Obama’s Wars: implications for Pakistan

http://tinyurl.com/2fo9n6z

Daily Times
Thursday, September 30, 2010

COMMENT: Obama’s Wars: implications for Pakistan —Dr Mohammad Taqi

While NATO may have softened its position from its earlier stance of using the ‘right’ of hot pursuit, Pakistani authorities will find it increasingly difficult to defend their untenable position in the face of intense pressure and scrutiny from the US


We do not know if Bob Woodward had meant to time it this way, but his latest book, Obama’s Wars, has hit the shelves exactly 14 years after Kabul fell to the Taliban, with Pakistani ‘security advisers’ present as the marauding hordes tortured, killed and mutilated the dead body of the former Afghan president, Dr Najibullah and chased the then president Burhanuddin Rabbani to Jabal-us-Siraj, outside Kabul.

After talking to 100 key individuals, sifting through countless documents and 40 major interviews including one with President Barack Obama, Woodward has once again given an insight into the workings of the White House, one that has almost become a ritual for US presidents, readers and the grand old man of the Washington press corps himself.

Impugning Woodward’s credentials as an investigative journalist, some, like Salon.com’s Christopher Hitchens and Andrew Bacevich, had called him the stars’ stenographer or the gossip chief. The fact, however, is that Woodward no longer has any pretensions to being the investigative journalist, who, along with Carl Bernstein, brought down a US presidency. He does not stake any claim to run-of-the-mill political punditry either.

Over the past three decades, Bob Woodward has evolved into a contemporary historian with an unmatched knack and resources to have power players spill their guts to him. The information he presents might not be a journalistic scoop of the time-sensitive nature that geopolitical strategists can peg their forecasts on. But it still remains invaluable to the understanding of the thought process — along with its shortcomings — in how Obama will flesh up his drawdown plan.

The aforementioned security advisers feature repeatedly in Woodward’s memo-by-memo account of the events leading up to the development of Obama’s plan for a handover to the Afghans and exiting Afghanistan. They first appear on page three of the book, when the Director of National Intelligence, Mike McConnell, briefed Obama, two days after his election:

“It was a dishonest partner of the US in the Afghan War ‘They are living a lie,’ McConnell had said. In exchange for reimbursements of about $ 2 billion a year from the US, Pakistan’s powerful military and its spy agency, ISI, helped the US while giving clandestine aid, weapons and money to the Afghan Taliban. They had an office of ‘hedging your bets’...It was as if there were six or seven different personalities within the ISI. The CIA exploited and bought some, but at least one section — known as Directorate S — financed and nurtured the Taliban and other terrorist groups...the Pakistani spy agency could not or would not control its own people.”

With this massive trust deficit in the foreground, Obama gave approval for a plan proposed by Joe Biden as “counter-terrorism plus”, which ultimately resulted in raising the 3,000-strong counter-terrorism pursuit teams trained to kill or capture terrorists inside Pakistan. Perhaps a coincidence that the question of hot pursuit came up this past weekend when the ISAF airstrikes killed the fighters of the Haqqani network, on the Pakistani side of the Durand Line.

While NATO may have softened its position from its earlier stance of using the ‘right’ of hot pursuit, Pakistani authorities will find it increasingly difficult to defend their untenable position in the face of intense pressure and scrutiny from the US in the months leading up to the July 2011 phased withdrawal.

We are likely to see an increasing reference to the UN Security Council Resolution 1373, which states that the state’s sovereignty means that a state is duty-bound to control its territory and obligated to not allow its land to be used by non-state actors or terrorist groups to carry out attacks against its neighbours. This resolution, adopted under Chapter VII of the UN Charter and thus binding on member states, obligates them to “deny safe haven to those who finance, plan, support, or commit terrorist acts, or provide safe havens”.

