Opinion

Ending Sexual Harassment and Abuse at the UN

GENEVA – Around the world, brave women (and some men) have been breaking the silence surrounding sexual harassment and abuse committed by those in positions of power. Their courage is paving the way for others to speak out about their own experiences.


Unfortunately, the experiences victims are describing have included sexual exploitation by staff of the United Nations. But it is not the responsibility of survivors to prevent abuse. That responsibility belongs to all UN staff members and leaders.

It is time to eradicate the culture of impunity that has prevailed for far too long within the international community. The priority should not be to protect those in power, but to ensure that survivors receive justice and the support to which they are entitled.

As members of the UN system, the Office for the Coordination of Humanitarian Affairs (OCHA) and the International Organization for Migration (IOM) have a zero-tolerance policy regarding sexual exploitation by our personnel against those we are assisting; the same is true for sexual harassment directed at colleagues.

OCHA and IOM are firmly committed to the global fight against sexual exploitation, abuse, and harassment in the humanitarian sector. To that end, we are taking decisive action across the domains of policymaking, advocacy, and operations to prevent and punish abuses.

The relationships between OCHA and IOM field staff and the vulnerable people they assist are built on trust. Sexual exploitation and abuse by humanitarian and development workers of the very people they are meant to be helping is the gravest violation of that trust. It fundamentally contradicts our organizations’ core principles and obligations.

To protect the vulnerable from sexual exploitation and abuse, we have adopted standard operating procedures for submitting and addressing complaints. We have established reporting, investigative, and disciplinary proceedings, as well as victim-assistance programs. And we are committed to mandating regular training for all staff members, and to making information about sexual-abuse prevention available to all personnel.

We have also reformed the OCHA and IOM human-resource structures to ensure better protection for aid beneficiaries across regional- and country-level offices. In field programs, UN Humanitarian Coordinators are charged with ensuring that effective prevention and response systems are in place, and they are expected to deliver annual progress reports to the Emergency Relief Coordinator.

Looking ahead, the leaders of all UN agencies and major nongovernmental organizations will need to maintain the current momentum on preventing sexual exploitation and abuse, as previously agreed through the Inter-Agency Standing Committee (IASC), a key humanitarian coordination platform chaired by OCHA. After all, there is still a long way to go before we can say that sexual abuse is a thing of the past.

Progress toward creating a culture of accountability suffers when incidents go under- or unreported. That is why we must ensure that all survivors know how to report abuse, and that they receive the justice they deserve.

But the UN’s zero-tolerance approach cannot stop there. We must also protect our own staff from harm. Workplace sexual harassment is a violation of basic rights and the UN Charter. It also causes emotional and physical harm, and generally excludes women and gay, bisexual, transgender, and intersex personnel from participating fully at every level of an organization.

In fact, achieving greater diversity is crucial for protecting staff from sexual harassment, which is why we have made it a high priority. Recruiting more women in all areas and at all levels would almost certainly accelerate the pace of progress. But, at the same time, we must not forget that men, too, can become targets of sexual harassment and abuse in the workplace.

In line with Secretary-General António Guterres’s UN-wide policy on workplace sexual harassment, we have imposed strict zero-tolerance policies in each of our organizations. And we have established reporting mechanisms and follow-up procedures to address abuses at the highest levels. Now, this progress needs to be matched with proactive policies to empower survivors and prevent abuses in the first place.

Sexual harassment in the workplace, like sexual exploitation of people in need, has no place in the United Nations, or anywhere else. As international officials, we feel a special responsibility to lead by example and continue to work every day to eliminate these scourges once and for all.

Mark Lowcock is UN Under-Secretary-General for Humanitarian Affairs. William Lacy Swing is Director General of the International Organization for Migration (IOM).

By Mark Lowcock and William Lacy Swing

A Bangladeshi Prescription for Cholera

DHAKA – By now, cholera should be history. For decades, health officials have understood how to prevent the disease, doctors have known how to treat it, and development experts have recognized that with clean water and sanitation, outbreaks rarely become epidemics. Unfortunately, the world is not so simple and neat, and the nightmare of cholera persists.


In many parts of the world, cholera has in fact been tamed. Waterborne illnesses are virtually nonexistent in advanced economies. And even in resource-starved countries and regions where cholera remains a problem, the availability of oral rehydration therapy, or ORT, has helped prevent countless deaths.

And yet cholera continues to flare up during times of crisis, killing the most vulnerable among us. One of the worst epidemics today is ravaging Yemen, where armed conflict has led to the collapse of health, water, and sanitation systems – precisely the conditions under which cholera thrives. The first cholera cases were reported in October 2016; within a year, the number of cases had soared to more than 600,000.

International organizations like the United Nations and the World Health Organization, in cooperation with Yemeni health-care officials, have mounted an impressive response. Their efforts have kept the fatality rate to roughly 0.33% of infections (some 2,000 deaths), mitigating the tragedy. But Yemenis are working in impossible conditions, and need resources and training. My country is leading the effort to ensure that they receive both.

In October, a team of Yemeni nurses and doctors arrived at the International Centre of Diarrhoeal Disease Research, Bangladesh (icddr,b), where I have worked for much of my professional life. Our institute is the birthplace of ORT, and medical professionals from around the world come to Dhaka to be trained to administer this simple solution of sugar, salt, other elements, and water.

