Mark Leon Goldberg2013-06-19T09:30:23-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/author/index.php?author=mark-leon-goldbergCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Mark Leon GoldbergGood old fashioned elbow grease.Why I Am Thinking About the Nobel Peace Prize on World Malaria Daytag:www.huffingtonpost.com,2012:/theblog//3.14533882012-04-25T16:56:53-04:002012-06-25T05:12:02-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
Unitaid Chair Philippe Douste-Blazy, standing in a drug warehouse in Cameroon.
It is World Malaria Day today. The theme this year is "Sustain Gains, Save Lives: Invest in Malaria," which is a distressing acknowledgement that funding for malaria control and treatment is quite precarious. From the Roll Back Malaria partnership:
Investments in malaria control have created unprecedented momentum and yielded remarkable returns in the past years. In Africa, malaria deaths have been cut by one third within the last decade; outside of Africa, 35 out of the 53 countries, affected by malaria, have reduced cases by 50% in the same time period. In countries where access to malaria control interventions has improved most significantly, overall child mortality rates have fallen by approximately 20%. However, these gains are fragile and will be reversed unless malaria continues to be a priority for global, regional and national decision-makers and donors.
They are right to be worried that these impressive gains may be reversed. Funding for malaria and global health more broadly is slowing down. The Global Fund to Fight AIDS, Tuberculosis and Malaria had to cancel a round of grants this year because donors simply did not contribute enough money. What's worse, for the first time in over a decade, inflation reduced the value of aid from donor countries last year by nearly 3%. In all, donor countries gave $133.5 billion in all forms of official development assistance last year, but when inflation was taken into account, this actually amounted less than what they could buy with similar funds in 2010.
There is simply less money available for the global fight against infectious diseases. This is why groups like Roll Back Malaria are so concerned about keeping up the incredible progress that has been made in humanity's fight against this terrible disease.
We need to diversify how we fund the global fight against diseases like malaria. The term for this is "innovative financing for development." The world's laboratory for innovative financing is located in Geneva, in a small outpost of the UN family called UNITAID. The world's top evangelist for finding new sources of funding to fight global diseases is the medical doctor-turned-politician-turned-diplomat, Philippe Douste-Blazy.
Douste-Blazy is a former foreign minister of France and currently serves as the UN undersecretary general for innovative financing and chairman of UNITAID. In 2006, he convinced the French and Brazilian governments to impose a small levy on the purchase of commercial airline tickets -- just one dollar or two per ticket (or more if you fly business class) -- and turn that money over to UNITAID to invest in global health programs. Today, nine countries participate in the airline levy program. UNITAID has raised over $2.5 billion for global health since 2006 though millions of these tiny contributions from airline passengers.
This year, UNITAID took me to Liberia and Cameroon to see the results of their work. I saw how investments in rapid diagnostic tests for malaria help patients access effective drugs. I met a woman who developed resistance to first line HIV drugs, but lives a healthy and productive life thanks to (more expensive) second line therapies provided by UNITAID; and I met health officials who relied on UNITAID ability to drive down the price of malaria, TB and HIV medicines, so they can buy more medicines at cheaper costs.
UNITAID was able to accomplish this though the tiny contributions of airline passenger in just a few countries around the world. But if we want to not just contain malaria, HIV/AIDS, or TB--but effectively eliminate these diseases, we will need to think bigger. So, Douste-Blazy has been actively pursuing a micro-tax on financial transactions, including the buying or selling securities or derivative products. Unitaid conducted a feasibility study last year which found that if a levy on financial transactions of about 0.001% were applied across every G-20 country, over $260 billion could be raised.
To Americans, the idea of a redistributive financial transaction tax seems far off, (despite the best efforts of the Occupy Wall Street movement!) But, to much of Europe there is nothing particularly controversial about it. The UK has had such a tax for decades and it is still among the strongest economies in the world. Some countries are on the verge of considering a FTT, including France and Germany. If just France adopted a tiny financial transaction task, UNITAID predicts it could yield 12 billion euros per year.
These are game-changing numbers. But in order to actually change the game, we need an extra push from outside.
This is where the Nobel Committee could make a huge difference.
Granting the Peace Prize for UNITAID's pioneering work in innovative financing would introduce the concept to everyday people around the world. It would give innovative financing for development the spotlight it deserves as a way to sustain a more healthy and productive planet. This is not unlike what occurred after the Nobel Committee gave its 2006 Peace Prize to Mohammed Yunus and Grameen Bank for micro-finance. The prize helped bring the concept of micro-finance to the mainstream. A prize for UNITAID could have a similar effect on the innovative financing movement.
Another, perhaps more immediate impact of conferring the prize for innovative financing, would be to give some political heft and backing to debates ongoing in parliaments across Europe as they consider imposing a Financial Transaction Tax. Several Europe countries, (and even the European Parliament) are discussing using an FTT as a mechanism to cover countries' burgeoning debt crises. It is only a matter of time before Europe's largest economies, like Germany or France, impose some sort of FTT. A Nobel Prize for UNITAID would put momentum behind the idea that at least a portion of funds levied by an FTT should support the world's most vulnerable people.
The UN, the IAEA, the UN Refugee Agency, UNICEF, UN Peacekeeping, have all won Nobel Peace Prizes for facing the most pressing challenges of their era. There is no more urgent cause today than bringing effective, life saving health care to millions of people around the world who suffer from easily preventable and treatable illness. It is a shame that on World Malaria Day we are worried about how we will raise the next dollar to purchase a bed net to prevent the disease, a microscope to diagnose it or artemisinin combination therapy to treat it.