This also forms the premise of what appears to be a Pakistan-specific ‘retribution’ plan, which, according to Woodward, will be triggered if there is a 9/11-like attack against the US by terrorists based or originating in Pakistan. Woodward notes: “Under this plan, the US would bomb or attack every known al Qaeda compound or training camp in the US intelligence database...The retribution plan called for a brutal, punishing attack on at least 150 or more associated camps (in Pakistan).”

This past May, the Times Square botched terror plot nearly set the plan into motion. Leon Panetta, Lieutenant General Douglas Lute and General James Jones had conveyed in person the gravity of the situation to the Pakistani authorities on May 19, 2010 that, “if that happens, all bets are off”. At the time, the US delegation did not reveal that the response could entail bombing 150 sites!

Woodward has included in his book the memorandum dictated by Obama and circulated to the principals before his December 1, 2009 speech. The fact that no other US president before Obama has ever sent out written orders for his war plans makes this document the bedrock of his Pak-Afghan strategy. Among other things, he lists two metrics, which could alter the US policy towards Pakistan:

“1) Are there indicators that we (US) have begun to shift Pakistan’s strategic calculus and eventually end their active and passive support for extremists?

Has Pakistan approved our (US) specific request for assistance against al Qaeda and other extremists, including the Afghan Taliban and the Haqqani network?”

Based on an assessment of these metrics, the progress of Operation Dragon Strike and the outcome of the November elections in the US, Mr Obama will make critical decisions about Pakistan, Afghanistan and his political and military teams, culminating in the Afghan strategy review.

Barack Obama has made a candid observation to Woodward: the US can absorb a 9/11-like attack and come out strong. As a nation this is true for the United States. But politics in the US has recently taken a hard right turn and it would be impossible for Obama not to project hard personal and national power if certain red lines are crossed. As Woodward records, “President Obama’s only choice would be to respond.”

The US is not about to handover the keys to Kabul. Hopefully, the Pakistani establishment will reconsider its strategic calculus; living lies is incongruent with the geopolitical realities.

The writer can be reached at mazdaki@me.com

The fire of chinars

Daily Times

The fire of chinars

http://tinyurl.com/2g2s2ln


By Dr. Mohammad Taqi

September 23, 2010

The fall season has officially started in the US, with road trips already planned to enjoy the spectacular fall foliage when the nature’s paintbrush turns the leaves to bright yellow and vibrant reds. In South Asia, nowhere is this splendor of colors on a better display than in the vale of Kashmir. The Kashmiris call this crimson tide sweeping their land the ‘aatish e chinar’ (fire of the chinar trees).

However, the autumn has historically also meant the Kashmir Valley being taken by geopolitical firestorms. Whether it was the tribal invasion of the 1947, the accession to India by Maharajah Hari Singh or several arrests of the late Sheikh Abdullah by the Indian government, it all happened between August and October. This year has already seen killings of at least a hundred Kashmiris, in as many days. The chinars are on fire again.

The ruling coalition in New Delhi has been scrambling to cobble together a response to an apparently non-violent and indigenous uprising in the Kashmir Valley. However, the Indian response at best has been disjointed and at worst, deceitful and ruthless. The United Progressive Alliance led by the Congress Party, has gone from supporting the Kashmir Chief Minister Omar Abdullah and his call to repeal the notorious Armed Forces Special Powers Act (AFSPA), to gradually steering the media narrative towards an alleged trust and governance deficit, between the Kashmiris and Mr. Abdullah’s state government. The Congress matriarch Sonia Gandhi, who initially made an impassioned plea for ‘placing the anger, the pain and the aspirations of the (Kashmiri) youth’ at the heart of the solution to the Kashmir issue, too has switched gears towards admonishing Omar Abdullah.

