Afghanistan and Central Asia

Tajikistan, already one of the world’s poorest nations, has suffered much this year with a harsh winter, continuing health concerns, and with rising food prices.  But the worse could be yet to come as its President Rahmon’s rule appears to be showing some cracks and news reports about the country have titles such as ‘Who’s in Charge’ and ‘Tajikistan is not in control.’  Not that President Rahmon has gone out of his way to help his people or been at least an ‘organized’ autocrat, but the violent battle for power or overthrow of his rule could send the nation into greater chaos.

Two reports exemplify Rahmon’s weakening power; the strange disappearance of Khasan Sadulloyev, one of the nation’s most powerful business men and the President’s brother-in-law, and the government led attack on the Langariyevs’ household, who had fought ’side by side’ with Rahmon against the Islamic opposition during Tajik’s civil war in the 1990s. These instances seem to portray a government on its heels, trying to eliminate ‘enemies’ and possible power challengers.  Eurasianet.org calls the Sadulloyev incident a sign of presidential ‘dysfunction’ and a leader who does not have control over his own power circle.  The article references the fall of Kyrg’s President Askar Akayev in 2005 as a possible outcome for the Tajik leader.

In other, more positive Tajik news, Kazakhstan’s government has pledged to help build and finance Tajik’s much needed and sought after Rogun Dam project and Rahmon has stated that an ‘international consortium‘ would also help the impoverished nation get the dam operating within 4 1/2 years.  The dam would provide much needed electricity for the nation and the region as well.

Tajik’s Foreign Minister Khamrokhon Zarifi met with US Undersecretary of State for South and Central Asian George A. Krol on June 16 and discussed a ‘broad spectrum’ of issues concerning US-Tajik relations and agreed that the 4th meeting of the Trade and Investment Framework Agreement (TIFA) would ‘become another major step towards development of regional trade and economic cooperation.’  TIFA is between the US-CA states and promotes the expansion of trade and investments in the region through the involvement of customs procedures in international standards.  US soft power one might say.

Getting health care and health care policy right is a continual battle for developed countries, as one hears cases of doctor and medical mishaps all to frequently, but one thing we have come to count on, at least here in the US, is that the blood transfusions we receive are clean and safe. A new World Bank study titled ‘Blood Services n Central Asian Health Systems– A Clear and Present Danger of Spreading HIV/AIDS and Other Infectious Diseases‘ reports that this is not so in many CA states. For a little background on Central Asia’s HIV/AIDS problems here is a old write-up with some useful resources.

The World Bank study retested 7,500 blood donor samples from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan and identified the prevalence of several infectious diseases; including .2% for HIV, 2.7% for Hepatitis B, 3% for Hepatitis C, and 3.6% for Syphilis. These results show that current donor screening methods in the region are not fully effective and need improvements quickly. In fact, the report found that some CA health facilities did not even test their blood donations at all!

Radio Free Europe reports that since 2006, hundreds of people, have been infected with HIV/AIDS by tainted blood in CA hospitals, including 149 children in Kazakhstan, 69 children in Kyrgyzstan, and several more in Tajikistan.

Patricio Marquez, the main author of the World Bank report, stated; “Numerous parts of these countries’ blood transfusion systems are in serious need of restructuring, of new investments and of increased budgetary support for operation and maintenance.” The reports official recommendations

A. Establishing nationally coordinated blood transfusion systems and universal unpaid blood donor systems

B. Optimizing laws, regulations, and donor promotion campaigns

C. Effective donor screening strategies, training of medical personnel, and the promotion of using blood and blood products

D. International support to assist the restructuring of these nations health care systems

Lastly, as we have discussed before, there are cultural constraints present in Central Asia (and in many other places in the world) that prevent an open discussion about HIV/AIDS and how to prevent it and the lack of effective blood donor campaigns is a sad result of these beliefs and fears. The people who are mistakenly infected with tainted blood are one thing and one thing only, unfortunate victims, and should be treated with the utmost respect and care.