This need not be the case. Innovative financing schemes like the ones devised and used by UNITAID offer the kind of stability that donor-driven aid does not provide. It is well past time that we become more creative in how we fund the fight against malaria and other preventable diseases.]]>In Cameroon with UNITAID: Keeping HIV Patients Alive and Welltag:www.huffingtonpost.com,2011:/theblog//3.9402302011-08-29T19:36:00-04:002011-10-29T05:12:02-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
A member of a support group for women living with HIV shares her story with UNITAID Chair Philippe Douste-Blazy. (This is not Beatrice).
Beatrice didn't want us to take her picture. Neither did she want me to use her real name. Most of her friends and family don't even know she's HIV positive -- the stigma here against people living with HIV is strong. Still, she was brave enough to tell her story to a room of journalists and health officials, including the chair of UNITAID, Philippe Douste-Blazy.
Beatrice is 30 years old and the proud mother of a 13-year-old and devastatingly cute 16-month-old baby. In 2002, Beatrice was diagnosed HIV-positive. She quickly went on anti-retroviral treatments, which for her meant taking two pills once a day. Every month, she would travel to the local health center to pick up the medicines. She stuck with that routine for eight years. But after she delivered her second baby -- who was healthy and HIV-negative -- she decided to stop her treatment. As she tells it, she was feeling perfectly fine and didn't see the need to keep up with her routine.
That turned out to be a very big mistake.
Two months after she quit her treatment, she fell very ill. Skipping two months of ARV treatments raises the possibility that the virus may develop a resistance to the medicine. That is exactly what happened to Beatrice. Her doctor told her that if she wanted to live, she would need to go on so-called "second-line" ARVs.
She was able to get on the second line drugs, and after one month she began feeling better. But instead of taking two pills a day, she now has to take six. If she develops resistance to the second line, the results could be catastrophic. Third-line drugs, while they do exist, are not available in Cameroon. If for some reason she misses a month or two of treatment, the virus could become effectively untreatable.
Beatrice is committed to her second-line drug regimen, but circumstances outside her control could interrupt her treatments. In Cameroon, "stock outs" of drug supplies are an ever present threat. Beatrice lives with the stress that she may miss a treatment through no fault of her own. She fears what that might mean for her children.
Beatrice's story is moving on a personal level. But as a public health challenge, her circumstance illustrates a huge gap in the way governments and donors have historically approached people living with HIV. The second-line drugs that Beatrice takes daily are several orders of magnitude more expensive than traditional, first-line ARV treatments. The problem is that as more people access first-line treatment, there will be more opportunities for people to develop resistance to that first line. Donors and governments in the developing world simply can't afford that kind of outlay.
It costs about $70 to $100 dollars per patient per year for first-line ARV treatment in the developing world, but $700 to $1,000 per patient per year for second-line treatment. For resource-poor countries, the costs of expensive, second-line drugs is a huge barrier to providing care. Here in Cameroon, there are about 95,000 people on ARVs, about 5 percent of whom are on second-line treatment.
The government estimates that there is a further 150,000 people who could be on treatment but are not because they do not know their HIV status. As the government and NGOs get better at reaching HIV-positive people with treatment, the number of people who will require second- and third-line treatments may sharply increase. If you count on a first-line treatment failure rate of about 5 percent, that means the sum that government and donors would have to set aside for second-line treatment would be impossibly high.
UNITAID Chair Philippe Douste-Blazy at a drug warehouse in Yaounde, Cameroon
One of the reasons that the costs of second- and third-line treatments are so high is that the drug manufactures hold expensive patents on the drugs. On the one hand, this is reasonable enough: drug manufacturers invest a great deal into R&D and deserve a decent return on their investment. On the other hand, if costs don't come down, several thousand people living with HIV who require second-line treatment will not be able to access it.
UNITAID's brand new "patent pool" seeks to bridge the moral imperative to provide low-cost drugs to patients and drug companies' need to see a return on their investments. Drug companies who participate in the patent pool hand over their patents to UNITAID, which makes those patents available to generic drug manufacturers. Part of the deal is that the generic drugs can only be sold in lower-income countries, which helps to preserve the value of the patent. UNITAID then pays a modest royalty to the original patent holders. The fees that the patent holder receives are smaller than what they would otherwise earn on the sale of their drugs in rich countries, but the patent pool opens markets for their drugs where it would otherwise not exist. The difference is between receiving a small royalty or simply being priced out of the market entirely.
The pool was officially launched last month when Gilead Sciences turned four HIV drug patents over to UNITAID. They need other major drug manufacturers like GlaxoSmithKline and Johnson and Johnson to get on board if it is going to really work.
This is a tall order, but it could mean the difference of several thousand lives that would otherwise be needlessly wasted.]]>Why Ban Ki-Moon Deserves a Second Term as UN Secretary Generaltag:www.huffingtonpost.com,2011:/theblog//3.8719552011-06-06T16:02:57-04:002011-08-06T05:12:01-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
This morning, he sent a letter to the Security Council and General Assembly to announce his candidacy for re-election when his term expires on December 31. So far, there are no other candidates to challenge Ban, and no veto-wielding permanent member of the Security Council has indicated any serious objections. It is almost assured than Ban will win a second five-year term.
But does he deserve it?
Any discussion about the performance of a UN Secretary General has to be mindful of the constraints inherent to the position. The Secretary General is a role that comes with high visibility, but very little authority. A Secretary General cannot order interventions, cannot force national governments to adopt policies, and cannot threaten sanctions should his recommendations go unheeded. As the founders of the United Nations intended, real power lies with the member states themselves not the General Secretariat.
Still, when judged by how well he is able to operate within these constraints, Ban's record is strong. Two recent crises -- on Libya and Ivory Coast -- offer good examples of Ban's leadership style.