In face of the opposition by the Bharatiya Janata Party (BJP) at the center, the Peoples Democratic Party in Kashmir and the Indian Army chief, General VK Singh, New Delhi has slowly backtracked on its offer to withdraw or dilute the AFSPA in at least some areas. Instead a contingent of political leaders, strong in numbers but without any mandate, has descended upon Kashmir. Curfew was clamped in Srinagar upon the arrival of this delegation and the irony is that even those Kashmiri leaders, who were extended written invitation to meet this group, were put under house arrest!

In New Delhi’s chaotic handling of the present situation, two things stand out. Firstly, this time around the Indian government and General VK Singh both found it extremely hard to pin the blame on Pakistan or its political and militant proxies in Kashmir. Secondly, and more importantly, the non-Kashmiris’ understanding of the Kashmiri grievances remains poor. Especially, a progressive, secular-liberal political narrative on Kashmir, beyond what Indo-Pakistani human rights groups have developed, simply does not exist.

It is pertinent to note that the late Dr. Muhammad Din Taseer (father of the current governor of Pakistani Punjab, Salman Taseer) was one of first few individuals to attempt negotiating a solution to the Kashmir issue, back in October 1947. In her book” The Kashmir of Sheikh Muhammad Abdullah”, Mrs. C Bilqees Taseer has chronicled the efforts of her husband to work with his friend Sheikh Abdullah to help resolve the issue. Dr. Taseer, a founding father of the Progressive Writers Movement, though at serious odds with the leftists by then, was still a leading light of the liberal Pakistan. Later on even the best known Pakistani progressive and Lenin Peace laureate, Faiz Ahmed Faiz helped draft and affixed his signature to a statement by the Pakistani writers, supporting the Kashmiri’s right to self-determination, published in the Pakistan Times (owned by the leftist leader Mian Iftikharuddin). Since then,however, the progressives and liberals – especially in Pakistan- seemed to have ceded the Kashmir issue to the jingoism of the right-wing and religious parties and the security establishment(s).

Writing on the national issue, Lenin had made a detailed case for a peoples’ right to self-determination, agitation and struggle towards that right including secession. He concluded, however, that “this demand (secession), therefore, is not the equivalent of a demand for separation, fragmentation and the formation of small states. It implies only a consistent expression of struggle against all national oppression.”


Since the rise of the jihadist militancy in Kashmir in the 1990s, the secular-liberal forces have shied away from endorsing the right of self-determination for Kashmiris, reverting to the pre-1953 autonomous status of the Jammu and Kashmir or even the full implementation of guarantees provided in Article 370 of the Indian constitution. On occasion this discourse echoes the BJP stance that because there have so many elections in Kashmir with significant participation of the people, the right of self-determination is redundant and the martial law-like AFSPA remains India’s internal matter.

What is being overlooked is that the elected state governments of Kashmir have been consistently demanding a larger quantum of autonomy and withdrawal of the Indian troops from the Valley. It is pertinent to recall that the National Conference’s Autonomy Committee headed by the current Finance Minister Abdul Rahim Rather had submitted a detailed report in 2000 that was rejected by New Delhi. The conundrum of whether to condemn the jihadist menace or support the Kashmiri autonomy must not paralyze the progressive intelligentsia. They have to do both.

Incidentally, one of the more progressive proposals to resolve the Kashmir imbroglio had come from Chakravarti “Rajaji” Rajagopalachari- the right wing, anti-Nehru associate of Mahatma Gandhi. On the eve of his 1964 trip to meet Gen Ayub Khan, the late Sheikh Abdullah had sought Rajaji’s counsel, who had already written to a confidant “any plan should therefore leave the prizes of war (Jammu and Azad Kashmir) to be left untouched. Probably the best procedure is for Sheikh to concentrate on the valley leaving Jammu as a counterpoise to Azad Kashmir, to be presumed to be integrated to India without question. This reduced shape of the problem is good enough, if solved as we desire, to bring about an improvement in the Indo-Pakistan relationship. And being of reduced size would be a fitting subject for UN trusteeship partial or complete.” (Ramachandra Guha: Opening a Window in Kashmir - Economic and Political Weekly, August-September 2004).