On a separate note, I would like to acknowledge the passing of Chingiz Aitmatov, a widely popular writer and statesman, who was buried in Bishkek, Kyrgyzstan a couple days ago. Kyrg President Bakiev eloquently eulogized ‘One more star in the sky has faded; the heart that was filled with joy and sorrow, pure feelings and reams o not only the Kyrgyz nation but also of all the peoples of the world, has been stilled, has stopped.’

(Photo: Children were infected at hospitals in Kazakhstan and Kyrgyzstan (Source: RFE/RL)

The world has been facing some tough days recently. Burma’s tsunami, western China’s earthquake, and the continual rising of food prices has wreaked havoc on many of the world’s poorest people. As has been discussed earlier, food prices have been escalating in Central Asis for months now and show no signs of slowing. These rising prices have affected nearly everyone in the world, but the poor are especially vulnerable with one Kazakhstani woman stating ‘all we buy is food, food and food’ and some cannot even do that.

This situation is not only dreadful because of the human suffering, but in the possibilities for greater unrest and instability in nations and societies already in tenious situations, such as Afghanistan where World Food Program officials are warning that the poor and unemployed are being hit the hardest and that their is fear for greater unrest. It has been reported that millions of Afghani’s are spending up to 70% of their income on food alone and that many are starting to go hungry.

Even Kazakhstan, the world’s fifth largest wheat exporter, has been hit hard by this problem. Its citizens purchasing power has been ‘devasted’ by these rising food prices and the overall economy is suffering, with a Standard & Poor official predicting that its economic growth will fall sharply to below 4% in 2008, well below its recent double digit levels.

Central and Greater Asia are also facing rising levels of inflation as this story reports, the region’s central banks are going to have to soon make major decisions concerning interest rates. They must decide if food inflation itself warrants a corrective move in interest rates. Glen Maguire, a chief economist in the region, stated that the key debate was ‘how soon the central banks make the transition from viewing food price inflation as a short-term, cost-push effect to treating it as a long-term structural driver of inflation.’ In these banker’s eyes, this does not appear to be an ebbing problem that will go away anytime soon.

Lastly, here is a sobering piece detailing the health-related problems stemming from malnutrition, facing many of Central Asia’s most unfortunate.

Just a quick one today folks. If you haven’t checked it out yet, make sure to take a look at the post on May 11 ‘A Autocratic Dawn’, I think it raises an important issue that will and has affected CA and the world.

EurasiaNet has written a scathing report chronicling the Tajikistan government’s voluntary tax request from some of its poorest citizens in order to raise $10 million dollars to finance the Rogun project. The news outlet calls the tax ‘arbitrary’ and ‘confiscatory’ and rightly claims that it will dramatically hurt the poorest of the nation for amounts to a very small percentage of the projects ultimate budget, around $550 million. The people of Tajik deserve better and if this money is raised, the government needs to be transparent of its use, otherwise it will disillusion its populace to an even greater degree.

Kyrgyzistan’s President Bakiyev has provided a one-time compensation payment of $14,600 to 72 children and their families, who were accidentally infected with the AIDS virus in two southern Kyrg hospitals, because of what has been asserted as medical personnel negligence. This is a tragic way for progress to be spurred, but hopefully this is a sign that the Kyrg government is going to start taking HIV/AIDS prevention more seriously.

A while back we discussed an upcoming major AIDS conference in Moscow, well the event has arrived and it comes with some positive news. It was the largest Eastern Europe/Central Asia conference ever held and lasted for three days. Around 2,000 participants from over 50 nations took part to assess regional achievements, share results and best practices, examine the epidemic’s recent feminization, and determine how to meet this epidemic’s challenge to their region. The official theme of the conference was ‘Accelerating Access to HIV Prevention, Treatment and Care for All,’ and was hosted by entities from the UN, the Global Fund to Fight Aids, Tuberculosis, and Malaria, the International AIDS Society, and a Russian government sponsored organization.

