IHP News 633 : Spooky Times

IHP news 633 : Spooky times ( 27 August 2021) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, Many in the global health community still enjoyed a relatively quiet (holiday) week, in spite of a world in turmoil. Things will no doubt pick up again in September, among others with pandemic treaty related discussions in Geneva. More in general, as Tedros argued on Wednesday (pointing to three major meetings in the coming months), it looks like autumn will be critical for future pandemic preparedness & response. We’ll see. Also in September, Trips waiver related negotiations (WTO) “restart” again, there’s a G20 Health Ministers’ meeting in Rome scheduled (5-6 Sept), and let’s not forget the (UN) Global Goals week later this month. Wonder what the prevailing mood will be there. As Patrick Stewart pointed out, referring among others to the latest IPCC report, “ As damaging as COVID-19 has been to the SDGs, the global climate emergency presents a much graver long-term threat. “ That is exactly right. Already, the current Anthropocene/Capitalocene is called by some the ‘Pyrocene’. Add to this the danger - in an age of more and more crises hitting countries at the same time - that our empathy runs out and mankind basically becomes ethically numb (or more accurately: even more ethically numb ☹) (as Jacob Stern worried in The Atlantic ) and you know we will very much need a radicalized young generation throughout the 21st century. At the very least. Together, among others, with a global revival of the idea of “Common prosperity”, now advocated by Xi Jinping and, according to The Economist, “spooking” the prosperous there. (Here’s to spooky times for the (very) prosperous !) But let’s also not forget to spook Xi on some of the less enticing Chinese characteristics of his “model”. On the global vaccine (in)equity front, although there has been some improvement lately, Madhukar Pai still pretty much nailed it on Twitter: “By now, the world over, every plant capable of making vaccines must be making Covid shots for 7.7 billion people Leaders in rich nations have instead chosen to allow a few companies to supply, procured a giant share for themselves & offer boosters for their citizens.” Obviously, ‘global solidarity’ hasn't worked much as an argument for the powers that be, in spite of their rhetoric, so perhaps Friedman & Gostin’s case in Foreign Policy , “The Whole World Needs Vaccines Before a Worse Variant Than Delta Arrives”, might spook Western leaders and citizens sufficiently to finally make progress on vaccine equity. Still, I wouldn’t count on it. The ugly truth is our leaders feel way more pressure from public opinion (including on social media) on migration, for example, than on global vaccine equity. But who knows, perhaps a good ‘outcome’ of the German federal election end of September could bring some new momentum in Trips waiver negotiations? In Tokyo, the Paralympics have started, the sort of sports event where athletes routinely display the resilience and perseverance I can only dream of. Guess we should all be inspired by these brave 1 people, to try make progress in a world with so much injustice and so many challenges. They never give up. Neither should we. Enjoy your reading. Kristof Decoster Featured Article How the Afghan crisis could impact Pakistan Mehr Manzoor (IHP correspondent & EV 2018) As U.S. and other NATO troops are leaving Afghanistan, and the macro-economic situation deteriorating rapidly, the country finds itself once again on the brink of collapse. Echoes of desperation, fear, helplessness, and chaos fill the air as the Taliban take back control and are cracking down on individuals they believe to have helped or worked with the Americans, threatening to kill them. Even some of those who surrender are being executed. Many Afghanis see no hope under the Taliban, in spite of some of their more reassuring official messages, and want to flee the country. Although it’s far from clear which (political) scenario will prevail in the coming months and years, sustained Afghan instability forms a threat to the entire region for a number of reasons. In this article we will focus on the potential impact on Pakistan, one of the key players in the region. Indeed, while most of the efforts to end the war in Afghanistan have focused on the Afghan government, the Taliban, and the United States, Pakistan’s (potential) role in facilitating meetings with the Taliban to negotiate a more inclusive government has largely been ignored by the U.S., mainly due to mistrust. Pakistan has previously been accused of its dual policy, of both aiding the Taliban behind the scenes, while also working with the United States in combating terrorism. Those who believe Pakistan gains from the current crisis, argue that the Taliban victory removes the threat of Afghan