In his autobiography “Aatish e Chinar”, the late Sheikh Abdullah, an arch-secularist himself, had given the outlines of a progressive solution to the dilemma of his beloved Kashmir. Guha’ article also alludes to this. Sheikh had emphasized that the solution should not only be secular in character itself but must not undermine India’s secularism, not be a victory celebration for India or Pakistan, must not cause mass displacement of Kashmiris, and must grant Kashmiris the right of self-determination.

While the fanaticism of Asya Andarabi or Syed Ali Geelani’s hard-line must be denounced, the Valley’s demands for autonomy, relayed by its elected leaders deserve at least a fair hearing. Chinars have been on fire, far too long; could there be a solution that does not flow from the barrels of the militants’ or the military’s guns?

Gainesville, Florida: upholding old civilities

Daily Times Thursday, September 16, 2010

COMMENT: Gainesville, Florida: upholding old civilities —Dr Mohammad Taqi

http://tinyurl.com/2bed37c

The people of Gainesville made Pastor Terry Jones look like not a saint, not the devil, not even a villain, but exactly what he was — a fool. The voices of sanity had drowned the voice of hate

“Where the mind is without fear and the head is held high;

Where knowledge is free;

Where the world has not been broken up

Into fragments by narrow domestic walls...

Where the clear stream of reason

Has not lost its way into the dreary desert sand of dead habit...”



Throughout history, the burning of manuscripts and books has been aligned more with persecution and primitive censorship than with protest. From burning the agnostic treatise of Protagoras to the “amputation of all the gangrenous members of the bibliographic body” by Urbain Domergue’s French revolutionaries, all sides have partaken in the pogrom of the written word. But the thought of having something similar in the vicinity of one of US’s largest universities was rather disconcerting.

With Tagore’s above quoted lines from Gitanjali, Professor Vasudha Narayanan opened the Gainesville Interfaith Forum’s proceedings, a day before the obscure pastor of the fringe Dove World Outreach Centre had planned to carry out his abhorrent outrage. While listening to Vasudha enunciate the creed of our university community, I also thought of the Shakespeare’s Richard III rambling:

“And thus I clothe my naked villainy

With odd old ends stol’n out of holy writ,

And seem a saint, when most I play the devil.”

But when I looked around, they stood up for the right cause at the right time, in overwhelming numbers and they had subdued the lone bigoted charlatan. The people of Gainesville made Pastor Terry Jones look like not a saint, not the devil, not even a villain, but exactly what he was — a fool. The voices of sanity had drowned the voice of hate.

As the world just turned its focus on to what a fringe group might do on September 11, 2010, for many in Gainesville, a civil rights movement of sorts was turning a year old. Long before our erstwhile neighbour at the Centcom in Tampa, Florida, General David Petraeus weighed in on the national security concerns arising out of Pastor Jones’ planned biblioclasm, the local community was grappling with what may appear to some as the human rights minutiae like free speech, hate speech and the constitutional protections afforded, if any, to either one.

The Dove Church started its campaign more than a year ago with rather crude signage in its front-yard. Subsequently, some of the children from this church’s member families showed up at local schools, wearing shirts — ostensibly of their own accord — with a hateful message inscribed on them. This is when the Gainesville community decided to make its disgust at the Pastor’s actions, known for the first time. In August 2009, a few elementary and middle school kids, wearing the shirts with the abusive messages, were sent home by the school authorities.

The local school board then held public hearings where many testified to uphold the constitutional freedoms — including free speech — yet vociferously condemned the hateful messages. The school board subsequently decided to introduce a uniform dress code, which went into effect earlier this year. Whereas litigation against the school board — perhaps futile now — remains pending, this was the first the step in building a community consensus against intolerance.