In November 2010, incumbent President Laurent Gbagbo refused to cede power after losing an election to his challenger, Alassane Outtara. A stand-off ensued in which Gbagbo grew increasingly isolated in the international community and increasingly violent at home. Eventually, the political crisis teetered at the edge of descending into a civil war.
When the crisis was reaching its apex, a 9,000 strong UN peacekeeping force -- which was largely restricted to physically protecting Outtara's compound -- did something that peacekeepers rarely do: for two days in April, Ban ordered a series of missile attacks on Gbagbo's compound, eventually leading to Gbagbo's arrest.
That decision carried huge risk. Gbagbo's army could have turned against relatively lightly armed peacekeepers; a rocket propelled grenade could have felled one of the attack helicopters (the mission only had a few); or Gbagbo's forces could have stepped up attacks against civilians. Still, Ban made the decision. He may not have been thumping his chest while doing so -- that's just not his style. But he took the risk and it worked.
Ban's reaction to the crisis in Libya offers another insight into his approach to the job. Speaking to reporters at the United States Holocaust Memorial Museum in February, Ban said unequivocally than Gaddafi had "lost his legitimacy" as ruler of the Libyan people. This was a full two weeks before the Security Council approved a NATO-led international military intervention.
Ban had stuck his neck out to help drive the conversation about the intervention over Libya. By making this statement -- in Washington, D.C. no less -- Ban was tacitly aligning himself with the American (and Western) position on Libya. Should the Americans have judged that the UN system was not prepared to back a potential intervention, they may have sought to bypass the Security Council. That would have been a fatal blow to the entire international system.
Ban cannot be credited with the U.S. and European decision to take the Libya question to the Security Council, which was made in Washington, Paris and London. But Ban's diplomacy around the Libya debate helped create the conditions in which the Security Council became the platform at which the international community fashioned a response to the Libyan crisis.
One real power that a Secretary General can wield is to set global priorities by holding what in UN parlance are called "High Level Events" to draw attention to issues of global concern. Over the past five years Ban has used that convening power effectively in service of the global good.
Two years before the 2009 Copenhagen Climate Conference, Ban invited a very diverse set of world leaders to the UN for a meeting to build momentum for the Copenhagen Climate Conference. Ban could not dictate the outcomes of these meetings the way an American president, Chinese premier, or leader of a bloc like the EU or G-77 could. But Ban can, and did, bring world leaders to the UN to keep climate change on top of the global agenda. He has not given up on the cause, even though some world leaders have shifted their focus at times.
Under Ban's tenure nearly every UN agency -- from the Universal Postal Union to the International Civil Aviation Authority -- has adopted a climate change portfolio of some sort. Climate change was arguably Ban's signature issue his first term.
A second major priority of Ban's has been maternal health and gender equality. Under Ban's leadership, the United Nations undertook one of the most significant institutional reforms of the past several decades. Last year, four UN agencies that deal with gender equality and women's health merged into a single entity called UN Women. Ban appointed a global rockstar, former Chilean President Michelle Bachelet, to lead this new body.
This was a powerful choice. Bachelet is a former head of state and well respected by world leaders. She can set the agenda for this brand new body as it establishes its place in the pantheon of international health and development institutions. Bachelet joins the head of the UN Development Program, the High Commissioner for Human Rights, the top humanitarian official, the UN's head legal counsel, top auditor and police chief as women leaders at the UN. In all, there has been a 40 percent increase in the number of women holding senior leadership positions at the UN.
Ban's agenda-setting focus on maternal health is best crystallized in his Global Strategy for Women and Children. The report, which was released ahead of the 10th anniversary of the Millennium Development Goals in 2010, was a response to the fledgling progress of the MDGs relating to reproductive health and women's empowerment. Should member states adopt the strategy as their own, as many as 16 million lives could be saved by 2015.
On the sidelines of the UN summit in September Ban used his convening power to secure endorsements and commitments to his global strategy. The UN called the meeting "Every Women, Every Child." The meeting secured $40 billion worth of commitments to the Strategy from donor countries, private companies and philanthropies. Recipient countries also made concrete policy commitments. Afghanistan, for example, pledged to increase public spending on health from $10.92 to $15 per capita. Bangladesh pledged to double the percentage of deliveries by a skilled birth attendant -- one of the most effective ways of preventing maternal deaths -- from 24 percent today. Commitments like this are helping to ensure that women and girls are central to the UN agenda going forward.
Ban's tenure has not been perfect. He was criticized early in his tenure for a diplomatic style that prefers quiet diplomacy to naming and shaming. But over the past few years, Ban has grown into his role as Secretary General. The issues that he has chosen to personally champion -- climate change and maternal health -- are among the most urgent challenges facing the international community. Even in a constrained position like the Secretary General, Ban has been a force for progress at the UN and around the world.
He deserve five more years at the helm of the UN.
Cross posted to UN Dispatch ]]>On World TB Day, Fighting Tuberculosis in Bangladeshtag:www.huffingtonpost.com,2011:/theblog//3.8402412011-03-24T15:10:31-04:002011-05-25T18:40:24-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
There is plenty more info on UN Dispatch. Let me know what you think. ]]>Five Stories to Follow During UN Weektag:www.huffingtonpost.com,2010:/theblog//3.7320022010-09-20T15:10:07-04:002011-05-25T17:45:25-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/Cross posted to UN Dispatch
Hundreds of world leaders make their annual pilgrimage to New York for the opening session of the United Nations General Assembly. This is what is on their agenda.