Both regions were said to be at a ‘critical turning point’ in this fight and the UNAIDS Executive Director Peter Piot optimistically noted that the region’s governments, civil societies and communities were displaying indications of ‘enhanced leadership and cooperation’ on this issue. However, he lamented that discrimination and a negative stigma still resonates in both regions, keeping HIV prevention projects from making real progress. Overall there was good news which showcased that prevention efforts have made an impact; the estimated number of new HIV infections dropped from 230,000 in 2001 to 150,000 in 2007.

A report by the Times of Central Asia included a terse examination of HIV/AIDS in Tajikistan with an emphasis on the fore-mentioned stigma and discrimination that have been associated with the disease. They present a much darker picture of the epidemic’s spread and of a culture and society that has largely turned its back on its victims. They cite recent government data, which indicates that the disease has been on the rise in the country every year since 2001. The Times states that the nation is ’struggling’ to cope’ with the spread HIV/AIDS because of poor medical services and ‘conservative moral attitudes which encourage shame and secrecy.’ We can only hope that the recent conference can bring some effective policies to Tajikistan and help them deal with this challenging and deadly disease.

I want to leave on a more positive note, so here is a story about how the Global Fund to Fight AIDS is considering providing loans, to replace grants, to nations moving above their required income-level such as Russia, Kazakhstan, and Turkey. Kazakhstan’s rising economy will push them above the income-level to receive grants, but Michel Kazatchkine, the fund’s director, cites the nation as an example of a country which can still benefit from a loan and extended help. This sounds like good policy since many of these nations still only have incipient HIV prevention structures and civil society’s which may perish or fall into disrepair without continual aid and oversight by such a group as the Global Fund.

The Journal of Turkish Weekly recently wrote an interesting piece concerning Central Asia’s growing water issues, which I briefly touched on about a week ago when I reported on EU Foreign Policy Chief Javier Solana’s speech concerning climate change.  The Journal’s outlook focus’s on Kazakhstan and Kyrgyzstan’s ‘uneasy’ water and energy relationship, mainly pertaining to the Syr Darya river basin, which overflows and threatens populated areas in Kazakhstan, and Kyrgyzstan’s Toktogul hydroelectric power station, which has failed to provide enough electricity during a harshly cold winter.

Kazakhstan’s government has decided to build a reservoir on the river of Syr Daya near Koksaray village, hoping this will create a more efficient irrigation system and slow down the flooding.  The reservoir project is supposed to begin this year and cost over half a billion US dollars.  The Journal accurately warns that a similar project in Uzbekistan resulted in the loss of thousands of hectares of farm and meadowlands, leading to agricultural losses in the hundreds of millions.

The Journal advocates for an intergovernmental water and energy consortium between the CA states, where they can work on water issues that transcend their borders.  The good news is that Kazakhstan, Kyrgyzstan and Uzbekistan have a meeting in this regard set for this April.  I will do my best to keep you updated on its accomplishments or lack thereof.

In my short time as the lead writer for this blog, I have written much about NATO’s mission in Afghanistan, as I believe the nation’s stability and effective governance would do much for Central Asia, South Asia, and the Middle East regions.  On March 10th I discussed NATO troop levels and restrictions.  In light of the ongoing NATO Bucharest Summit, Foreign Policy has created The List: Who’s Left in Afghanistan?, which nicely catalogs individual NATO nation troop levels, restrictions of engagement, and provides an outlook into possible changes to these in the near future.  The report is rather disparaging to the nation’s who either have very low troop levels or major limitations as to what and where their troops can do and go.  The report specifically targets Germany, Austria, and Ireland for consternation.