After failing to gain traction through his front yard and T-shirt vitriol, Pastor Jones announced his book-burning plans some two months ago. Earlier on, the small local Muslim community felt uncomfortable, but even during these uncertain times, it made certain key decisions anchored in the best traditions of the human rights movements. In her book Burning books and Levelling Libraries, Rebecca Knuth opens the chapter on ethnic biblioclasm with F R Scott’s poem, ‘Degeneration’:

“Soon kindling animosities

Surmount the old civilities

And start the first brutalities.

Then come the cold extremities

The justified enormities

The unrestrained ferocities.”

The exact opposite of Scott’s concerns was to serve as the template for the Gainesville Muslim Initiative — a coalition for building the discourse against hate mongering. It included the leaders from two mosque-centres in Gainesville and individuals who did not belong to the either congregation or for that matter any particular doctrinal persuasion. The consensus was to steer clear of any reactionary or confrontational response to outrage, denounce and disown violence in any form and adhere strictly to the constitutional protections for everyone. Additionally, no financial, material or physical support was to be sought from the outside the communities. Civilities were to be upheld and animosities avoided at all costs.

As the media spotlight began to simultaneously highlight and sanitise the Pastor’s virulence, support for the local community from the city’s political, civic and academic leadership, a host of local and national faith-based groups, American Civil Liberties Union, Council on American-Islamic Relations and so on, rose exponentially. With the national political and military leaders also recording their condemnation, it was tempting for the locals to latch on and seek their own two minutes of glory like the dubious Houdini act of Imam Muhammad Musri of Orlando or worse — seek an unconstitutional recourse. They fell for neither.

For the Gainesville citizens, whether followers of a faith or not, the issue was to set an example that the rest of the US and indeed the world could follow. No doubt the protests across the world could pitch the US troops and Muslim civilians against each other. But what if there was no war in Afghanistan? Would it be okay to remain mum then? For Gainesville, silence was not an option in either case, so it went on to do what it does best: serve humanity through healing, teaching and helping.

On September 11, 2010, people from across all divides came together for ‘A Day of Peace and Unity’ sponsored by the Gainesville Muslim Initiative at Gainesville’s Bo Diddley Plaza. They contributed books to the libraries, donated blood and fed the hungry. A local T-shirt shop distributed shirts with inscription ‘Love, not Dove’ while the university students shared wristbands reading, ‘Islam is of the heart’. As the speeches by religious and community leaders celebrated diversity, fellowship and charity, the vigil marking compassion and peace came to life with candles, a thousand of them — one lit from the other. Gainesville had successfully upheld its old civilities and built new bridges. Communities around the world where humans are savaged may have an example to emulate now.

PAKISTAN: Minorities Under Siege

OUTLOOK INDIA
SEPTEMBER 9, 2010

PAKISTAN: Minorities Under Siege

The suggestion, even if well-intended, that the communities being targeted by terrorists should voluntarily restrict their activities in the open, could have far-reaching adverse consequences.

MOHAMMAD TAQI

HTTP://WWW.OUTLOOKINDIA.COM/ARTICLE.ASPX?267047
After the carnage at the Karbala Gamay Shah, Lahore and Meezan Chowk, Quetta on September 3, some television anchors and some in the print media would have one believe that if only the organizers of the Quetta procession had stopped a few yards short, the slaughter of some 60 people including two media-men would have been averted.

For example, Mr Ahmed Quraishi, blogging for The Express Tribune, wrote this past weekend:

“It is important that non-religious and non-essential public events in Pakistan – political and religious – be curtailed under these circumstances, regardless of sect and politics. If the government and the army can call off parades on days of national significance, including Independence Day, then unnecessary public congregations can be curtailed as well”

While pointing the finger of blame at the elusive Indo-Zionist operatives, Mr Quraishi was essentially echoing a statement made by the federal interior minister Rehman Malik who has suggested for the communities under attack to (voluntarily) restrict their activities in the open. Mr Malik has made these atrocities sound like a breakdown in police-public relationship rather than a significant aspect of the ongoing war against terror. Such off-the-cuff remarks by government officials could have far-reaching adverse consequences and may even contribute to further marginalizing and even ostracizing the communities already under attack.