1) Millennium Development Goals
When: Monday, Tuesday, Wednesday
What: Before the UN General Assembly officially kicks off, presidents and prime ministers will gather at the UN for a summit on 10th anniversary of the Millennium Development Goals (MDGs). These are a set of eight anti poverty and global health targets that world leaders set for themselves in 2000. They are due in 2015 and progress, so far, has been mixed.
Some of the goals will be met, but that is mostly because the rapid economic development of China and India over the past decade lifted millions out of poverty. Sub-Saharan Africa still lags behind on most indicators. The idea behind this summit is to inject some political will and secure new commitments that will close the gap to reaching the MDGs. To that end, all summer long, diplomats have been pouring over the text of a "summit outcome document" that heads of state will endorse when they arrive in New York.
Expect world leaders to laud progress made toward some of the goals, and lay out some grand new commitments to achieving others. Whether they follow through on those commitments is another story.
2) Women and Children First
WHEN: Wednesday
WHAT: Not all of the MDGs have been approached equally. The Goals farthest from their targets are Goal 4 (a two-thirds reduction in child mortality) and Goal 5 (a three quarters reduction in maternal mortality and universal access to family planning). Progress toward these goals have been particularly stunted in 49 of the least developed countries in the world, the majority of which are in sub-Saharan Africa.
In late August UN Secretary General Ban Ki Moon released a Global Strategy for Women and Children's Health, which calls for an additional $26 billion to reach these goals. The summit outcome document (see item 1) endorsed this plan in principal. On Wednesday, the Secretary General is convening a meeting of major donors and recipient countries, philanthropists and private partners to secure tangible commitments toward implementing the plan. "We want developing countries to come to the table with policy commitments and donor countries will come to the table with financial commitments," says UK Ambassador Mark Lyall Grant who met with a group of journalists last week to preview the event.
The UN says more than 15 million deaths of children under five could be prevented; 33 million unwanted pregnancies could be avoided; and 740,000 women would be saved from dying from complications during child birth should these efforts be fully implemented. No one predicts that $26 billion of additional funding will suddenly materialize during the UN meeting. But most UN watchers do expect that convening this meeting will result in a big dent in the funding gap for women's and children's health.
3) Can Pakistan Get Some Relief?
WHEN: Friday
WHAT: The waters are beginning to recede, but Pakistan's epic floods remain the single worst natural disaster in recent history. It has affected more people than the Haiti earthquake, the 2004 Indian Ocean Tsunami, and the 2005 Kashmir Earthquake ... combined.
On Friday afternoon, there will be a special meeting on Pakistan flood relief, prior to which the United Nations Office for the Coordination of Humanitarian Affairs (which is sort of like the UN's FEMA) has released a new estimate of what it will cost to fund humanitarian operations in Pakistan for the rest of the year. The UN is now asking donors for an additional $1.6 billion to support relief efforts.
These funds pay for the emergency work of UN agencies like UNICEF and the World Food Program and international NGOs like Save the Children and CARE International which are delivering food rations, providing emergency shelter, schooling displaced children and offering health care for people affected by the floods.
If past is prologue, expect donors to come up short on funding. It has been over one month since the UN launched its initial $460 million emergency appeal for Pakistan flood relief. To date only about 80% of that emergency funding has been committed by donors.
4) Trying to Avert Disaster in Sudan
WHEN: Friday
WHAT. Sudan is very close to another civil war. Its southern provinces will vote for independence in early January, and the central government has made it clear it does not want to lose its grip on the oil-rich southern region. (At least, not without a fight.)
In the lead up to this vote, the Obama administration is ramping up its diplomatic efforts to avert an outbreak of violence, which intelligence analysts believe would likely result in mass atrocity or even genocide. Last week, President Obama's special envoy to Sudan Scott Gration met with leaders in Khartoum to present a package of diplomatic enticements -- including an easing of some U.S. sanctions -- should Sudan allow the referenda to go forward and respect the results.
On Friday afternoon, countries will meet with Sudanese representatives on the sidelines of the General Assembly. The administration hopes that this meeting will galvanize international support for a peaceful independence referendum.
This meeting represents one of the few times that Sudan is dealt with directly by the president himself -- President Obama will speak directly to Sudanese representatives at the meeting. That, itself, is a boon for the prospect of a peaceful referendum. Still, Sudan watchers and those in the advocacy community will be eager to see if some diplomatic sticks are presented along with these carrots.
5) The Curious Case of Paul Kagame
WHEN: Thursday
Muammar Ghadaffi will not be around this year to work translators into the ground, but Iranian president Mahmoud Ahmadinejad and Venezuelan president Hugo Chavez can be counted on to put on their usual show at the General Assembly. This year, though, particular attention will be paid to the remarks of Rwandan president Paul Kagame.
Kagame came to power as the leader of a militia that was able to stop the Rwandan genocide in 1994. In the years since, Kagame has been a darling of the international community. Rwanda has experienced tremendous economic growth and is on pace to meet many of the MDGs. Ban Ki Moon even appointed Kagame to co-chair a body called the "Millennium Development Goals Advocacy Group."
But there is a problem. Two weeks ago a the French newspaper Le Monde published the leaked contents of a draft UN report that accuses the Rwandan army (read: Kagame's Tutsi militia) of committing genocide against Hutus as they fled Rwanda for the Democratic Republic of the Congo. Needless to say, the Rwandan government was very, very displeased to see that in the paper. The government even threatened to withdraw their troops from UN peacekeeping, which would effectively dissolve the UN peacekeeping mission in Darfur.
This sparked a flurry of diplomatic activity. The top UN human rights official delayed the publication of the report for at least until October. And on September 8, Ban Ki Moon paid an emergency visit to Rwanda to convince Kagame to maintain his commitment to UN peacekeeping.