Over the course of a week, Yemen’s health professionals received training on outbreak management, surveillance methods, and sanitation. They observed the treatment of cholera patients in our hospital, an experience that provided hands-on training for case management and assessing dehydration status.

This is just one example of how icddr,b has helped alleviate human suffering in times of crisis. As a founding member of the WHO’s Global Outbreak Alert and Response Network (GOARN), icddr,b has deployed expert teams to Zimbabwe, Sudan, South Sudan, Mozambique, Syria, Somalia, Haiti, Sierra Leone, Ethiopia, and Iraq. By sharing the knowledge and expertise that we have developed over decades of diarrheal disease management and research, we are playing a leading role in global efforts to tackle outbreaks.

Bangladesh knows wartime cholera all too well. In 1971, fighting broke out when Bangladesh, then known as East Pakistan, declared independence from Pakistan. In the ensuing conflict, refugees poured across the border into neighboring India into crowded camps, creating conditions that inevitably gave rise to cholera outbreaks. The standard of care at the time was poor, and a dearth of intravenous drips meant that rehydration solutions could not be administered widely.

As many people lay dying, a pioneering doctor named Dilip Mahalanabis took a chance in a desperate situation. American researchers in Bangladesh had shown that ORT could reverse fatal dehydration in cholera patients, but its effectiveness outside hospitals had not yet been proven. Lacking proper equipment and medical facilities, Mahalanabis administered ORT in camps, and in the process, saved thousands of lives. As a result, ORT became the new standard of care for diarrheal disease treatment; it has since saved more than 80 million people around the world.

Now, new wartime cholera crises have emerged, and Bangladeshi expertise is again being called into service. Yemen is only one example.

Since August, hundreds of thousands of Rohingya have crossed the border into Bangladesh from Myanmar, the highest weekly outflow of refugees anywhere in the world since the Rwandan genocide in 1994. These desperate and vulnerable people are crowded into refugee camps, and there is a high risk that conditions may lead to a deadly cholera epidemic.

In response to this threat, icddr,b is collaborating with UNICEF, the WHO, and other important stakeholders on multiple cholera-prevention initiatives. Efforts are being made to improve access to clean water and sanitation, and ORT sachets are being stockpiled. We have also worked with the WHO to secure some 900,000 doses of oral cholera vaccine (OCV), an internationally accepted tool to prevent and control outbreaks.

Like ORT, the development of OCV has roots in Bangladesh, and at icddr,b in particular. The vaccine’s first successful field trials were conducted at icddr,b in the 1980s, and today, our scientists are drawing on decades of institutional knowledge to execute the second-largest OCV campaign ever conducted.

It might be hard to imagine that a developing country like Bangladesh could play a pioneering role in managing a disease of such magnitude. But time and again, researchers and health workers in Bangladesh have demonstrated their expertise at containing cholera outbreaks and saving lives. As the world looks for new ways to curb opportunistic epidemics, it must not overlook the science that developing countries already possess.

Cholera is back in the Global South. But, as our work in Bangladesh demonstrates, the Global South has the skills to beat it.

Azharul Islam Khan is chief physician and head of hospitals at the International Centre of Diarrhoeal Disease Research, Bangladesh (icddr,b).

By Azharul Islam Khan

Good Times at Last?

LONDON – In February 2017, I wrote an optimistic commentary called “The Global Economy’s Surprising Resilience.” The piece came as a surprise to those who saw only bleak prospects for Western countries, not least the United States, where US President Donald Trump had just been inaugurated.


Now, nearly a year later, my three decades of experience in global financial markets leads me to believe that the economic situation is not quite as straightforward.

On the positive side, the half-dozen cyclical indicators I listed last February remain strong, and some have even strengthened further. One key indicator is South Korea’s monthly trade data. The country’s exports grew by 15.8% in 2017, the largest increase since 1956, when it began reporting these data. Moreover, export growth occurred even as Trump threatened to withdraw from the US-Korea Free Trade Agreement and stoked tensions with North Korea – a powerful rebuke to those who have predicted retrenchment of global trade.

As I suspected a year ago, the slowdown in global trade in past years probably stemmed from the euro crisis and falling commodity prices, and would thus prove temporary. Now that those two events are behind us, global trade appears to have picked up.

Of course, much will depend on whether trade momentum can be maintained. Although South Korea’s export performance in December was impressive, it fell slightly short of forecasters’ expectations. We will have to wait and see if it remains strong in 2018.

Another key cyclical indicator is reflected in monthly Purchasing Managers’ Index (PMI) surveys for manufacturing and services, which include underlying sub-indices for inventories and sales. Here, the news is remarkable: PMI survey results in many countries around the world are the strongest they have been in years.

That includes the US, where I have found the Institute of Supply Management’s manufacturing index to be consistently accurate and indicative of underlying realities. It also includes the eurozone, where PMI-survey data have reached their highest levels since before 2000.

Even the United Kingdom’s monthly PMI surveys are showing momentum, though not as much as in other Western countries, most likely owing to the Brexit effect. If the global economic environment continues to improve, the UK might luck out in its timing for withdrawing from the European Union, notwithstanding the growth-weakening effects that Brexit will surely have.