Given the history and nature of the violence against the non-Wahabi sections of the Pakistani population and the abysmal record of the administration to bring to justice even a single mastermind or perpetrator of the atrocities, Mr Malik’s advice carries zero credibility with the affected communities. Needless to say that the Ahmadiyyas praying at their Lahore mosques had not violated any police cordon, the Hanafi-Barelvi-Sufi followers of Data Ganj Bakhsh had not brought out any procession and the women shoppers at Peshawar’s Meena Bazar were not out expressing solidarity with Palestine, when they were brutally massacred by the Wahabists.

Unlike the Kingdom of Saudi Arabia, no state-sanctioned anti-Shiite doctrine exists in Pakistan. However, the interior minister’s advice, perhaps given in good faith, is perceived as an attempt to replicate the Saudi model, where after violently targeting the minorities for years, the open observance of their faith was severely curtailed. In Saudi Arabia, the Shiite are considered Kafir (infidels) and mubdi’un (heretics or innovators) who should be converted to the “right” path (of Islam) i.e. Wahabism and attacks on their life and property are permissible (halal) in such attempts to convert. A systematic cycle of fatwas against the Shiite followed by physical violence has achieved the desired result of ghettoisation of the Shiites in the Kingdom. For three decades, the anti-Shia fatwas and violence have raged on in Pakistan; it should not be a surprise if they fear ghettoisation too.



The Lashkar-e-Jhangavi al-Aalami, while taking credit for the Lahore and Quetta bloodbath, has also warned against any future Shiite processions, just like their Taliban cohorts had warned the women of Swat against going to school or for shopping. The state machinery had capitulated then, only to see the emboldened barbarians demand more control and more territory. The height of naïveté would be to assume that confining the Shiite indoors would satisfy the jihadists for good. It is equally naïve, nay, irrational to dismiss the issue as a local police matter with the usual “law and order” implications.



In his 1888 short story “On the City Wall”, Rudyard Kipling mentions the police preparations in advance of the Muharram processions in the walled city of Lahore:

“Their passage is rigorously laid down beforehand by the Police, and detachments of Police accompany each tazias, lest the Hindus should throw bricks at it … Mohurrum time in a "fighting" town means anxiety to all the officials, because, if a riot breaks out, the officials and not the rioters are held responsible.”

There is no doubt that for years the Pakistani police have gone beyond the call of duty to work out the details of security arrangements at the Muharram or Rabi-ul-Awal processions. Indeed, officers like Khan Raaziq, the IGP Malik Saad and scores of policemen sacrificed their lives while carrying out such duties. The Pakistanis in general and the Shiite in particular owe a lot of their leftover freedoms to these fine men.



The tele-media’s lazy gimmick of grilling the police officers after the areas under their supervision are bombed or Mr Rehman Malik’s remedy of negotiating the procession routes and the code of conduct etc. and for that matter banishing the activity altogether from the public domain, is more in sync with what Kipling wrote more than a century ago. Lest they missed the happenings in the interim, the paradigm of sectarian persecution has undergone a massive change; it is not even the same as two decades ago let alone the 19th century brick batting.



Having started as the anti-Shiite terrorism of the 1980s and 1990s, the Wahabist violence against all groups that they consider heretic, is now a fully matured front in their global jihadist war. The violence against the Shiite, the Hanafi-Barelvis, the Sufis and the Ahmadiyya is not random and is perpetrated not just by the young suicide bombers. Battle-hardened, war-trained and thoroughly indoctrinated jihadists plan such attacks months in advance. To expect the police to counter this vast jihadist network in the usual course would be unfair to both the police and the populace. There is little doubt that during wartime, extra-ordinary measures must be adopted. But that requires building a national consensus with all stakeholders, including the affected communities. There are multiple examples where organizers of religious events have worked closely with the law enforcement agencies to modify or even suspend their activity due to the warlike situation.