Expect Kagame to receive some extra-special attention from diplomats in New York. More than just the usual crowd will tune in when he addresses the General Assembly on Thursday.]]>The Afghan Election Controversy Revisitedtag:www.huffingtonpost.com,2009:/theblog//3.3213342009-10-14T16:45:47-04:002011-05-25T14:20:22-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
Peter Galbraith is a legendary American diplomat with a proud record of accomplishment. Kai Eide is also a veteran international trouble-shooter and former head of the United Nations efforts in Bosnia and Kosovo. Their dispute, which lead the firing of Galbraith and a subsequent scathing op-ed from Galbraith in the Washington Post, centered on how the UNAMA should handle fraud committed during the Afghan presidential election.
Let's be clear: fraud certainly occurred. No one is disputing that, least of all the UN. They key point of dispute between Eide and Galbraith was over what to do about that fraud. Galbraith suggested a course that involved more direct UNAMA intervention. The basic UN approach to elections, however, is to give local ownership and control over the process. This was particularly the case in Afghanistan where the UN was explicitly mandated by the Security Council to support the Afghans in their elections. The problem is, these two positions became personalized around support (or lack thereof) of Afghan President Hamid Karzai. For example, to prevent fraud, Galbraith suggested shutting down a number of polling stations where the security situation prevented election monitors from visiting. However, most of these stations were in ethnic-Pashtun provinces that could be counted on to support Karzai; if the UN had taken Galbraith's advice, it would have disenfranchised thousands of Afghan voters likely to vote for Karzai. For his part, Eide as head of the mission, had to implement the mandate given to him by the Security Council, which was to refer all allegations of fraud to the Independent Election Commission (an entirely Afghan body that Galbraith says is staked with Karzai supporters). The IEC ended up deciding to close fewer polling stations than Galbraith had suggested.
That is just one example of the kind of policy disagreement that separated Galbraith and Eide. The main dispute, though, is not over how many ballot stations to open or how to conduct a fraud audit. Rather, it is over the correct role of UNAMA in this entire election process. Galbraith wanted the UNAMA to intervene more directly in the process to maintain the purity of the elections. Eide was trying to ensure that UNAMA respected and supported the Afghan-owned electoral process. Both positions are perfectly defensible, and both include trade-offs. On the one hand, taking the Eide position can lend the impression that the system was rigged to elect Karzai. On the other hand, taking the Galbraith position would have meant undermining Afghan sovereignty, upon which the entirety of the UN's work in Afghanistan depends for legitimacy. (And it is important to note that this work involves the kind of nation building that is ultimately the only viable exit strategy for the international community.)
In the end, both diplomats were doing what they believed to be in the best interests of Afghanistan. Unfortunately, their two positions were simply contradictory. It is too bad that this disagreement led to one of them being let go. ]]>Time for the Save Darfur Movement to Declare Victorytag:www.huffingtonpost.com,2009:/theblog//3.2426602009-07-22T09:57:38-04:002011-05-25T13:40:22-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/Foreign Policy magazine. Newcomb argues that the forthcoming dissolution of Sudan into two separate countries (following a 2011 referendum) may presage the return to civil war. If the Obama administration doesn't provide a clear roadmap for how to handle the dissolution of Sudan, disaster may ensue. So, Newcomb writes, it is up to the movement to convince the Obama administration to make good with that roadmap. Another movement leader, John Norris of the Enough Projectagrees. "The time for activism is now," says Norris.
I respectfully disagree. The time for activism is long gone. In terms of being able to affect change, the movement has played itself out. This is not meant to diminish the accomplishments of the Save Darfur movement. In fact, I would argue that the Save Darfur movement is a singular example of successful activism (thanks, in part, to the likes of Newcomb and Norris). Like the anti-apartheid movement of the 1980s, the Save Darfur movement was able to bring to light a disaster halfway around the world and nurture a general political consensus around it. In fact, the movement was so successful it infiltrated the institution whose behavior it was seeking to change. A number of the leading lights of the Save Darfur movement now hold top positions in the Obama administration. Darfur is a household name.
These are amazing successes -- for any movement.
But we are now at a point where outside pressure has reached its limit. Unlike the previous administration, the Obama administration does not need convincing that Darfur should fit somewhere on its roster of global issues to which it ought to pay attention. Thanks to the movement it's already there.
Rather, the question now is what to do about Sudan policy, which is something relegated to the vagaries of the inter-agency policy making process. And here, there is a dispute within the Obama administration on the best way to approach Sudan. On the one hand, movement alumni in the administration are pressing for a hard line while others, like Sudan Envoy Scott Gration, reportedly prefer a more conciliatory approach that the movement abhors.
It is hard for me to see how activism (among, frankly, people who will vote Obama anyway) can influence this inter-agency debate. It seems hard to distill support for Susan Rice's policy prescriptions over those of Scott Gration and the State Department's Sudan desk into a placard. It's unrealistic to ask a movement to get that in the weeds of a policy debate. Furthermore, pinning the success or failure of the movement on the outcome of that interagency debate does disservice to the great successes that the movement has achieved.
The fate of Sudan may very well hang in the balance over the next 18 months. But the trajectory of U.S. policy toward Sudan depends more on whether key administration officials are willing to go down in flames in support of policies they think will make a difference than activists making phone calls or attending rallies.
