and Yemen. The governments of Columbia, DR Congo, Sri Lanka, and Nicaragua have been accused of using threats of violence to deter or punish human rights defenders. Russia, Ethiopia, India, Israel, Jordan, Uganda, Turkmenistan, Libya, Venezuela, Peru, Cambodia, Rwanda, Kyrgyzstan and Egypt have all been accused of creating restrictive laws on NGOs and associations in an attempt to restrict the monitoring of human rights. China, Iran and Syria have all disbarred lawyers, refusing to renew their professional licenses to prevent them from representing victims of human rights abuses. China, Uzbekistan, Rwanda, Iran, Morocco, Serbia, Indonesia and Sri Lanka have been accused of trumping up criminal charges to silence human rights defenders.

The report then details the efforts made by some leaders to silence or curtail the activities of the International Criminal Court (ICC). After the ICC issued an arrest warrant for sitting Sudanese President Omar al-Bashir, the African Union (AU) adopted a resolution urging African states to not cooperate with the arrest proceedings. The AU accused the court of unfairly targeting Africans, even though no objections were raised when the court indicted several warlords and the African governments themselves had requested the court to open the investigations. The ICC has also been hampered by the lack of ratification in the areas it is most needed, namely Sri Lanka, Iraq, Gaza, and Chechnya and a seeming double-standard that allows major Western powers and their allies to escape impunity.

The UN Human Rights Council is also described as problematic. The report demonstrates the bias and subjective nature of inquiries into human rights violations. Regional solidarity reigns in voting procedures over human rights principles, with members convinced to ignore their domestic principles for their allegiances to repressive neighbouring governments. Repressive leaders at the Council seemed determined to silence voices of dissent whenever possible. Similar problems have occurred within the UN NGO Committee, who has the power to decide which NGOs are able to gain “consultative status” and the right to speak before UN bodies. Several governments who are extremely restrictive towards NGOs seem to actively seek membership within the Committee to ensure that certain voices are silenced. For example, a Christian group from China was rejected for refusing to provide a list of its Chinese members, an action that would have severely endangered the lives of those involved. Another group, the Ethiopian Human Rights Council, was denied the right to speak because it had not complied with Ethiopia’s new stringent civil society laws.

The European Court of Human Rights has repeated issued rulings against Russia (more than 100) for the abduction, torture, and execution of the people in Chechnya, and failing to properly investigate the crimes. Russia has refused to implement structural reforms ordered by the Court, as well as share relevant documents with the court in over 40 cases. The Russian government continually postpones visits by the rapporteur of the Parliamentary Assembly of the Council of Europe on human rights situations in the North Caucasus and has so far faced little consequence.

The ASEAN Commission on Human Rights was highlighted as a potentially positive new institutional development in the eastern world. Launched in late 2009, the 10-member Association vowed to adopt a “constructive”, “non-confrontational” and “evolutionary” approach to human rights, however, its non-interference policy ensures that member states cannot be monitored and investigated properly, giving each state the right of veto. Engagement with civil society remained repressive as each state was allowed to chose the civil society organization it wished to be part of an “interface meeting” on human rights.

More vigorous governmental defense of human rights activists and institutions is necessary, even in the face of abuse by allies. The attack on those who would defend human rights is an attempt to silence. The world cannot sit silent in the face of abuse. Voices must be heard. Human rights is a relatively new concept on the earth, but is one that must be vehemently defended if our rights and freedoms are to be respected.

Please read through the Universal Declaration of Human Rights. Is there anything written there that you wouldn’t want for you and your family?

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An End to Foreign Rule and Other Ideologies of the Taliban Movement