Being in a war or warlike situation also begs the question as to what role, if any, have the country’s armed forces played on this front, other than cancelling the 23rd of March parade? If the three-year old siege of the Shiite part of the tribal Kurram Agency by the Taliban is anything to go by, the role of the armed forces is rather disappointing. While the Parachinar-Peshawar road route is open in theory, the Shiite from Kurram are still forced to travel to Kabul for an onward journey to Peshawar. But then it took the Pakistan Army good two years to move against Mullah Fazlullah in Swat.

Most leaders of the Pakistani jihadist-terrorist outfits, including the Tehrik-e-Taliban Pakistan, are the alumni of the Wahabist Sipah-e-Sahaba Pakistan and its offshoots like Lashkar-e-Jhangavi. They work hand-in-glove with the al-Qaeda and the Afghan Taliban, especially the Haqqani network and the Quetta Shura. While the Pakistan Army continues to boast victories in the war against terrorism, its inaction in face of the jihadist violence against the non-Wahhabi population raises serious concerns about such claims.



Peter Gourevitch notes that "the dead are innocent, the killers monstrous, and the surrounding politics insane or nonexistent" (in We wish to inform you that tomorrow we will be killed with our families: Stories from Rwanda). When the Taliban were ravaging Swat, the politics of resisting them appeared nonexistent. The media then, especially the English newspapers, did an admirable job of building the political and military will to fight the jihadists. Banishing the minorities has never stopped the fascists. One hopes that the Pakistani leaders and media call for banishing the barbarians, not their victims.

Dr Mohammad Taqi teaches and practices Medicine at the University of Florida.

Click here to see the article in its standard web format

Floods and humanitarian medicine

Daily Times Thursday, September 02, 2010

COMMENT: Floods and humanitarian medicine —Dr Mohammad Taqi

Unlike spontaneous volunteers, healthcare professionals must think critically to avoid overwhelming the local resources and decide where in the disaster cycle they would be most effective

“Bani Adam aaza’ e yak o deegarand,

Keh der aafreenesh ze yak gauharand.

Choon uzvi ba dard aaward rozgar,

Digar uzvha ra na manand qarar.

Tu keh az mehnat-e-deegran beghami,

Nashayad keh naamet nahad aadmi.”

(Human beings are members of a whole,

In creation, of one essence and soul.

If one member is afflicted with pain,

Other members uneasy will remain.

If you have no sympathy for human pain,

The name of human you cannot retain)

— from Gulistan by Saadi Shirazi, adorning the UN Hall of Nations.

It is perhaps the overall dominance of this spirit of mankind being one whole that its members continue to feel the pain of others, despite the mind-numbing barbarism, doom and gloom coming our way in recent years.

When struck by a disaster, the predominant response of people is empathy, support and a desire to channelise these sentiments, through direct or indirect means, into tangible help for the affected group. In many instances this altruism has to take the form of physical participation, making the process tangible — and thus satisfactory — for the helper as well. This direct involvement in assisting the affected population, beyond donating supplies or money, constitutes volunteerism.

Generally, the spontaneous volunteer activity in the early response phases of a disaster is important and helpful. But if not properly coordinated, the convergence of untrained and trained volunteers has the potential to adversely affect and overwhelm the disaster management, as was observed in the US in the aftermath of the 9/11 tragedy and Hurricane Katrina.

Hurricane Katrina also raised several straightforward but ominous public health concerns like water safety, sanitation and hygiene, infection control and immunisations and restoring access to healthcare. That these issues needed to be addressed was obvious but much more complicated was how.

Flooding is the most common natural disaster but our scientific understanding of the health effects of the floods is disappointingly limited. Another factor hampering an effective public health response after the floods is that studies conducted in developed countries have limited application in what we are experiencing in Pakistan.