alignment with India, which was previously a concern for the Pakistani government. India on the other hand strongly opposes the role of the Taliban in Kashmir, thus limiting any possibility of an alliance with the Taliban. This view (of Pakistan being one of the geopolitical ‘winners’ in the current crisis) however largely ignores that Pakistan has been a victim of civil unrest in Afghanistan since the 1980s and continues to face the major brunt of the consequences. Including now. Major threats facing Pakistan in the aftermath of a Taliban victory include border insecurity, the growing threat of terrorism especially from “Taliban elements” within Pakistan that have been responsible for killing thousands of civilians and attacking the military, a potential huge new influx of refugees (which it can’t afford to take in anymore, considering that the country already hosted millions of Afghan refugees in the past 3 decades), and a threat to women rights. Below I cover all four of them. 1) Security Risk Pakistan has had a long history of tense relations with Afghanistan, with whom it shares its western border, resulting in poor bilateral relations marked by lack of trust and anti-neighbour sentiments on 2 both sides. Upon the creation of Pakistan, as a sovereign state in 1947, Afghanistan was the only country who did not recognize the country and voted against its inclusion in the United Nations. Till now Afghanis don’t recognize the colonial-era Durand Line as an international border. Both countries blame each other for harboring terrorist elements that launch terrorist attacks on innocent civilians on both sides of the border, a porous border facilitating such threats. Recently, Pakistan has tightened its border security to reduce the frequency of such attacks. Afghanis also blame Pakistan of having friendly ties with the Taliban and question why Pakistan has not leveraged these ties to pressurize Taliban to reduce violence. Pakistan denies such leverage. Moreover, in relation to its neighbours, Pakistan feels a bit “sandwiched” with India sharing its eastern border, China and Russia in the north, and Afghanistan and Iran on the west. The growing involvement of China, Russia, Iran (and to a lesser extent India) in Afghanistan means more competition for Pakistan to maintain its strategic position (even if relations with China aren’t bad given the Belt and Road connection). There is also the constant threat of border insecurity and militant attacks from all corners, which has resulted in a major portion of Pakistan’s annual budget being allocated for strengthening its military capability and tightening its border security rather than spending on education and health. It’s a complex picture, though. As the Taliban seize control of Kabul, Pakistan’s political stance on the Taliban will at least partly be “inspired” by its fear of India. Indeed, Pakistan is believed to seek support of the Taliban in combating Indian militant attacks. Also, as is well known, several factions of its army (and intelligence community) admire the Taliban. Nevertheless, all in all, the security risks for Pakistan in the wake of Taliban’s victory remain a real threat for its own stability. Which brings me to the next point. 2) Threat from Terrorism Recently, Pakistan army’s top command declared the Afghan Taliban and their counterparts, the Tehrik-e-Taliban Pakistan (TTP) group, “two faces of the same coin”. TTP has been responsible for launching several violent attacks in Pakistan, killing thousands of civilians (among others, in an attack on a school in Peshawar in 2014 that killed 150 people, mostly children). They have also repeatedly attacked the army. While many Pakistanis condemn TTP, it is widely believed that they have a soft(er) spot for the Afghan Taliban. There are various reasons for this. Many Pakistanis have mixed feelings about the role the U.S. played in the region and its fight against Islamic extremism in recent decades; the former Afghan government led by Ashraf Ghani (who fled the country as the Taliban entered Kabul), backed by the US, was perceived as weak and corrupt; and last but not least, India has been showing growing interest in Afghanistan, threatening among others Pakistan’s border security. All of these mitigated Pakistani sentiments on the rise of the Taliban, even if the latter comes with its own risks. Indeed, the rise of the Taliban poses a serious security threat to Pakistan in terms of spillover and terrorist groups like TTP becoming more active again. Furthermore, Pakistan doesn’t want a Taliban-type government in power over its own people. On a side note: the #SanctionPakistan campaign went viral as the Taliban seized control of Afghanistan. It was tweeted around 73,000 times with 37% of the tweets emerging out of Afghanistan.

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