On May 2-4, Moscow will host a major International AIDS conference that will focus on the virus’s growth in Eastern Europe and Central Asia.  In an interview, Peter Piot, Executive Director of UNAIDS, stated that ‘HIV is increasing more rapidly in Central Asia than in any other part of the world.’  Piot blames widespread injecting-drug use and prostitution for the virus’s growing strength in the region.  The Moscow Conference will be attended by representatives from all the CA countries, and the issue HIV prevention, particularly regarding drug-use, will be ‘very high’ on the agenda.

Matthew Bryza, US Deputy Assistant Secretary of State for European and Eurasian Affairs, spoke out in support of Gazprom’s price hike for buying Central Asian gas and voiced his opposition to the creation of a Gas OPEC at a conference at Georgetown University.  Bryza stressed the importance of market forces in the supply of gas to Europe and argued that the extensive profits that Gazprom receives, has gone to ‘nefarious uses,’ such as organized crime and providing a ‘disincentive for reform, be it of the countries along the supply chain, or Gazprom itself.’  This last remark was a clear accusation that Russia’s control of the gas supply system has kept Central Asian states’ authoritarian and corrupt leaders in place and protected.  These are some of the first comments by a US government official I have seen concerning Russia’s recent increase in payments to CA gas producing states.

UN Secretary-General Ban-Ki Moon has designated 2008 as the Year of Water Sanitation, a worthy effort which dovetails into public health and climate change issues–and which Central Asian states could use to their benefit.

According to the UN, investing $10 billion a year could halve the proportion of people without basic toilet facilities by 2015.  This grimy state of affairs affects 2.6 billion people worldwide, and not just aesthetically.

Public Health vs. Polio:
In Pakistan and Afghanistan, polio, spread by fecal-oral contact, continues to be a public health problem.  Afghanistan has had an immunization program over the past year at enormous effort; Pakistan needs one desperately.  Dr. Chan at the UN’s World Health Organization has stated that the last pockets of polio incidence are also the most expensive and difficult to reach–Pakistan, India, Afghanistan, and Nigeria.  Cultural differences, difficulty in understanding the vaccine regime, and security and transportation problems  frequently hinder efforts.  Hardline preachers in the Pakistani tribal areas have forbidden health workers to immunize children, as late as August of this year.

Rotary International, a long-run enemy to polio virus, and the Bill and Melinda Gates Foundation, are jump-starting the continued effort with a grant to WHO of USD 2 million.

“An estimated 42,000 people die every week from diseases related to low water quality and an absence of adequate sanitation,” U.N. Secretary General Ban Ki-moon said in a statement announcing 2008 as the Year of Sanitation.   Water-borne diseases such as botulism, cholera, and typhoid mostly affect children.

Climate change:
Add to the fact that climate change hits poor countries the hardest–and water quality in poor countries is the worst.  What this means is that water sources themselves become exploited in a heightened fashion, because water itself is not taken care of downriver.  The effects of climate change in Central Asia’s aquifers and in Xinjiang make it more important than ever to safeguard and safely treat/sanitize the water that is available.  It’s a great program for 2008.  I hope Central Asia officials are busy writing their grants for water sanitation projects–Today–at the very latest., for their major rivers and their dead lakes, their sewage infrastructure, and whatever else that they can think of that will bring water quality up for human use–and for human industry–and human health.

Further Reading: Wikipedia on Poliomyelitus, a disease spread by poor sanitation

Photo: BBC

Before NATO, there was Afghanistan’s Taliban movement (you can’t call it a government, because it offered no protection and no services to its people).  And the new Taliban, neo-Taliban, or whatever we call them have the same, tawdry, consistent practice of gratuitous cruelty in this regard–

Here’s the whole story from AFP wire, as printed by the Pakistan Daily Times:

WANA: Local Taliban militants seized and burned thousands of kilogrammes of food destined for pregnant women from a hospital in South Waziristan, officials said on Sunday.

The food, mainly lentils and cooking oil, had been supplied by the aid charity Save the Children to feed pregnant women suffering from malnutrition.