Crucially, key indicators for China are looking good, too, particularly in terms of long-term growth in services and domestic consumption. I continue to believe that these two factors will prove immensely consequential not just for China, but for the rest of the world as well. Many countries want to export more than just commodities and manufacturing inputs to China, and companies around the world are jockeying for access to China’s massive domestic market.

All told, forecasts projecting global GDP growth of 4% or more for 2018 seem credible. I would not be surprised to see sell-side forecasters lifting their numbers even further in the next two months. The International Monetary Fund almost certainly will at its annual spring meeting, if not sooner.

So, what’s not to like in the global economic picture for 2018? For starters, as a veteran of financial markets, I am usually wary of a strong consensus. While many oft-cited concerns in 2017 turned out to be unwarranted, that doesn’t mean economic risks have disappeared.

In contrast to a year ago, people are increasingly acknowledging that the global economy is stronger than they had thought. But if growth continues to accelerate, the US Federal Reserve might end up hiking interest rates more than markets anticipated. And the other major central banks, particularly the People’s Bank of China, the European Central Bank, and the Bank of Japan, might reverse their exceptionally loose monetary policies.

To be sure, if the global economy is truly returning to relatively high and stable growth, monetary-policy tightening need not be harmful – and may even be less harmful than waiting for stronger evidence of inflation to emerge. Nevertheless, the world’s major economies have enjoyed remarkably generous monetary policies for a decade – and for far longer in Japan’s case. At the end of the day, no one really knows what the consequences of higher interest rates will be.

For my part, I suspect that productivity growth will accelerate in a number of places, which would justify monetary-policy adjustments and make rising interest rates more tolerable. But that is just a hunch, based on my reading of tentative wage and productivity data in the UK and the US, among other places.

One final concern is that, while not having gone full circle, the global mood has shifted from fear about political risks to obliviousness, even though many such risks still loom large. The potential fallout from poor US leadership in the Middle East and on the Korean Peninsula cannot be ignored; nor can the long-term challenges still confronting Europe. I have long believed that, at least for financial investors, it is better for everyone to be worried about everything than for a small minority to be worried on everyone else’s behalf.

Still, and more important, as long as financial conditions don’t tighten excessively as a result of today’s cyclical strengthening, global economic performance for the rest of this decade could end up being more robust than anyone would have imagined just a few years ago.

Jim O’Neill, a former chairman of Goldman Sachs Asset Management and a former UK Treasury Minister, is Honorary Professor of Economics at Manchester University and former Chairman of the British government’s Review on Antimicrobial Resistance.

By Jim O’Neill

The Fear Factor in Today’s Interest Rates

CAMBRIDGE – Many who attended grade school during the Cold War will remember what they were instructed to do in the event of a nuclear attack. When the siren wailed, US students were told, one should “duck and cover.” Apparently, squatting under your desk with your arms covering your head would save you from nuclear annihilation. If only it were so.


To recall this absurd advice is also to appreciate the current angst now being felt in Japan. Several times in recent weeks, cellphone texts (today’s sirens) have informed the public that the faint streak in the sky overhead is an intercontinental ballistic missile launched by a nuclear-armed 33-year-old dictator with impulse control issues.

This is a manmade threat to the world order that Atlantic-hugging policymakers and pundits, buffered by a continent and a large ocean to their west, may not fully appreciate. But the threat posed by North Korea’s Kim Jong-un has had a significant effect on global financial markets in recent months.

Simply and discouragingly put, sabre-rattling on the Korean Peninsula has increased the risk of direct conflict with the North, which would shatter the relationship between China and the US. Any such conflict would involve massive loss of life and trigger a large regional, perhaps global, contraction in economic activity.

The theory of “rare disaster risk” has progressed considerably in recent years, owing to the work of the Harvard economist Robert Barro. The core insight is that no one can rule out the occurrence of an Old Testament-style event – war, famine, pestilence, or societal collapse. Such disruptions to a settled way of life slash output, consumption, and human welfare. Because they do not happen often, they are far removed from the smooth center of the probability distribution from which baseline scenarios are drawn.

The experience of the Great Recession tells us what to expect from financial markets when output plummets: as inflation tumbles, so do nominal and real (inflation-protected) yields on Treasury bills. The yield curve flattens because owning a long-term term claim on a safe-haven asset is valuable insurance. As yields on Treasury securities fall, other spreads widen relative to them.

In the current context, geopolitical tensions create the remote possibility of a disaster – the odds of which shift daily – that would make everyone much worse off. We claim no special insight into the mind of Kim Jong-un, but knowing that there is an unknowable helps to make sense of current asset prices. In such circumstances, risk-averse investors, especially those more directly in harm’s way along Asia’s Pacific Rim, will want to insure against an adverse event by taking advantage of the expected financial-market effects now. Nominal, real, and inflation-break-even Treasury rates are lower than the cyclical position of the economy warrants, owing to investors’ perception of acyclical and atypical risk.

In a recent speech, Gertjan Vlieghe, a member of the Bank of England’s Monetary Policy Committee, pointed in the same direction. He explained that when future consumption prospects are misshapen relative to the tried-and-true bell curve, so that there seems to be a higher chance of bad outcomes, the market-clearing (or “equilibrium”) real interest rate falls relative to its history.