“I start in the name of God, the most merciful, the most compassionate…” –voice of an anonymous Taliban fighter (Smith, 2008).
This quote seemed the most fitting way to start understanding the mind of a Taliban fighter since it was echoed at the start of almost every filmed Taliban interview and video. The image of the Taliban as a hard-line, ultra-fanatical religious movement has often cast individual Taliban fighters as uneducated, brainwashed religious nuts who are innately violent and destructive. Although the Taliban have an extremely strict and anti-modern ideology based on Islamic Shariah law, many of the fighters are not strict religious adherents and believe indiscriminate violence is wrong.
These Taliban fighters do strive for Islamic rule for the nearly ninety-nine percent majority Muslim population of Afghanistan, but they also strive to stop the occupation and invasion of their country, to restore the security situation of their land, regain economic security for themselves and their families, and to reclaim the territory lost to the Durand Line on the Pakistani border, among other things. The people that make up the Taliban live in an area that has been almost continuously occupied and invaded by several different factions for centuries (amidst incredible local resistance), and which has recently been devastated by almost thirty years of war. The individual reasons for Taliban fighters to join and support a so-called “terrorist” or human-rights violating organization are complex, but are most often rooted in socio-economic, political, historical and cultural reasons and not solely in blind religious fanaticism.
Afghanistan has experienced almost constant restrictive occupation for the last thirty years; first by the Soviets, then by the Taliban, and currently by the Americans since 2001. The Soviets invaded Afghanistan in 1979, a conflict which has often been referred to as one of the proxy wars of the Cold war. This war lasted until the withdrawal of Soviet troops in 1989, after the Soviet Union had begun to crumble and were no longer able or willing to support the effort. The US government, through the CIA and with the help of Pakistan’s secret police (ISI), channeled money to groups of mujahid warriors in Afghanistan (who included Osama bin Laden) to fight off the communist threat of the Soviets and gain an important strategic foothold in the Central Asian region. The extremist mujahid warriors (along with ethnic separatists) were seen as the best option to oppose the Soviets, not because they could form a stable government, but because it was hoped that they in fact, could not (Kakar, 1995: 147-9; 156).
The lack of local government along with the plethora of scattered, ‘tribal’ leaders left religious scholars with an important role in Afghanistan against foreign invasion and dominance. During the Soviet invasion a decree stating “Now is the time to free your country and wage your holy war against the Russian invader!” (The Final Call, 2001) was declared by many religious scholars, prompting the masses to take up arms and enjoy martyrdom if killed in battle. After defeating the Russians, these religious scholars went back into religious schools and mosques while some of the mujahid warriors began to fight each other for control of Kabul and other resources. For four years the scholars saw fighting, chaos and anarchy with traditional society and culture effectively uprooted, and thousands of refugees fleeing to neighboring Pakistan. In the communist controlled areas, the traditional “feudal” culture had been completely disrupted and replaced with “productive” urbanization, with Kabul swelling to over three million people (Kakar, 1995: 279).
It was in this climate that the Taliban really began to emerge. The term ‘Taliban’ comes from the Pashtu (and Arabic) word for ‘student’, and is used to describe a militant student movement group that grew out of hard-line religious schools in Pakistan in the early 1990s (Reuters AlertNet, Afghan Turmoil: 2008). In the late 1970s and 80s, Wahhabis from Saudi Arabia (a strict religious sect) began joining the mujahid warriors and heavily funding these religious schools (madrassas) to support the many “Afghani Jihad” orphans. These students, most of who were Afghani refugees living in camps on the Pakistani border, were offered free schooling and often even given a meal if they attended classes (Khan, 2003). They were schooled in the evils of non-Muslims, how to resist the Russians and any other occupation, and taught strict Islamic guidelines based upon Qur’anic verses. The Taliban brought possibilities to these students of education, work, much needed money, solidarity with others, and an actual role to play in society to make them feel useful again. It also brought hope for a future (even if only in heaven), something that is very hard for many refugees living in camps to imagine.
The Taliban shifted from these humble beginnings to rule most of the Afghan region from 1996 until their overthrow by US and NATO forces in 2001. They ruled with tremendous religious rigidity, and were condemned by human rights organizations who claimed they implemented the most brutal and strict interpretation of Shariah law ever seen in the Islamic world, which saw the closure of all girls’ schools, the ban of women from leaving their house without male familial accompaniment, as well as the ban of every conceivable kind of entertainment (Rashid, 2000: 2-3). This interpretation is informed by Shariah law combined with ancient Pashtu tribal codes (the Pashtunwali) that stress the right to revenge and to avenge injustice in equal proportion, as well as ideals of hospitality towards guests, asylum, honor and the protecting of Pashtu culture (Mardsen, 1998: 85).
Incessant fighting of competing Mujahidin warlords during the late 80s and early 90s, paved the way for the Taliban to overthrow the government in 1996, a move that was welcomed by many in the Pashtu majority who were happy to again see Pashtu political power in the country and an end to indiscriminate roving violence (Khan, 2003). In fact, Afghanistan’s former Ambassador to Pakistan, Abdul Salam Zaeef, was reported as saying in 2000 that the Taliban had developed “out of public demand” to put an end to the anarchy and chaos and to disarm the unscrupulous militias of mujahidin struggling to fill the power vacuum created by the departure of the Soviets (Global Security, 2000). Under this auspice, many Afghanis joined the cause.
The Taliban ruled until US and Coalition forces invaded in 2001, supposedly in search of Osama bin Laden. The Taliban, using Pashtunwali codes of asylum and hospitality towards guests as their guide, refused to hand over bin Laden without evidence proving his guilt. They actually agreed on several occasions, if evidence was submitted, to capture bin Laden and bring him to justice along with three other alternative options for justice. The US would not accept this offer. Many argue that in fact the US only turned against the Taliban after they refused to sign an oil pipeline deal through Afghanistan, instead offering the deal to an Argentine consortium (Margolis, 2008). The truth lies under much propaganda, and is incredibly difficult to ascertain. The Taliban and much of the Afghani public viewed this new infidel invasion much as they had the previous invasions, believing all Afghanistan’s problems would be solved if foreign interference were to stop immediately. Development projects were seen as a controlling mechanism of the non-Muslims, and were criticized for their wasteful spending. The Taliban also suggested that some UN and international projects were not sincere in their goals of helping the Afghani people, and were exaggerating the situation to continue their financial support and missions (Global Security, 2000).
The Taliban’s original goal, according to Zaeef and Ambassador Abdul Hakeem Mujahid (a Taliban representative to the UN in 2001), was to ensure peace and security in the country. They claim to have tried to solve all issues and disputes “through understanding and peaceful means”, even extending ‘”to the opposition an invitation for peace in an effort to stop further bloodshed in Afghanistan” (Global Security, 2000; and The Final Call, 2001). The main goals after restoring order were national unity for Afghanistan (which included restoring territory lost to Pakistan with the Durand Line in the 1920s); to disarm all the warlords and build a strong central government built on Islamic values. The Taliban claimed they would return to the mosques and schools once this had been attained (The Final Call, 2001).