A Taliban activist said they were destroyed because “foreign NGOs want to harm our future generations.” An administration official, Tariq Salim, said the Health Ministry officials had not consulted him before distributing food directly to the women. Meanwhile, in North Waziristan, three people were killed and five wounded when troops conducted “retaliatory” strikes on suspected militant hideouts in Mir Ali, local officials said. Several houses were destroyed in the strikes that came after militants hit a checkpost with a missile barrage. One soldier was wounded in the rocket attack late Saturday, they said.

Well, if you could’ve seen me, I’d hopped right onto my local soapbox.  And then I stepped right back off again, to think instead of react. 

1. NGOs
It’s past time to honor the NGOs such as Save the Children whose work is dangerous and difficult.  Those who deliver aid on-site face numerous disappointments and trials, but they are there, putting human concerns first.  As of October 29th, the United Nations has documented the death of 34 aid workers in this troubled state for 2007.  They are soldiers too–we need to look at it just like that.

2. Donors
It’s also past time to honor those who donate funds to worthy NGOs working in Afghanistan.  Stories like this often make people wonder if their charitable impulses do any good–and this leads to what is often called “donor fatigue”.  But worthy, well-run programs do make a difference.  Not everything we do has the immediate effect we want it to, even with people we know.  But in the long term, the expression and relationship makes a difference.  In Afghanistan, where malnutrition, poverty, and childbed mortality are large problems, donations make a big difference.

3. In Unrelated News? Or, related News?
You can miss it if you read fast, but what is the relationship between the Waziristan official’s gripes about food distribution and the story of Taliban destruction of the warehouse?  These are two separate issues, related only by being in the same story. But it brings some questions to mind:

What is the relationship between warehouse protection by regional officials and Taliban incursions? What is the relationship between NGO/government for coordinating aid efforts?  What is the obstruction to aid efforts that are posed by regional officials?  Questions like this can make you mad, but they should also remind one of the difficulties in getting an aid effort moving and its mission to the target recipients. 

4. Evening out the competition
It’s strategically intelligent of the Taliban to bomb aid–because they don’t offer any.  By decimating our ability to help Afghanistan’s people, the contrast between “them and us” becomes one only of who’s the meanest person around–a life full of fear and no benefit.  We can’t give up on aid, or else Afghanistan’s people will have no horizon for the future.  The fact that babies are involved only underscores the need for aid today.

I am angry–I am thinking about those expectant mothers who will not eat this week.  But I am also humbled by the consistent heroism of those who are making aid happen in a world where “serving the people” seems to be a huge risk.  I am thankful for those who have served so consistently, by deed and by donation, in Afghanistan. 

I regret that I haven’t been writing recently on Afghanistan:  especially since it’s past time to write about trouble that aid workers are having in delivering food and services.  Here are some aid statistics for the last ten months:

– 34 aid workers have been killed. 
– Seventy-six have been abducted. 
–Fifty-five convoys have been attacked, by either Taliban or criminals, six times higher than last year.  The UN World Food Programme has lost 1,000 tonnes of food aid due to these depredations.
–Due to the convoy attacks, six weeks have passed since food has been delivered between Herat and Kandahar.  And in another six weeks, snow will make many of these roads impassable for aid delivery–according to the UN director on the ground, Mr. Corsino, this will mean starvation for 400,000 Afghan citizens.  This would be about 0.8% of the five million people who need some sort of food aid in Afghanistan.

Furthermore, according to Declan Walsh’s article in The Guardian (who reported all of these statistics):

The Afghan education ministry says 400 schools in the south and east are shut because of violence. Taliban fighters have burned down 20 schools in Helmand in the past 15 months.

Further reading:
UN Secretary-General Ban Ki-Moon’s Special Representative Mr. Koenigs on Afghanistan’s aid delivery
UNICEF press release on the plight of Afghanistan’s children from the Child Alert: Afghanistan report
UNAMA–UN Aid Mission to Afghanistan Web site

Photo: Luke Powell for the UN