The growing perception of rare disaster risk has three implications. First, low interest rates do not necessarily indicate that advanced economies are mired in a low-growth trap as a consequence of adverse demographic trends and slow productivity growth. Rather, they tell us that competition for safe assets has heated up.

Second, this is no counsel for government to ramp up spending. The near-term cost of financing deficits is low because households are worried that the possible “seven lean years” will be very lean, indeed. If citizens are storing up for the worst case, are their leaders – even officials concerned about the cyclical management of aggregate demand – justified in throwing caution to the wind?

And, third, low policy interest rates in the advanced economies are not necessarily evidence of ample accommodation by the monetary authorities. This is because monetary-policy ease is measured in terms of the difference between the actual rate and the equilibrium rate. The current low policy rates maintained by the US Federal Reserve, the European Central Bank, and the Bank of Japan may not look so low if the equilibrium rate is actually low.

The idea of rare disaster risk complements other explanations for the current low level of real rates globally. Perhaps the risk of a remote catastrophe is what created the “global saving glut” that former Federal Reserve Chair Ben Bernanke warned about in 2005. And, if government officials are worried about future conflict, they may have greater incentive to push real interest rates lower through “financial repression,” so that they have sufficient budget space to prepare.

These, however, are explanations of longer-term trends. Recognizing the existence of the global savings glut helps us to understand the 15 years after the Asian financial crisis of 1998. Financial repression makes sense of the experience after wars or on other occasions when government debt piles up. Rare disaster risk is most likely a contributing factor in such episodes, and it may be even more relevant for explaining short-term dynamics in financial markets when missiles fly.

Carmen Reinhart is Professor of the International Financial System at Harvard University’s Kennedy School of Government. Vincent Reinhart is Chief Economist for Standish Mellon Asset Management.

By Carmen Reinhart and Vincent Reinhart

Supporting Turkey’s Refugee Response

NEW YORK – Turkey’s crackdown on press freedom and political dissent is of great concern to many, for good reason. But as regrettable as the government’s repressive policies are, Turkey’s role in protecting people who have fled armed conflict and persecution is worthy of support. Unfortunately, opposition to Turkey’s record on civil liberties is preventing many countries from working with Turkey on refugee protection.


Turkey currently provides safe haven to more refugees than any other country in the world. More than 3.4 million live in Turkey, of which 3.3 million are Syrian. Turkey also shelters tens of thousands of refugees from other conflict-ridden countries, including Afghanistan and Iraq. Nearly 5% of Turkey’s 80 million people are displaced from somewhere else.

Some Western countries have been generous in accommodating refugees from these conflicts. But, despite being poorer, Turkey has still taken in more than twice as many refugees as Sweden, Germany, and Canada, the three most accommodating Western countries. In fact, in recent years, Turkey has resettled more people fleeing violence than Europe and the United States combined.

A study by M. Murat Erdoğan, Director of Hacettepe University’s Migration and Politics Research Center, offers important insights into Turkish views on supporting these displaced people. Erdoğan found that, although Turkish society is “anxious and deeply pessimistic” about Syrian refugees, the prevailing sentiment is one of “reluctant acceptance.” Despite lingering concerns about coexistence, societal attitudes “do not escalate into reactionary behavior except for very exceptional circumstances.” While Turks rarely define Syrians as brothers and sisters in religion, or consider them cultural allies, they nonetheless tolerate their presence.

As in other countries, immigrants in Turkey exacerbate existing economic anxiety. The majority of Turks do not think Syrians should have the right to work, and many Turks are skeptical of refugee assimilation. While more than 70% of Turks believe Syrians will one day become permanent residents in Turkey, nearly 76% oppose giving Syrians Turkish citizenship.

But Erdoğan discovered that, despite the standoffish attitude of their hosts, more than half of Syrian refugees in Turkey are happy in the country, and that only 21.9% are “not happy at all” or “not happy.” Despite the difficulties they face finding work or accessing education, two-thirds of Syrians surveyed said they did not want to settle anywhere other than Turkey.

In addition to being unpopular among Turks, the accommodation of so many refugees from Syria and other conflict zones has cost the Turkish economy tens of billions of dollars. This suggests that the Turkish government has acted for humanitarian reasons, rather than in pursuit of domestic political gain. Even if the Turkish public is unenthusiastic, it has broadly accepted the government’s approach to the crisis, making the authorities’ actions all the more admirable. It is all the more impressive that most Syrians appear satisfied with their treatment.

There has been a great deal of discussion in Europe about how to manage the large inflow of refugees. Burden sharing by the European Union has produced very modest financial support for refugees in Turkey, with most of the aid going to help Turkey’s government stop further westward migration of the displaced.

But the findings of Erdoğan’s study – which was funded with support from the Open Society Foundation of Turkey – suggest that there may be a better approach. Rather than fund programs that prevent refugees from leaving Turkey, why not provide financial support to help them stay? Erdoğan’s data show most Syrians prefer remaining where they are, and no doubt Turkey could use help bearing the huge costs.

Turkey’s curbs on political freedom have made Europe understandably hesitant to provide financial support for any human-rights-related initiative that entails cooperation with the government. But Turkey’s humanitarian response to the refugee crisis is deserving of support; indeed, to the extent that such support advances integration of refugees, it would reduce the need for aid intended to keep asylum-seekers out of the EU. For the international community, decoupling two legitimate concerns – human rights and management of refugee flows – may be the only way to address either successfully.