Cross posted at UN Dispatch]]>Restoring American Global Leadership, One Step at a Timetag:www.huffingtonpost.com,2009:/theblog//3.1579432009-01-14T15:48:19-05:002011-05-25T13:00:22-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
Today, a group of 145 foreign policy experts, including former senior government officials, at least one ex-president (Jimmy Carter), academics, activists and advocates signed a letter spelling out exactly what policies would do the most to restore American global leadership and global standing. The letter is distributed under the aegis of the Connect US Fund and provides very specific markers for judging whether or not the incoming administration is willing to adopt the kind of policies that constitute a brave new era of American global engagement.
Repair U.S. credibility and influence on international human rights and humanitarian law:
* Issue an executive order that reaffirms an absolute prohibition on torture and ensures that all detainees within the custody of the United States are treated consistent with standards articulated in the U.S. Army Field Manual and international legal instruments; that halts the practice of secret detention; that ends rendition to torture and that directs a review of all legal opinions and policy guidance relating to treatment of detainees.
* Announce your intention to close the Guantanamo Bay detention center promptly and to treat all detainees in U.S. custody in a manner consistent with international obligations and domestic law.
* Re-engage in a positive way with international human rights institutions, such as by supporting the work of the ICC to investigate and prosecute individuals for genocide, war crimes and crimes against humanity.
Establish U.S. leadership on international efforts to address climate change:
* Commit to binding caps on carbon emissions that would reduce greenhouse gases by at least 80% by 2050, and thereby effectively contribute to worldwide efforts to limit the average world temperature increase to two degrees Celsius above pre-industrial levels; to funding and mechanisms to assist developing countries mitigate and adapt to climate change, access clean energy technology and avoid deforestation and degradation; and to legislation that promotes domestic green jobs and renewable energy.
* Quickly put in place a U.S. negotiating team led by a senior White House official, to work with Congress and civil society to formulate key elements of the U.S. position prior to climate negotiations scheduled for June in Bonn.
Reduce the threat of nuclear war and weapons proliferation:
* Resume talks with Russia on a new, legally-binding, and verifiable agreement that would, by the end of 2012, achieve significantly deeper and irreversible reductions than currently planned in deployed and reserve U.S. and Russian nuclear stockpiles and delivery systems, and that would extend or strengthen key verification and monitoring provisions of the 1991 Strategic Arms Reduction Treaty (START).
* Outlaw nuclear weapons testing: undertake bipartisan efforts to win prompt Senate approval of the Comprehensive Test Ban Treaty, and actively support ongoing diplomatic efforts to bring on board other states whose ratifications are required for the treaty to enter into force.
* In order to reduce the threat of nuclear terrorism, commit to the goal of securing and retrieving vulnerable nuclear weapons usable materials worldwide within four years.
Ensure a safer and more secure world by dramatically strengthening U.S. programs to promote diplomacy and development:
* Transmit to Congress with the FY2010 budget a separate national security and international affairs budget that includes funding for Foreign Operations, Homeland Security, and Defense. The justification for this separate budget should highlight how the four agencies that support national security (DOD, Homeland Security, USAID, and the State Department) complement one another to make America and the world more safe.
* Include in the FY2010 budget substantially increased resources for civilian agencies engaged in development, diplomacy and efforts to assist fragile states.
* Elevate the development functions within government: promptly name a highly respected development professional to lead U.S. development programs and ensure that that the National Security Council staff includes a senior staff position dedicated to development.
* Work with Congress to create a coherent, effective, U.S. development strategy that affirms the Millennium Development Goals, as well as the use of all key tools to achieve them (such as increased and reformed foreign aid, expanded debt relief and trade reform), and that guides a rewrite of the Foreign Assistance Act of 1961.
* Request that Congress ensure that the appropriation for the International Affairs Budget for fiscal year 2009 is at least at the level requested by the current Administration.
* Ensure that international deliberations on the global financial crisis include
representatives of developing countries, and that decisions on managing the crisis do not unduly impact critical international development priorities.
(cross posted to UN Dispatch.)
]]>Giving Peace a Chance in Northern Ugandatag:www.huffingtonpost.com,2008:/theblog//3.1477742008-12-02T13:29:53-05:002011-05-25T12:55:17-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/ADDIS ABABA, Ethiopia. Victor Ochen is from northern Uganda. He is in his late twenties, affable, and wears a permanent smile. But being 20-something and from northern Uganda means he is part of an entire generation lost to war. From the late 1980s to 2006, the Lord's Resistance Army, (LRA) a militia led by the charismatic faux-religious warrior Joseph Kony, turned northern Uganda into as close to hell on earth as you can imagine.
Tens of thousands of people were killed and over 2 million displaced in two decades of conflict. But those numbers tell only half the story. The LRA was notorious for swelling its ranks with child soldiers. In all, some 60,000 children were abducted during the course of the war.
How they conscripted these children are tales that defy the imagination. One night seven years ago, the LRA raided the village of one of Victor's friends. Rebel commanders separated the children from their parents and hacked to death the adults. In all, 27 people were killed. But the LRA was not done. They placed the human remains into a large pot and cooked them over the fire. LRA commanders forced the children to eat the stew.
Such were the horrors to be visited upon northern Uganda. But acts like this were not done out of sheer brutality. They had a strategic purpose, which was to drive a deep wedge between conscripted children and the places they once called home.
Today, the war is coming to close. The leaders of the LRA are wanted by the International Criminal Court and a tenuous peace process is underway. But deep social cleavages born from these acts of brutality remain embedded in war-affected communities, making long lasting peace difficult to achieve.
This is where Victor comes in.
He was one of the 'lucky' children who avoided conscription into the LRA. Life was not easy, though. He grew up in refugee camps. His mother paid for his schooling by carrying water for government soldiers. In high school, he paid his own school fees by selling heated charcoal. Still, he distinguished himself as a student leader forming student groups to raise awareness for HIV/AIDS and for the needs of former child soldiers.