To the Taliban, western “extremist” visions of their rule as human-rights abusing were unjustified. As repeated in mantra-like form, the Taliban has restored security and justice, along with the idea that education is not a right, but an obligation. Within Islamic-Pushtun principles this obligation means no-coeducation, with females separately educated for their own modesty and to prevent impure thoughts among the males. For the leaders of the Taliban, questions regarding the education of women were defended by showing the hypocrisy of the world for not criticizing the UN and Soviets who did not offer non-coeducational schools, limiting much of the Afghani population from attending. It was seen as offensive by the Taliban to force women into coeducational experiences that would dishonor their culture, and they claim many women who were able to enjoy education under Taliban rule missed out on education under the Soviet and UN systems (The Final Call, 2001).
The Taliban also take offence to the claim of indiscriminate killings and arbitrary violence. Taliban leaders, along with fighters stressed the fact that they were to avoid civilian deaths as much as possible. Certain statistics would seem to back this up. Taliban suicide bombers in Afghanistan are more prone to hit “hard” military targets than civilians with nearly half (43%) of all bombings causing no civilian fatalities. This “low accuracy” rate was attributed to the “amateur” abilities of the Taliban by Coalition troops. The Taliban affirms that this is a calculated decision to avoid killing innocents and inciting anti-Taliban sentiment in the country, a tactic that has proven effective in demonizing the Coalition among the locals for their indiscriminate bombings that have killed scores of innocent civilians (Williams,2007).
Controversy over the makeup of the Taliban is clouded by mass propaganda (American, Russian and local), conflicting accounts and faked reports. The Taliban’s strict ban on entertainment makes video, radio, or local newspaper accounts and debate almost non-existent. Interviews of the Taliban were highly tense situations, evidenced in the fact that every single Taliban member being interviewed other than top officials giving declarations hid their face from the camera with part of their turbans, perhaps in fear of revealing their identities and being punished. The responses were formulaic and expected. Mantras were common among the interviews of Taliban leaders, spokesmen, and fighters, suggesting some level of “brain-washing” or at least preparation and indoctrination before interviews. There seemed to be standard answers for standard questions. Phrases such as “puppets of the Americans” or “slaves of the non-Muslims” were repeated ad naseum (Smith, 2008. Also see list of Taliban interviews in the Bibliography). The difficulty in assessing the validity and motives of the speakers from these accounts is compounded by the fact that most were dubbed into English, and not subtitled, leaving little room for objectivity and verification of translation.
So who is the Taliban really? One side, namely that of Marc Sageman describes the Taliban as conscious actors, who are politically and religiously motivated and do not need brainwashing to take up the Taliban cause (Sageman, 2004: 99-137). He also suggests that they are not uneducated or lower-class individuals, but in fact are represented by many educational and class levels. These types of reports have been contrasted with the more common perception of Taliban fighters as lower-class people who have been seduced, bribed, tricked, manipulated or coerced into blowing themselves up as “weapons of God”. The National Directorate of Security (NDS), the Afghanis intelligence service, has reported apprehending bombers who were deranged, mentally and physically retarded, unstable or on drugs. Several of the bombers caught by the NDS were supposedly carrying mind altering hallucinogens or sedatives to calm their nerves before death. Media and think-tank reports also mention cases of physically disabled suicide bombers, including a blind man, an amputee, and a disabled man whose only motive was to make money for his family (Williams, 2007). Although there are clearly some educated and upper-class Taliban members, the evidence and choice of interviewees seems to corroborate the latter view for the majority of its fighters. All of the interviews of former Taliban members described their motivations to be mostly economic or through coercion (sometimes by force).
Most of the fighters interviewed were former blue collar workers, who took up arms in solidarity with the Taliban against the non-Muslim infidels and their servants (the current Afghani government). High levels of unemployment (as high as 60% country-wide); lead many young men to join the Taliban for pocket money, a mobile phone, or other financial incentives. Where the government is failing to provide basic services for its citizens, the Taliban seems to be jumping in to fill the gap with radical alternatives (IATT, 2008).
Many of those interviewed were former farmers who had been kicked off their land in poppy raids by the current government. They had family and friends who had been killed by invaders, had lost their homes and livelihood to violence and were unable to leave the country. A definite link between the eradication of poppy and the growth of the Taliban in rural areas can be determined (Smith, 2008). The Taliban offered these often lonely, marginalized men a chance to bring security, money, and medical care to their families. It also offered them a chance to belong, and feel like productive members and agents in their own future.
The poppy-Taliban connection is an interesting one, especially when one considers that the cultivation of the poppy for narcotics purposes is strictly prohibited by the Qur’an. All of the Taliban respondents interviewed about poppy cultivation openly admitted this fact, but stated they had been in cultivation for financial reasons. The Taliban seemed to help these former farmers finance their basic human needs after they were stripped of their livelihood. This suggests that Sageman’s proposal that Taliban fighters are mostly religiously motivated is flawed, since so many informants clearly disobey Islamic rules in full knowledge of their own wrong-doings.
Whatever the motivations of individual Taliban members to join, it seems that local sympathies and recruitment for the Taliban are in fact increasing and spreading across the Islamic world. The continued presence of foreign invaders who disrespect local cultures and values jeopardizes the possibilities for peace in the future. Almost all of the Taliban interviewed say they will continue their fight to the last man standing, as long as any infidels reside in and control their territory. A newly signed pipeline deal brokered by the Americans solidifies the “need” for continued American “pipe-line protection troops” in the region for many years to come (Foster, 2008). This means that this war will inevitably continue, and perhaps even intensify in the future.
The Taliban’s negative image has been widely broadcast in North American media. Clearly, the Taliban is guilty of many human rights abuses and atrocities, but theirs are not the only hands with blood on them. Many of the individual Taliban fighters are victims of massive cultural, structural and direct violence that shapes their worldview and in a sense, “legitimizes” their continual struggle against repressive foreign invasion. They are “justified” in continuing their struggle because they see injustice in their lives brought about by foreign powers. More objective research into the mind of the Taliban fighters, their individual backgrounds, daily lives and mindsets would be the first step towards achieving peace in the region, since the root causes of the fight have yet to even truly begin to be addressed. Any justice in the region must be all-encompassing, and include solutions to local structural injustices, as well as the injustices created and continued by American invasion. The foreigners must be reigned in, basic structures rebuilt, local cultures revitalized and reconciliation processes enacted. The Taliban strive for recognition of their values, and until they receive this recognition, they will continue their fight to the death, in the name of Allah.