Aryeh Neier, President Emeritus of the Open Society Foundations and a founder of Human Rights Watch, is the author of The International Human Rights Movement: A History.

By Aryeh Neier

Prisoners of Pain

PRINCETON – Last month, an Egyptian court sentenced Laura Plummer, a 33-year old English shop worker, to three years in prison for smuggling 320 doses of tramadol into the country. Tramadol is a prescription opioid available in the United Kingdom for pain relief. It is banned in Egypt, where it is widely abused. Plummer said that she was taking the drug to her Egyptian boyfriend, who suffers from chronic pain, and that she did not know she was breaking Egyptian law.


The UK media have been full of sympathetic stories about Plummer’s plight, despite the fact that she was carrying a quantity in excess of that for which a UK doctor can write a prescription. Whatever the rights and wrongs of Plummer’s conviction and sentence, however, the case illuminates an issue with much wider ramifications.

Last October, the Lancet Commission on Palliative Care and Pain Relief issued an impressive 64-page report arguing that relieving severe pain is a “global health and equity imperative.” The Commission is not the first to make such a claim, but its report brings together an abundance of evidence to demonstrate the seriousness of the problem. Each year 25.5 million people die in agony for lack of morphine or a similarly strong painkiller. Only 14% of the 40 million people requiring palliative care receive it.

The report begins with a doctor’s account of a man suffering agonizing pain from lung cancer. When the doctor gave him morphine, he was astonished by the difference it made; but when the patient returned the next month, the palliative-care service had run out of morphine. The man said he would return the following week with a rope; if he could not get the tablets, he would hang himself from the tree visible from the clinic’s window. The doctor commented: “I believe he meant what he said.”

Citizens of affluent countries are used to hearing that opioids are too easy to get. In fact, according to data from the International Narcotics Control Board and the World Health Organization, access to these drugs is shockingly unequal.

In the United States, the quantity of available opioids – that is, drugs with morphine-like effects on pain – is more than three times what patients in need of palliative care require. In India – where the man threatening to hang himself was from – the supply is just 4% of the quantity required; in Nigeria, it’s only 0.2%. People in the US suffer from over-prescription of opioids while people in developing countries are often suffering because of under-prescription.

Although it is generally the poor who lack access to opioids, the main problem is not, for once, cost: doses of immediate-release, off-patent morphine cost just a few cents each. The Lancet Commission argues that an “essential package” of medicines would cost lower-middle-income countries only $0.78 per capita per year. The total cost of closing the “pain gap” and providing all the necessary opioids would be just $145 million a year at the lowest retail prices (unfairly, opioids are often more expensive for poorer countries than richer ones). In the context of global health spending, this is a pittance.

People suffer because relieving pain is not a public policy priority. There are three main explanations for this. For starters, medicine is more focused on keeping people alive than on maintaining their quality of life. And patients suffering a few months of agony at the end of life are often not well positioned to demand better treatment.

Third, and perhaps most important, is opiophobia. The misplaced fear that allowing opioids to be used in hospitals will fuel addiction and crime in the community has led to tight restrictions on their use, and clinicians are not trained to provide them when they are needed.

While opioids can be harmful and addictive, as America’s current crisis demonstrates, the fact that something can be dangerous is not sufficient reason to impose extreme restrictions on its clinical use. Risks are justified when the expected benefits clearly outweigh the expected harms. Policymakers in the developing world are making a choice to impose what the WHO calls “overly restrictive regulations” on morphine and other essential palliative medicines. Low or zero access is neither medically nor morally justified.

Designing a system that provides adequate access to morphine without encouraging over-prescription or leaking drugs onto the black market is tricky but not impossible. The Lancet Commission draws attention to the Indian state of Kerala, where trained volunteers are at the center of community-based palliative care, bolstered by international collaboration with the WHO, university researchers, and non-governmental organizations. There is no incentive to over-prescribe, and no evidence of opioid diversion.

Another model worthy of study, the Commission says, is Uganda, where a hospice run by an NGO supplies the national public health-care system with oral morphine.

Laura Plummer’s smuggling of painkillers was doubtless foolish; her experience in an Egyptian jail will be a personal tragedy. But if her story is true, she is also a victim of the excessively tight restrictions on opioids that prevented her boyfriend from obtaining tramadol legally.

Plummer’s case thus highlights a broader misfortune: that so many citizens of developing countries are denied effective pain relief by governments in the grip of opiophobia. This is not merely foolish; in the words of the Lancet Commission, it is also a “medical, public health, and moral failing and a travesty of justice.”

Peter Singer is Professor of Bioethics at Princeton University, Laureate Professor at the University of Melbourne, and founder of the non-profit organization The Life You Can Save. His books include Animal Liberation, Ethics in the Real World and, with Katarzyna de Lazari-Radek, Utilitarianism: A Very Short Introduction.

By Peter Singer

Resuscitating Africa’s Health Care

FREETOWN, SIERRA LEONE – In late October, the International Federation of Red Cross and Red Crescent Societies (IFRC) confirmed what many had long suspected: millions of dollars donated to fight the Ebola outbreaks in Guinea and Sierra Leone had been mismanaged and stolen. The world’s oldest humanitarian organization was “outraged” by the findings, it said.