He is now a budding social entrepreneur. I met him at a meeting of the Africa Commission's Youth Panel in Addis Ababa, Ethiopia. The forum was sponsored by the Government of Denmark (which also sponsored my trip) and included around 60 youth leaders from 22 African countries. Victor attended as the founder and director of an NGO called the African Youth Initiative Network.
The NGO's mission is no less than to heal the social rifts caused by two decades of conflict. It is an ambitious goal, but with very limited resources, the network has already accomplished much. In 2006, the NGO received a $50,000 grant from the International Criminal Court's victims' trust fund, which is a small pool of money provided by the ICC to support victims' rights in places the court has opened cases.
With $50,000 Victor was able to work miracles. One of his first projects was to bring in a team of Dutch plastic surgeons to treat victims of mutilation -- a common LRA tactic, again intended to make it difficult for victims to re-integrate into their communities. With such a small sum, the Africa Youth Initiative Network was able to provide plastic surgery for 80 patients, mental health services to over 1,000 and other surgical services, like removing bullets, to 200 others.
The NGO also provides advice to local village leaders on how to bring traditional forms of justice up to international standards. "We want to teach justice, not revenge," says Victor. This work, he says, is most central to the Africa Youth Initiative Network.
All of these programs have a singular purpose, which is to promote grassroots forms of community reconciliation and rehabilitation. This is an urgent need. In 2011 there are national elections scheduled for Uganda. Elections, though, have historically been times of chaos and organized violence. And with such a large population of alienated youth whose only marketable skill is wielding an AK-47, Victor is fearful of what may come.
On the other hand, if grassroots peace building organizations like the African Youth Initiative Network are supported more robustly, lasting, durable peace stands a fighting chance. ]]>Traveling Through West Africa With President Clintontag:www.huffingtonpost.com,2008:/theblog//3.1167572008-08-05T09:39:59-04:002011-05-25T12:40:20-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/Dakar, Senegal:
We touched down in Liberia this morning and traveled the road from the airport to the capital of Monrovia with a security escort provided by United Nations peacekeepers. These peacekeepers have been in the country since 2003 to provide security following a brutal civil war that killed over 200,000 people. Considering the population of Liberia is only 3.5 million, these are truly staggering numbers.
Our time here was brief. We first stopped at a construction site of a new Clinton Global Initiative project, the Golden Key Hotel, which promises to be a new high-end hotel and conference center. At a quick ceremony the President and Liberian Minister of Information and Tourism chatted with reporters.
As fate would have it, the Minister and President have crossed paths before. The Minister also happens to be a minister of the religious variety who fled Liberia during the civil war and relocated to Gaithersburg, Maryland. During the string of arson attacks on Black churches in the mid-1990s, the president and minister-Minister worshiped together in a show of solidarity. Here, 3,000 miles and a decade later, they once again joined teamed up, this time to highlight the promise of Liberia's economic development.
After a brief tour of an open air market, we made our way to the office of President Ellen Johnson-Sirleaf, a Harvard-trained economist, Africa's only female head of state and arguably the most popular political figure on the continent. At a public ceremony with President Clinton that included a number of Liberian politicians and the entire American delegation (celebrities and all), the President announced a new Clinton Foundation sponsored anti-Malaria program for the country.
Malaria is the number one killer of children under five in Liberia. A nurse affiliated with a Clinton Foundation sponsored hospital estimated that about half of all deaths in Liberia were in some way connected to Malaria. The problem is, drugs to combat the disease are expensive and hard to deliver to rural areas most in need. At the ceremony with President Sirleaf, President Clinton announced that he was able to secure a 30% reduction in price of the most effective anti-Malarial drug by working with donors to purchase the medicine in bulk. He also announced plans to establish delivery mechanism to make sure that the drugs are able to reach communities most in need.
After a photo-op with President Sirleaf, we left Liberia and headed north to Senegal for one of the Africa trip's major announcements.
In the garden outside a pediatric AIDS clinic in Dakar, former French foreign minister Philippe Douste-Blazy (who is the executive director of UNITAID), a representative from the World Health Organization, a current French government minister, Senegalese officials and hospital workers announced the launch of a new partnership to treat all HIV positive children under 12 months old in 16 of the neediest countries around the world.
This is a significant development. Treating an infant with AIDS is a cumbersome and expensive task. It requires multiple steps and multiple trips to the hospital, which in turn means that parents in poor countries often have difficulty adhering to the diagnosis and treatment regimen. The World Health Organization recently announced new policy guidelines recommending that countries streamline this process by delivering new (and more costly) Anti-Retroviral Treatments to infants immediately upon diagnosis.
Of course, the problem is funding and implementing this new policy. The big announcement today was that, UNITAID -- a French sponsored organization that raises money to fight HIV/AIDS, Malaria, and TB from a 2 Euro tax on commercial airplane tickets -- has declared that it is going to provide $460 million in 16 countries to fund this policy. The Clinton HIV/AIDS Initiative will be one of the on-the-ground NGOs that will implement the policy in partner countries. If implemented, infant mortality rates for HIV-positive children under 12 months old could decrease four-fold. This means hundreds of thousands of children's lives could be saved.
Now, we are off to Mexico City, the final leg of our trip where President Clinton will deliver a keynote address at the 2008 World Aids Summit. Stay tuned. ]]>Traveling with President Clinton in Rwandatag:www.huffingtonpost.com,2008:/theblog//3.1166432008-08-03T19:30:12-04:002011-05-25T12:40:20-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/Rin Kwavu, Rwanda
We kicked off the day with an early morning trip from Rwanda's capital city to a small farming village in Rin Kwavu, eastern Rwanda. Chelsea Clinton and members of his delegation, including Ted Danson, Joe Wilson, and Iowa Governor Tom Vilsack, all touched down via helicopter to check up on some Clinton Foundation projects here.