Bibliography
Foster, John. (June 19, 2008). A pipeline through a troubled land: Afghanistan, Canada, and the new great energy game. Foreign Policy Series. Canadian Centre for Policy Alternatives. Vol. 3, No. 1.

Global Security. (November 8, 2000). IRIN interview with Taliban Ambassador. Globalsecurity.org. Retrieved October 4, 2008, from http://www.globalsecurity.org/military/library/news/2000/11/war-001109-saafg.htm.

Internet Anthropologist Think Tank (IATT). (February 28, 2008). Afghan youth join Taliban to escape poverty. War Intel Blog Spot. Retrieved October 4, 2008, from http://warintel.blogspot.com/2008/02/join-taliban-to-escape-poverty.html.

Kakar, M. Hassan. (1995). The Soviet invasion and the Afghan response, 1979-1982. University of California Press.

Khan, Feroz Hassan. (January 10, 2003). Strategic insight. Rough neighbors: Afghanistan and Pakistan. Center for Contemporary Conflict. Retrieved October 4, 2008, from http://www.ccc.nps.navy.mil/rsepResources/si/jan03/southAsia.asp#references.

Mardsen, Peter. (1998).Taliban: war, religion, and the new order in Afghanistan. Zed Publishers, New York.

Margolis, Eric. (July 30, 2008). Let’s speak the truth about Afghanistan. Huffington Post. Retrieved October 4, 2008, from http://www.huffingtonpost.com/eric-margolis/lets-speak-the-truth-abou_b_115591.html.

Rashid, Ahmed. (2002). Taliban: Islam, oil and the new great game in Central Asia. I.B. Tarius Publishers, New York.

Reuters AlertNet. (January 8, 2008). Afghan turmoil. Reuters Foundation. Retrieved October 2, 2008, from http://www.alertnet.org/db/crisisprofiles/AF_REC.htm?v=in_detail.

Sageman, Marc. (2004). Understanding terror networks. University of Pennsylvania Press, Philadelphia.

Smith, Graeme. (March 22, 2008). Talking to the Taliban. Globe and Mail, CTVglobemedia Publishing Inc., Canada. Retrieved October 4, 2008, from http://www.theglobeandmail.com/talkingtothetaliban.

The Final Call. (January 1, 2001). Who are the Taliban? The Final Call On-line Edition. Retrieved October 2, 2008, from http://www.finalcall.com/perspectives/interviews/taliban01-09-2001.htm.

Williams, Brian Glyn. (July 19, 2007). The Taliban Fedayeen: The world’s worst suicide bombers? Global Terrorism Analysis: Terrorism Monitor. Vol. 5, No. 14. Retrieved October 4, 2008, from http://www.jamestown.org/terrorism/news/article.php?issue_id=4183.

SELECTED YOU TUBE TALIBAN INTERVIEWS:


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International Intervention without Cultural Specificity: The Problems of Aid and Intervention to Russian Health Care

Distributing international aid can prove to be a problematic process if background situations and local considerations are not thoroughly regarded. International intervention within the post-socialist Russian health care system was fraught with difficulties stemming from misconceptions, flawed perceptions and a lack of coordination between locals, international NGO workers and the state. The legacy of the socialist period cast itself on the future of development assistance, as public prejudices regarding expectations were transferred from communism’s failure to the failure of capitalism. How has international intervention and aid to the Russian health care system shaped the relationships between citizens, civil society, and the state; and how has this changing shape been affected by the socialist legacy? How have the concepts of public and private spheres in the socialist context affected the way aid is being received? What are the problems facing international health care aid to this region and what is the best way to overcome these problems?

This paper will explore the transformation of health care services in Russia from the Soviet period to the post-socialist era, detailing the realities of the health care situation on the ground. It will attempt to describe the changing perceptions of public and private space and the expectations that coincide with these spaces, recounting the growing dominance of one space over the other under socialism, and later its repackaged continuance under capitalism. It will then turn to the emergence of international intervention (in the form of NGOs and development assistance) that were focused on transforming the socialist state into a market democracy, and how this assistance was misinterpreted and perceived by many as insulting, damaging the possibilities for overall success. The difficulties facing the depoliticizing of aid are explored, as well as the misconceptions precipitated by the Cold War ideologies. Pro-natalist agendas are discussed as shifting the perceptions and institutionalizing moral responsibilities, a practice that was continued in the delivery of international assistance. The devaluation of Russian skills and knowledge (by Westerners) as a mechanism for change is explored, as well as the disregard and disrespect for Russian input which resulted in the marginalization of the local. The paper will then describe Western attempts at ‘democratizing’ the health care system from the ground up, and how this was limited because of vertical hierarchies in existence. It then details how the perceptions of the socialist state cast themselves on the perception of international aid and intervention, and prevented it from succeeding. The example of Uryupinsk is then described as a type of home-grown “civil society” that is able to meet the needs of its population, followed by recommendations for strengthening the health care system and ensuring aid is better received in the future.