Needless to say, they were not alone.

I was national coordinator of Ebola burials for Sierra Leone at the height of the epidemic. For much of the crisis, beginning in 2014, we lacked the equipment and materials needed to contain the deadly virus. We lost many health workers amid the dearth of resources, and the thought of losing my own life – leaving behind a family and two young children – terrified me daily. These were anxious times for my country.

That anxiety has not vanished. My thoughts frequently return to colleagues who died during the heroic fight. And now, with confirmation that huge sums of aid were stolen, the grief is compounded by anger and disappointment – at the fraud itself, but also for what it says about Africa’s struggles to improve health-care access and outcomes.

The rampant fraud illustrates how problematic it can be when donors channel resources through big NGOs like the Red Cross. And the IFRC’s revelation is likely just the tip of the iceberg. Sierra Leone’s minister of health and sanitation first warned of the possibility of widespread fraud in May 2015; he even called for a full accounting of money received and spent. Unfortunately, his request was largely ignored.

The silence was lamentable, but not surprising; tracking donor funds is extremely difficult. When governments and private donors pledge monetary aid, the funds typically pass through a chain of large groups that determine how it will be allocated. But a full accounting often is never provided. For example, the United Nations Office for the Coordination of Humanitarian Affairs estimates that $3.3 billion was donated to the countries that were hardest hit by Ebola. And yet, the office’s data do not show how the money was spent.

There is widespread agreement among governments, development partners, and relief agencies that in a crisis like that caused by Ebola – or any other health emergency, for that matter – strong financial management is critical. Only with disciplined budgeting can staff be properly equipped and paid, hospitals stocked, and triage centers opened. When well-intentioned pledges fail to reach those in need, the result is measured in a lack of resources – from a shortage of doctors to a lack of vehicles to transport the sick and bury the dead.

Anger was my first emotion upon learning of the IFRC funding fraud. But it is the second sentiment – disappointment – that must drive Africa forward. If the continent is to make gains in achieving universal health coverage (UHC) and improving the quality of health care for everyone, it must start by ensuring that resources are used efficiently and fairly.

Some progress has been made in strengthening national planning processes and principles. And, according to the UHC 2030 Alliance, which works to improve the quality of and access to health-care systems around the world, recipient countries have done far more than their international counterparts to establish more effective budgetary frameworks. But Africa still has a long way to go before financial management and procurement systems meet adequate standards.

To improve the quality of Africa’s health-care systems, and avoid a repeat of the IFRC’s Ebola funding fiasco, countries that receive aid need better financial management protocols. In health emergencies, immediate aid is essential. But if that aid is to be allocated properly, recipient countries must already have the ability to manage large sums transparently. The goal must be to ensure that recipient countries have oversight over how donor funds are spent.

At the moment, the opposite is happening, and most African countries are like the parched sailor adrift at sea – we see money everywhere, but we have no ability to use it. To drink from the ocean of aid, African countries must first take control of their health-care funding destinies.

To do that, resources much be used efficiently. A regional and sector-wide approach is critical to improving coordination and preventing duplication. After the war and genocide in Rwanda, for example, the country’s government required that all development partners work according to the government’s agenda. Today, Rwanda is among the world leaders in health-care access and outcomes. Rwanda’s experience should serve as a model for other countries.

As the world observed Universal Health Coverage Day in December, I was left to reflect on the horrors of the last few years, and consider what steps we must take to improve health care in the future. In Sierra Leone, as elsewhere, the focus must be on strong leadership, governance, and partnerships. But most of all, we must use our collective dissatisfaction with past failures to fuel efforts to make quality health care a reality for everyone.

Samuel “SAS” Kargbo is Director of Policy and Planning at the Ministry of Health and Sanitation in Sierra Leone, and a 2015 Aspen Institute New Voices fellow.

By Samuel Kargbo

America’s Tax-Cut Peronists

WASHINGTON, DC – Name the country. Its leader rails against foreigners, erects various import barriers, and pushes for low interest rates and lots of cheap credit for favored sectors. Government debt is already high, but the would-be strongman in power decides to pile on even more by increasing the budget deficit, arguing that this will boost prosperity to previously unattainable levels. While the government claims to represent the common people, state contracts are awarded to friends of friends.


The answer, of course, is Argentina under Juan Perón, who was in power from 1946 to 1955 (and again briefly in 1973 and 1974), and many of his successors. One of the richest countries in the world around 1900 was laid low by decades of unsustainable economic policies that made people feel good in the short run but eventually ended in disaster, such as runaway inflation, financial crisis, and periodic debt defaults. (To be clear, Argentina’s economic policies today are quite different; for deep and up-to-date analysis, I recommend the work of my colleague Alberto Cavallo.)

But if your answer was the United States under President Donald Trump, you would not be far off. There is reason to fear that the US is now on the path to what was previously known as Latin American populism.

Consider the remarkable volte-face of the Republican Party on fiscal responsibility. There used to be a national debt clock in the hearing room of the House Financial Services Committee, and Republicans would rant about government profligacy as it ticked upward. When I was in that room recently, the clock was “under repair.”