This part of the country was particularly devastated by the genocide in 1994. During the 1960s and 70s, the Rwandan government re-located minority Tutsis in the eastern region of the country, not far from the Tanzanian border. In 1994, 800,000 Rwandans were killed--the vast majority of which were Tutsi. Those Tutsis who were not killed in Rin Kwavu were forced to flee.
When the survivors here returned to rebuild their homes and lively hoods after the war, they were hit once again. The staple crop of the region, Kasssava, was being wiped out by a vicious disease. By 2003, the crop had been nearly completely destroyed, threatening the lives and livelihoods of villagers who live on less than two dollars a day.
The president came here to show us one of his Foundation's first projects in Rwanda. In 2005, the Clinton Foundation began to introduce a resistant Kassava plant to Rin Kwavu. Visiting the area today, there is Kassava as far as the eyes can see. As he chatted up the local farmers, the president announced plans to open a processing plant to grind the Kassava root into flour.
Our next stop took us a few miles down the road to the home of Jean-Pierre, a fourteen-year-old HIV patient. Jean-Pierre lives far enough from the local health center that keeping up with his daily regimen of drugs would be impossible if he were forced to go there regularly. To make matters worse, his only familial support is his 19 year-old sister, who stunted her own childhood to take care of her younger brother.
So, rather than make the long trip to the hospital, the hospital comes to him. A community health worker from a Foundation-supported health center visits Jean-Pierre twice a day every day to deliver his medicine and check up on him. Jean-Pierre told the president he's back in school and "feeling good."
After this visit, the President left the press for a private lunch with Rwandan president Paul Kagame. This gave me time to explore the small town of Butaro, the President's next stop where he broke ground on a new hospital. Thousands of people -- mostly children -- lined the hilltops overlooking the soccer field turned helicopter landing pad. They screamed when he touched down. A women's choir awaited him a song, the lyrics of which we later learned were "Thank you for building us a hospital! Thank you for bringing us doctors!"
The president worked the crowd like it was 1999. It might as well have been. He's clearly in his element here.
Next stop: Liberia. Stay posted. ]]>Traveling With Bill Clinton in Africatag:www.huffingtonpost.com,2008:/theblog//3.1165172008-08-02T12:31:53-04:002011-05-25T12:40:20-04:00Mark Leon Goldberghttp://www.huffingtonpost.com/mark-leon-goldberg/
Debra Zeit, Oromia, Ethiopia -- I just met a group of young women who save lives for a living. They are not nurses. They don't even have a high school education. Yet, they are professional lifesavers. How? These young women are community liaisons between the Godina Health Clinic and the rural community of Debra Zeit. In doing so, they are critical players in a new trend in global health.
In developing countries like Ethiopia, the global health community's focus is starting to turn from initiatives to take on specific diseases like HIV/AIDS, Malaria and Tuberculosis to programs that strengthen public health infrastructures as a whole. The so-called "Health Extension Workers" that I met are at the cutting edge of this trend.
As I travel throughout Africa and Mexico with President Clinton this week I'll document how the donor community (including the Clinton Foundation and the United Nations Foundation, which is sponsoring my trip and sponsors my blogging UN Dispatch, respectively), UN agencies like UNICEF and the World Health Organization, and governments are shifting from disease-specific initiatives to strengthening public health systems.
The story of the young Health Extension Workers helps explain why this shift is so important--and why tackling the scourge of HIV/AIDS, Malaria and other public health emergencies in the developing world depends on recruiting more women like these.
First, some background that helps explain why targeting the disease--and only the disease--is not always effective. In the developing world about 30% of children born to mothers with HIV contract the virus. A drug that helps prevent transmission at birth is relatively inexpensive so around the millennium, the attention of the global health community turned to prevention of mother to child transmission of HIV/AIDS. Donors, NGOs and national governments invested great money and effort to programs that distribute this drug to HIV infected women.
But they hit a snag. The single pill, while helpful, did not have the dramatic affects that donors had expected. Not enough pregnant women were tested for HIV. And those that did know their HIV status did not always have access to health clinics. Even women that did take the pill did not always have the means or wherewithal to maintain the 18 months follow-up regimen. Programs to prevent mother to child transmission were, simply put, not comprehensive enough to put as large a dent into the statistics as donors had hoped.
Enter Health Extension Workers. Young women, who generally lack secondary education, are recruited as community liaisons for local clinics. They are trained not in medicine, but in social work. They are rural health clinics' eyes and ears in their local community. If their neighbor is pregnant, the health worker will let her neighbor know of available HIV testing and prevention programs. The worker is the go-between for the clinic and rural populations.
In Rwanda, use of community health liaisons is more commonplace than in Ethiopia--and have results to show for it. Rural Rwandans generally have quicker access to malaria medicines and higher adherence rates to treatment programs. In some Rwandan villages, women are even elected to the post in open caucuses.
This was one critical missing link in previous efforts to combat mother to child transmissions. This week, President Clinton's visit to Godina Health Center in rural Ethiopia marked the launch of a new partnership between the Clinton Foundation and the government of Ethiopia to, among other things, train 30,000 Health Extension Workers in rural communities throughout the country.
Clearly, this is an ambitious target. Nevertheless, is a goal upon which many thousands of lives will depend.
Mark Leon Goldberg writes for UN Dispatch, a blog about the UN and global affairs. He is traveling with President Clinton this week through Africa and to the Global AIDS Summit in Mexico City.