Even within the US a serious disconnect was reported between the healthcare needs of the Katrina victims and the objectives of the volunteer physicians who came in to help. In a letter to the editor, published in the New England Journal of Medicine, a Louisiana physician, Dr Katharine Rathbun had lamented that they did not need more thoracic surgeons or emergency physicians; what the displaced people needed was access to primary care for their chronic illnesses like diabetes, heart or lung diseases.

The above noted paraphrase of Dr Rathbun’s letter captures the essence of humanitarian or disaster medicine: when natural or manmade disasters bring health issues to the fore, the international medical community is expected more than ever to address the needs of the most vulnerable. However, along with the urge to do more, and quickly, avoiding a disconnect with the affected community and its needs is a must. Unlike spontaneous volunteers, healthcare professionals must think critically to avoid overwhelming the local resources and decide where in the disaster cycle they would be most effective. For example, there could be a long delay before local healthcare systems can function during the recovery phase and the volunteer medics could provide significant help during this hiatus.

Thousands of medical professionals in Pakistan are working day and night to deliver healthcare and relief supplies to the millions affected by the floods, as we speak. In addition, groups like the Association of Physicians of Pakistani-descent of North America (APPNA) are coordinating their relief work through colleagues on the ground in Pakistan. The Student Welfare Society of the Khyber Medical College (SWS-KMC), Peshawar is one such entity that has been working closely with APPNA and the college’s North American alumni association. The group, led by the college vice principal, Professor Ejaz Hassan and staffed by the faculty and students, has been conducting relief activities in Nowshera, Charsadda, Swat and D I Khan since early August. APPNA’s president visited the flood-ravaged areas of Punjab, Sindh and Khyber Pakhtunkhwa, including the APPNA-sponsored relief camps, early last month for a needs assessment. The SWS-KMC and APPNA will now adopt two villages in Charsadda and Nowshera for the ongoing relief efforts. The King Edward Medical College Alumni of North America has just announced adopting a village in Muzaffargarh for rebuilding and rehabilitation. Another group of Pakistani-American doctors in Kentucky and Indiana is working in earnest to deliver water-purifying units to Pakistan.

These efforts are accompanied by active fundraising campaigns by individuals in the medical fraternity and organised groups like the alumni groups and APPNA. More than $ 500,000 have been pledged to APPNA while the Association of Pakistani Physicians of Kentucky and Indiana has raised above $ 200,000 through the efforts of its young leaders.

While the need for practicing humanitarian medicine is urgent and unlimited, unplanned volunteerism could also be chaotic. Dr David Welling et al in their article ‘Seven sins of humanitarian medicine’ (World Journal of Surgery, March 2010), have cautioned medical volunteers against: “1. Leaving a mess behind. 2. Failing to match technology to local needs and abilities. 3. Failing of NGOs to cooperate and help each other, and accept help from local organisations. 4. Failing to have a follow-up plan. 5. Allowing politics, training, or other distracting goals to trump service, while representing the mission as ‘service’. 6. Going where we are not wanted, or needed and/or being poor guests. 7. Doing the right thing, for the wrong reason.”

As the floodwaters recede, medical professionals, including those in the US, must brainstorm to determine a cogent course of action to provide continued assistance. Prudence demands that Pak-American physician leaders dedicate their working meetings to actively engage US and international agencies to plan and fund projects to rebuild the healthcare delivery system. Liaising with the National Disaster Management Agency (NDMA), the UN Office for Coordination of Humanitarian Affairs, medical teaching institutions and the civilian and military authorities on the ground, could help avoid a well-meaning but fragmented effort. While alleviating the pain of afflicted mankind, first, we must do no harm.

(Note: The views expressed are the writer’s opinion and do not represent any of the organisations mentioned)

The writer can be reached at mazdaki@me.com



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