Self-proclaimed “fiscal conservatives,” such as Mick Mulvaney (a former member of the House of Representatives who now runs government finances as head of the Office of Management and Budget), are close to enacting a massive tax cut, despite knowing that it will drive up the deficit and the national debt. Mulvaney and his colleagues could not care less.

Despite controlling both Houses of Congress and the presidency, the Republicans are beset by internal divisions. As a result, they are finding it hard to “pay for” the tax cuts with any reduction in tax expenditures (incentives for various activities such as corporate borrowing, mortgage financing, or retirement saving). But Republicans are deeply committed to gigantic tax cuts, in large part because their donors are demanding that they enact them. As a result, the US will merely end up with bigger budget deficits.

Facts used to matter in Washington, at least a little bit. But this is no longer the case in the age of Trump, at least not when it comes to taxes. Instead, the strategy has been to state, in a bald-faced manner whatever one wants to believe and heap ill-mannered abuse on anyone who cites evidence to the contrary.

In Chapter 3 of White House Burning, James Kwak and I reviewed what happened after the tax cuts enacted in 2001 under George W. Bush. Great promises were made about the cuts, including that they would help most Americans. But while they did help rich people become richer, there is no evidence that they delivered faster growth or higher incomes for the middle class. Instead, they boosted the budget deficit and contributed significantly to increasing the US national debt (by around $3 trillion through 2010), which weakened the government’s ability to respond to crises, either in terms of national security or financial instability.

I have testified repeatedly before Congress on matters of fiscal policy. During the financial crisis of 2008-2009, Republicans were certainly interested in the facts. But this quickly tapered off, most notably in the House of Representatives. In fact, Kevin Brady, the representative who told me most clearly that he was not interested in looking at even moderately inconvenient facts, is now Chair of the House Ways and Means Committee, which plays a key role in what happens with taxes.

Ron Wyden, the senior Democrat on the Senate Finance Committee, calls the proposed Republican tax cuts “a middle-class con job.” He is being polite.

The cut in corporate taxes that the Republicans are likely to support will not boost wages significantly. As the Congressional Research Service, describing the broader blueprint put forward by House Speaker Paul Ryan, has put it, “the plan’s estimated output effects appear to be limited in size and possibly negative.”

Including all possible positive effects of the Republican proposals, the Tax Policy Center has concluded that federal government “revenue would fall by between $2.4 trillion and $2.5 trillion over the first ten years and by about $3.4 trillion over the second decade.”

The Trump administration has responded to this type of sensible, fact-based analysis in the way one has come to expect: by being rude.

American populism in the Trump era, though promising great gains for working people, will in fact benefit only those who are already rich. To be fair, this is quite a twist on anything Perón could have imagined pulling off. The results of irresponsible populism, however, are always the same.

Simon Johnson is a professor at MIT’s Sloan School of Management and the co-author of White House Burning: The Founding Fathers, Our National Debt, and Why It Matters to You.

By Simon Johnson

Resuscitating Africa’s Health Care

FREETOWN, SIERRA LEONE – In late October, the International Federation of Red Cross and Red Crescent Societies (IFRC) confirmed what many had long suspected: millions of dollars donated to fight the Ebola outbreaks in Guinea and Sierra Leone had been mismanaged and stolen. The world’s oldest humanitarian organization was “outraged” by the findings, it said.


I was national coordinator of Ebola burials for Sierra Leone at the height of the epidemic. For much of the crisis, beginning in 2014, we lacked the equipment and materials needed to contain the deadly virus. We lost many health workers amid the dearth of resources, and the thought of losing my own life – leaving behind a family and two young children – terrified me daily. These were anxious times for my country.

That anxiety has not vanished. My thoughts frequently return to colleagues who died during the heroic fight. And now, with confirmation that huge sums of aid were stolen, the grief is compounded by anger and disappointment – at the fraud itself, but also for what it says about Africa’s struggles to improve health-care access and outcomes.

The rampant fraud illustrates how problematic it can be when donors channel resources through big NGOs like the Red Cross. And the IFRC’s revelation is likely just the tip of the iceberg. Sierra Leone’s minister of health and sanitation first warned of the possibility of widespread fraud in May 2015; he even called for a full accounting of money received and spent. Unfortunately, his request was largely ignored.

The silence was lamentable, but not surprising; tracking donor funds is extremely difficult. When governments and private donors pledge monetary aid, the funds typically pass through a chain of large groups that determine how it will be allocated. But a full accounting often is never provided. For example, the United Nations Office for the Coordination of Humanitarian Affairs estimates that $3.3 billion was donated to the countries that were hardest hit by Ebola. And yet, the office’s data do not show how the money was spent.

There is widespread agreement among governments, development partners, and relief agencies that in a crisis like that caused by Ebola – or any other health emergency, for that matter – strong financial management is critical. Only with disciplined budgeting can staff be properly equipped and paid, hospitals stocked, and triage centers opened. When well-intentioned pledges fail to reach those in need, the result is measured in a lack of resources – from a shortage of doctors to a lack of vehicles to transport the sick and bury the dead.

Anger was my first emotion upon learning of the IFRC funding fraud. But it is the second sentiment – disappointment – that must drive Africa forward. If the continent is to make gains in achieving universal health coverage (UHC) and improving the quality of health care for everyone, it must start by ensuring that resources are used efficiently and fairly.