Health Care in Russia

During the socialist period in Russia, there were two phases of health care, the first taking place during the 1920s. This first period was dominated by the Marxist perception that illness within society was primarily the product of sickness (inequality and capitalism) in society and that the “cure” to problems such as alcoholism, drug abuse and prostitution would be socialism. This phase deemphasized the value of scientific and clinical approaches to health care and instead narrowed in on socio-economic factors. Beginning in the next decade, the second phase saw more scientific approaches to care exhibiting a belief that work force capacity was dependent on the health of its workers (Bar and Field, 1996). Poorly managed and poorly funded programs that left physicians without pay, resulted in fees-for-service, extending hospital stays and providing unnecessary treatments as money-making ventures (Rivkin-Fish, 2005:86). After the fall of socialism, a third phase occurred and involved reigning in already minimal payments by the government to the healthcare system and reducing the hospitalization rates and lengths of stay of patients as a means of limiting spending and becoming more “cost-effective” and “efficient” (Rivkin-Fish, 2005: 89).

During the Soviet period, education, healthcare and child care were to be provided by the state at no cost to the citizenry. The health services in particular however, were often under-resourced and segregated based on the person’s position within the Communist Party, their access to extensive personal networks and their ability to pay the increasingly expected fees and tips for supposedly free services. The government publicly prioritized the training and recruitment of doctors and provided large numbers of hospital beds, but often neglected the quality of the personnel or facilities being offered as the percentage of GDP spent on healthcare services plummeted (Bar and Field, 1996).

Professional associations for physicians were outlawed during the Soviet period. This resulted in the removal of an important system for monitoring the quality of care and the chance for physicians to lobby for better working conditions and rights. Claims of bribery, corruption and network favoritism cast shadows on the admission and graduation processes of many physicians, causing their skills to be considered extremely sub-par or non-existent by Western standards. Doctor’s wages came last among state spending, many receiving lower salaries than factory workers, leaving them with little choice but to charge their patients fees in order to survive. Pharmaceuticals and supply shortages lead to a reliance on gray and black markets for the provision of basic materials. Many hospitals lacked even adequate plumbing or sanitation systems, and electricity or the equipment necessary to run basic tests (Bar and Field, 1996). Patients were asked in some cases to provide their own bed sheets, nourishment and even blood for transfusions brought from home if having an operation while in the hospital (Rivkin-Fish, 2005:87) The dissolution of the state after the fall of communism led to a further erosion of these already abysmal services (Hemment, 2004, Spring). The World Bank and International Monetary Fund (IMF) restructured loan payments with the government, and advocated for the state to eliminate promises of universally free healthcare and to reign in their health spending, exacerbating the underlying problems and compromising patient care (Rivkin-Fish, 2005: 87-9).

The Changing Relationships between the State, Civil Society and the Individual

Radical economic and social reforms enacted by the new governments, who were under World Bank and IMF pressure, failed to install more equitable socio-economic structures. Rising unemployment, withheld wages, and hyperinflation forced the already poor and desperate to rely on personal networks in order to obtain the social security that the government was failing to provide (Hemment, 2004, Spring). Janine Wedel (1998:3) comments that many Westerners were and still are “naïve to the realities of the Eastern world and the political skills it took just to survive” on a daily basis. The changing relationships between the individual and the state and the growing institutionalization of the private sphere exacerbated the citizen’s distrust for the state. This distrust was later projected from the state onto Western aid and interventions (which will be discussed in a later section).

The public sphere is traditionally regarded as an inclusive space where private individuals could come together as a public to debate issues of public authority such as governance. The private sphere complemented this sphere as an area traditionally outside of the reach of the government or public institutions (Habermas, 1989:27). Civil society was seen to occupy the space between the state, the market and the private; and conventionally consisted of NGOs, associations, community groups, trade unions and social movements (Centre for Civil Society, 2004). The public, private and civil society spheres have been referred to as the legs on a “three-legged stool”, with a separate but equal balance existing between all three legs. In reality, the situation is slightly more complicated as balance is not necessarily equitable, and the legs are not entirely separate. A common neoliberal assumption asserts that there should be a distinct separation between the private, civil society and the state. This assumption neglects to realize that the boundaries between these entities are not always clear (Drue, 2002: 187-200).

Modern housing made available after the fall of communism allowed many citizens their first access to a truly “private” sphere, a location reserved specifically for families that could be closed to neighbours and other uninvited visitors previously forced onto the private sphere by institutionalized situations such as communal apartments during the Soviet era. The “official” or “public” sphere (that being controlled by the Communist party) became increasingly dominant in daily life under socialism, as housing was communalized, and a wide array of topics became too dangerous to be discussed in “public” spaces, which were now extended to sometimes include areas within people’s own homes such as shared kitchens, hallways and bathrooms (Oswald and Voronkov, 2004).

The state privileged the public over the private sphere. Increasing productive and reproductive duties were nationalized and incorporated as individual moral responsibilities making once private issues public concern (Einhorn, 1993:31-3). This private and public tension was further exacerbated by the secularization process undertaken by the state during socialism that strove to limit private influence in the public sphere (Richardson, unpublished, 2008). Destined for disaster, the state increasingly took on more responsibility by broadening its political reach into the private realms, overburdening and overstretching its already thin capacity. The state lacked equitable distribution capabilities, dooming it to be resented by the people whose needs were increasingly being ignored. The increasing control of the private sphere where individual responsibilities became public responsibilities only intensified the already deep resentment towards the state for its distributional failures. The fact that the state lacked the structural capabilities to fulfill its existing promises without taking on increasing responsibilities, made these private intrusions all the more hated (Oswald and Voronkov, 2004).