Some progress has been made in strengthening national planning processes and principles. And, according to the UHC 2030 Alliance, which works to improve the quality of and access to health-care systems around the world, recipient countries have done far more than their international counterparts to establish more effective budgetary frameworks. But Africa still has a long way to go before financial management and procurement systems meet adequate standards.

To improve the quality of Africa’s health-care systems, and avoid a repeat of the IFRC’s Ebola funding fiasco, countries that receive aid need better financial management protocols. In health emergencies, immediate aid is essential. But if that aid is to be allocated properly, recipient countries must already have the ability to manage large sums transparently. The goal must be to ensure that recipient countries have oversight over how donor funds are spent.

At the moment, the opposite is happening, and most African countries are like the parched sailor adrift at sea – we see money everywhere, but we have no ability to use it. To drink from the ocean of aid, African countries must first take control of their health-care funding destinies.

To do that, resources much be used efficiently. A regional and sector-wide approach is critical to improving coordination and preventing duplication. After the war and genocide in Rwanda, for example, the country’s government required that all development partners work according to the government’s agenda. Today, Rwanda is among the world leaders in health-care access and outcomes. Rwanda’s experience should serve as a model for other countries.

As the world observed Universal Health Coverage Day in December, I was left to reflect on the horrors of the last few years, and consider what steps we must take to improve health care in the future. In Sierra Leone, as elsewhere, the focus must be on strong leadership, governance, and partnerships. But most of all, we must use our collective dissatisfaction with past failures to fuel efforts to make quality health care a reality for everyone.

Samuel “SAS” Kargbo is Director of Policy and Planning at the Ministry of Health and Sanitation in Sierra Leone, and a 2015 Aspen Institute New Voices fellow.

By Samuel Kargbo

Universal Education’s Moment of Truth

LONDON – For nearly seven decades of a tumultuous century, the Universal Declaration of Human Rights has served as a beacon of hope worldwide. But some of its finely crafted provisions have come back to haunt us in the form of some shocking new statistics.


Article 26 of the declaration states explicitly that every child has the right to free primary education. Yet, 69 years after that pledge, a record number of children – some 70 million – are caught in the crossfire of humanitarian emergencies that are denying them basic rights and placing their futures in jeopardy. Of these, more than 31 million girls and boys are displaced from their homes, and 11 million have been forced to flee their countries.

Compared to other children, young people displaced by conflict and crisis are half as likely to attend school. Not surprisingly, they are also the most likely victims of child labor, child marriage, and child trafficking – an unholy trinity that should weigh more heavily on the world’s conscience than it does. Of the 70 million children in peril, two in five have personally experienced violence or abuse. And although many of these children will likely never enter a classroom, school is precisely where they want – and need – to be.

“I don’t want to die,” one terrified girl begged from a war zone, “just study.” But, writing to a friend in the United Kingdom, she added defiantly: “I’m still alive, and my dreams are, too.” Her escape, her hope, and her heart all revolve around education.

The total number of children ensnared in emergencies – a figure that has grown by five million in just a few short years, and today outnumbers the population of France – will only worsen in 2018 if we fail to act decisively.

Global humanitarian response plans for the coming year, coordinated under the leadership of Mark Lowcock and the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), will now place greater emphasis on displaced children’s educational needs, with particular support for girls at risk of being forced into marriage. But, despite the courageous efforts of aid agencies, conditions may still deteriorate before they improve. In Bangladesh, for example, more than 300,000 child refugees have been forced out of their homes as a consequence of sectarian violence in neighboring Myanmar. And while most refugees there have received food assistance, health care, and emergency shelter, only one in ten – some 30,000 children – are currently attending school, because only 5% of the humanitarian aid needed to educate Myanmar’s refugee children has been met.

While it is a remarkable achievement that one million Syrian children are now enrolled in formal or non-formal education programs in the region – including many in schools running on double shifts – one million more refugee children from that conflict are still awaiting their opportunity. Another 1.7 million children are out of school within Syria itself.

There can be no excuses for our failure to provide an education to children in the 19 global crisis zones that have suffered emergencies for five years or more, especially in the Democratic Republic of the Congo (DRC), Sudan, and Somalia – where crises have persisted for over 20 years. In the DRC, for example, even after all this time we reach only 8% of the 760,000 children. Only $230 per year per person is available for basic needs such as water, food, and shelter, and less than $10 per child goes toward education.

This year must be education’s moment – a window of opportunity opened by a new consensus that education is critical to achieving the UN Sustainable Development Goals, including reducing maternal and infant mortality rates, spurring job creation, improving quality of life, and opening our minds to issues of gender equality. But, most important, this is education’s moment because the world’s young people are demanding it.

When a girl holds a book up to an insurgent’s gun in Pakistan, when teenage mothers exiled from South Sudan in neighboring Uganda make education for their children their top priority, and when lights seen from space might include clusters of children huddled by candlelight trying to read and study, we know that education’s moment has come. Education provides hope – hope that a child can plan and prepare for a future defined by opportunity, not by child labor, marriage, or a life on the streets.

Gordon Brown, former Prime Minister and Chancellor of the Exchequer of the United Kingdom, is United Nations Special Envoy for Global Education and Chair of the International Commission on Financing Global Education Opportunity. He chairs the Advisory Board of the Catalyst Foundation.

By Gordon Brown

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