Gal and Kligman (2000: 39) suggest that the private and public spheres are not mutually exclusive and are more like a nested set of ideologies that are overlapping and malleable, sometimes permitting the private within the public and vice versa. The exact distinction between public and private is completely relative to the interactional situation to which it is applied. Civil society often appears as a sort of public within the private sphere, or as a private interaction between individuals and the state existing usually in public space. During the Soviet era, “civil society” in the western sense was almost non-existent, as its functions were being primarily met or excluded by the state. Thus civil society came to be known as anything not being determined or offered by the Communist Party (Hemment, 2004 Spring). International foundations in the post-socialist context presented civil society as the antidote to the state, which was characterized as corrupt and obsolete in Russia even though the state was needed for these NGOs to gain recognition, practice legally and distribute resources (Drue, 2002: 183).

The growing distrust for all things public, stemming mostly from a lack of adequate resource distribution, favoritism and corruption amongst unequal hierarchies, increased estrangement from the state or public sphere and induced a withdrawal of many citizens from the routinization, institutionalization and standardization that socialism was providing. The boundary between public and private was blurred and permeated by the resource-attaining practice of blat, a collection of personal networks that transcended the private sphere while attempting to obtain public goods (Oswald and Voronkov, 2004). Public space became increasingly masculinized after the fall of communism, as competition for jobs forced many women from public roles and back into the home, leaving little space for female involvement outside the private sphere. These women, barred from the traditional public sphere, often became increasingly active within civil society, organizing associations and NGOs and leading to a feminization of the civil society sector (Hemment, 2004, Spring).

International NGOs Combating Communism

International aid and nongovernmental organizations (NGOs) entered the former USSR upon its collapse, with the original intention of combating communism and transforming the state from communism to capitalism (Wedel, 1998). Expanding civil society was seen as instrumental to the development of free markets and democratic ideals (Hemment, 2004, Spring). The main categories of aid and NGO work being supplied internationally to Russia were interested in privatizing former state services, developing the private sector (including private property reform), democratization and basic humanitarian assistance such as health care. A disconnect between the West and the East facilitated by the Cold War ideologies however, prevented this work from being fully effective (Wedel, 1998: 4). NGOs were painted in opposition to the state, as inherently “good” and representing everything the state could not provide in a less bureaucratized, and more efficient manner that was able to reach local populations more effectively than centralized resource distribution (Fisher, 1997).

The West was originally regarded with suspicion, but also lauded as a potential savior whose eventual assistance was never really in question since it was perceived as fully capable of distributing resources. The East considered the West as a kind of rich Soviet Union able to furnish the vast array of products and services not being supplied under communist rule (Wedel, 1998: 22). The West lumped most of the former states of the USSR into the category of “undeveloped”, akin to the Third World, as they began providing aid, NGOs and development schemes to ease the transition from communism to capitalism in the region. This was interpreted by Russians as insulting since many saw themselves as being more or equally “civilized” and “cultured” as the West, needing institutional and social changes instead of economic growth and handouts (Wedel, 1998: 20). The problems in the post-socialist era were difficult to address as Hemment (2004) explains in her example of a highly educated woman with graduate degrees, who lives in a tiny two-bedroom apartment with no hot water, her family of five and her in-laws. The socialist situation was comprised of a highly educated population living in extreme poverty, with few rights and unable to make a living, and differed greatly from the Third World situations.

International anti-communist, pro-natalists intent on transitioning Russia towards capitalism after 1989, were accused by Russians of working to strategically depopulate the country due to their push for abstinence and individual moral changes in the face of existing East-West tensions, perceptions and suspicions (Rivkin-Fish, 2005: 215). Applying pre-existing and inappropriate models of aid in the Russian context had the reverse effect of transference to capitalism by solidifying support for the socialist parties and strengthening “mafia-style” networks that were clinging to resource possibilities and the power vacuum created upon the state’s retreat. The lack of transparency along the aid-distribution channels intensified the connection between the realities of the former socialist state and the realities of capitalism, as Western aid, untracked, was assumed to be in the pockets of the elites, much as under socialism. Many Western aid officials were assumed to be spies sent by the West to evaluate the potential competition of the Eastern producers, with as much as two-thirds of the Russian population believing that the US had a calculated anti-Russian foreign policy (Wedel and Creed, 1997).

Depoliticizing the Political

Perceptions can shape the success or failure of any aid mission, and to be most successful aid must be apolitical, not operating within the standard political debate (Creed and Wedel, 1997). The depoliticization of aid became nearly impossible in Eastern Europe as the socialist legacy ensured the economy was completely controlled by the political apparatus. Personalistic connections were required for the NGOs and associations to distribute, arrange and acquire resources, lending legitimacy to the existing inequalities and undermining attempts at institutional and social reform. Many sectors, such as health care and agriculture were highly politicized. Collectivized farms, for example, were seen as the biggest threat to capitalism, with Communist support being saturated mostly in rural areas. Attempts to decollectivize were promoted as the best way to defeat the remaining Communist influence that was primarily in control of the collective farms, essentially restricting the possibility of production to non-collective means, eliminating a way of life for many and hailing capitalist production as the only possible way (Creed and Wedel, 1997).

In health care during the socialist period, the state largely ignored its purported responsibilities to its citizenry by blaming “low levels of culture” (Rivkin-Fish, 2005:91) and an “underdeveloped sense of individual character” for ill health. It began targeting the individual for moral transformations instead of examining the possibility of structural or policy reforms. This essentially privatized perceptions and shifted the blame from state to individual. The widespread use of abortion during the socialist period offers a prime example of this politicization. The Soviet pro-natalist and state-production agenda originally passed restrictions on abortion, focusing on the size and quality of the population as being most important to national production and essentially making the issue one of national security (Rivkin-Fish, 2005:4-5).

Abortion was later institutionalized as the most accessible means of fertility control with all other choices being almost non-existent. As a result, abortion rates more than doubled the live-birth rate and the population began to decline. Official policies institutionalized the focus onto the individual as potentially antisocial and degenerate, changing health education to conform to standards of ‘proper’ hygiene and sexual restraint and making the problems individual moral problems as opposed to state structural ones such as growing inequality, poverty and the decline in universal services (Rivkin-Fish, 2005: 93-4).

Reinforcing Social Inequalities and Hierarchies

International aid officials decided they had seen the problems of the Russian health care system before and applied inappropriate and existing models from the Third World to ‘fix’ them. They were critiqued as not listening to Russian input or promoting cooperation and sharing of ideas between the East and the West; instead lecturing and devaluing the professionals in existence even though they claimed to be working in a democratic fashion in collaboration with the locals. They assumed total Russian ignorance and ignored the scientific and research opportunities in the socialist context that gave many Russians knowledge and abilities equal to or surpassing Western knowledge and abilities. Aid officials attempted to make appeals to change more receptive to the Russian audience by entirely disregarding their knowledge and former modes of care (Creed and Wedel, 1997). Westerners also completely ignored Russian priorities while claiming to be promoting them. Russian officials in the early nineties placed low priority on the health care system instead focusing on socio-economic and ecological causes of disease, while the WHO (professing to be following the priorities of the Russians) prioritized sanitation and maternal and infant health as the most pressing issue (Bar and Field, 1996).

An anthropologist noted the disrespect offered by many international organizations to local organizations at local-run events. This disrespect was evidenced in their sending low level workers with little decision-making capability that “dressed in blue jeans”, “appeared bored” and were unable to comprehend the language or situation at hand (Drue, 2002: 192). Drue (2002: 205) also illustrated the marginalization of local groups who had to account for their lives and convince sponsors of their social worth in order to receive funding or acknowledgement. This was compounded further by a complete lack of attention from the government and media even after receiving extensive NGO training in media and governmental relations by international parties and attempting to implement this generic training in the Russian context.

Convinced that the Russian health care system was akin to medical practices in the West in the 1960s and 70s, the international community emphasized the Russian’s problems as being “familiar” or “behavioural” and not technological or induced by systemic poverty. They moved away from the original focus of maternal mortality to narrow in on issues such as changing the practice of separating mother and child at birth, promoting breastfeeding over scheduled feedings; allowing companionship during birth, removing the “dehumanized” nature of practices and changing the emphasis from institutional demands to consumer wants and needs. This characterization of “dehumanized care” led the World Health Organization (WHO) to promote the reorganization of post-natal care from concentrating on biomedical expertise to the individual needs and demands of the patients. This essentially recontextualized the original issue of maternal health into a women’s social issue that ignored the local cultural norms and standards. It blamed the physicians while ignoring the role of the state attempting to be apolitical. What the aid officials didn’t realize is that the political was already thoroughly intertwined in the health care system through the unequal hierarchies (where physicians received low status against the powerful state), and the blurred boundaries that existed between public and private spaces that allowed for state control on almost all levels (Rivkin-Fish, 2000: 79-80).

‘Democratizing’ Clinical Practices

The Russian physicians blamed their problems on a lack of proper supplies, equipment, communication and financing from national sources, and placed little value on the institutionalized and medicalized nature of their health system. The WHO’s focus on eliminating embarrassing (by Western standards) procedures such as the forced provision of enemas and pubic shaving, routine in Russian birthing practices, reflected a lack of local cultural understanding of the body and its care in this region as Russians saw this to be an unimportant issue. Westerners assumed the medicalization of health care practices during childbirth equated to the subordination of women as a need for physicians to assert their power, much as doctors had in the West in the 1960s and 70s (Rivkin-Fish, 2005: 60-90).

International bodies assumed that the Russian physicians’ resistance to change was induced by a self-interested quest for power, much as in the West, due to their prestige and position as a physician and the lack of knowledge of their patients. They neglected to realize however, that physicians in Russia were not afforded the same status as in the West. In fact, the deep investment in the ideology of biomedicine, which stressed technology, knowledge and research in medical practices, was rooted in the need for physicians to achieve professional efficacy in a hopeless socio-political environment. Little chance for advancement of material or symbolic power due to low wages and poor status as a physician resulted in many clinging to their knowledge over their patients as a way to express their social dominance and experience social power that was otherwise missing from their lives. In fact, the feminization of the position was seen as caused by declining wages and low political socio-economic status, resulting in more than seventy percent of doctors in Russia being female. The West’s assumption that the Russian present was the same as their past neglected to address the low status to which doctors were afforded in Russia, and prevented the Russians from heeding the advice to individualize and humanize care (Rivkin-Fish, 2005: 60-72).

The international aid community failed to acknowledge the undemocratic position that physicians were accorded due to their limited access to state communication, policy direction and financing. Instead, they plowed along promoting a ‘democratic’ clinic setting hoping it would vertically transcend the hierarchies in existence, but not realizing the physicians didn’t have the technical, political or financial means to make it happen. By “throwing out ideas” at the individual level and hoping that they “plant seeds” into larger structures, the international community essentially commoditized these ideas, making them “seemingly available for any individual to choose according to their desire and whim” and un-attaching them from the structural positions in which they are embedded (Rivkin-Fish, 2005: 61).

Transferring Perceptions

The perception of international aid as being able to actually distribute resources and make changes quickly faded, casting it in much the same light as the former Communist state that was also unable to equitably distribute. The promises of change and lack of actual structural transformations brought about by the promises, only further isolated the population from the hierarchal structures of aid, and made them continue to be reliant on their own networks for survival. Individual blame and expectations of personal change as a way of achieving democracy, with no demands on institutional or structural changes, angered the population into resistance and reminded them of the public intrusions by the state into their personal affairs. The lacking levels of transparency and use of blat networks to distribute resources also painted international assistance in much the same light as the state. These perceptions and associations determined the fate of international intervention and prevented it from being a true success.

Hope for the Future

Is it possible for international aid and intervention into this region to be successful? Is international intervention even necessary and what can be done to ensure that this intervention is not reinforcing current hierarchies? The example of Uryupinsk, a city in the Volgograd region, demonstrates the ability of the community to strengthen itself without international intervention.

Uryupinsk has an incredibly active population with a strong sense of community and incredibly proud citizenry whose needs are being primarily met through local initiatives. The local cell of the Communist Party of the Russian Federation (KPRF) has taken on the role of civil society within the community and has been able to provide quality services for its citizenry. Since the KPRF is no longer the party in charge, it is able to play the role of intermediary between the population and the state. Zhensovets (women’s councils), trade unions and street committees are extremely active and powerful and are being fully promoted and funded by the KPRF.

The street committees are the most power organization at the grassroots level, and are able to deal with about half of the problems, conflicts, sanitary and welfare conditions of its population without using any state judicial or structural authority, literally reaching everyone in the community. They have also been described however, as the political machine of the mayor, as they use his access to networks and resources to negotiate supplying the population with their needs and desires in return for votes in the elections. The people who lead the street committees are actually neither directly imposed on from the state or criminal groups, and are able to use negotiation with these groups to provide for the welfare of their community. Their primary responsibility remains to the population (Kurilla, 2002).

If this is the case, it would seem a local form of ‘democratic’ structure has taken root here, sprung from the communist remains. The politicians are providing the citizens with their needs in return for votes. If the politicians failed to meet their promises, the citizenry could choose to change their votes in the next election, and find other ways to meet their needs. This example shows that the Russians are able to meet the needs of their population by themselves and use the existing networks to negotiate change. It is not without difficulties and problems, but shows that collaborative efforts created specifically for the Russian context by Russians have the ability to work and need to be encouraged.

International intervention would best be served as a two-way, collaborative effort between East and West as opposed to an imposition directly led by the West. Russians should direct their own priorities and be given the voice to strengthen their own structures. The international community would be best to address the issues of socio-economic inequality in the light of structural hierarchies that exist instead of focusing on individual changes to achieve democracy. The Russians have the ability, knowledge and passion to change their own future, but are being denied this possibility because of structural and institutional problems. Changing the role of the state sphere so that it doesn’t interfere into personal freedoms would be the first step for the Russians to attain balance and respect within their own system. International financial institutions like the World Bank and the IMF should promote the strengthening of certain state structures, such as the health care and education systems, so that they are functional on at least a basic level instead of trying to privatize all enterprises, to ensure the population is able to be productive and thus pay back their loans.

The governments need to prioritize their spending so that the basic needs of their citizens are being met, and restructure their system to allow for public input and opposition. The individuals need to be empowered by the state to take on this role, so that they are directing the services and in charge of their own future. The state must be supported by the international community in its efforts to be more transparent and accountable to its population. Specific sanctioning and provision of aid given on the conditionality of being as transparent as possible could help push the state towards this goal and help to ensure that aid is being received where it is needed. Investment into proper facilities, wages and equipment within the health care system is necessary for adequate levels of care. The encouragement of physician’s associations who can lobby for better conditions, education and services by the state and international officials, could help to strengthen the health care services and provide the physicians back their sense of pride and status. Most importantly, the Russians should decide how their systems should run, and all initiatives should be on a thoroughly collaborative, Russian-directed and specific basis.

Conclusions

This paper has demonstrated the state’s intrusion into the private sphere under socialism and how this intrusion led to resentment and withdrawal by the citizenry. It has shown that Western intervention and aid was received in this context, using these structures and reinforcing them in the way it structured and provided its assistance. It described the attempts of international officials to remain apolitical in a highly politicized environment and how this reinforced the structural hierarchies and prevented success. It detailed the crumbling health care system in Russia and how the undemocratic structure within the system left physicians with little power to make change. International intervention placed their emphasis for change upon these individual physicians while ignoring the larger structural problems that were preventing actual change. The need for a balancing of public, private and civil society was addressed as well as the importance of cultural specificity in the design, implementation and delivery of aid.

The Russians are fully capable of directing their own systems, and are in the most appropriate position to design programs that will exact positive change within their region. Aid supplied in non-specific, and unaccountable ways will only further exacerbate the underlying problems and provide temporary solutions to short-term needs. The international community would be best to provide assistance in the form of knowledge sharing, technological transfers, promoting localized solutions to problems and the restructuring of the state so that it is able to meet the needs of its population. It cannot do this without transparency in the face of clouded cultural perceptions. The international community needs to learn to work in collaboration with populations, governments and local organizations, in a more secondary or assistive and not authoritative and superior manner.

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