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A political tragedy in Kabul
The Rabbani murder has the ISI signature
by Lt Gen Kamal Davar (retd)
THE assassination of former President of Afghanistan Burhanuddin Rabbani in his own house in the high-security diplomatic district of Kabul on Tuesday, while he was reportedly engaged, in his current capacity as the Chairman of the High Peace and Reconciliation Council, in peace talks with his old foe, the Afghani Taliban, is a grim reminder of the terrible political tragedy which stalks this hapless land. The macabre act has the clear signature of Pakistan’s infamous Inter Services Intelligence (ISI), which has been hyperactive and gruesomely successful in Afghanistan for years. That it is currently sabotaging all peace endeavours between President Hamid Karzai and the recalcitrant Taliban is no surprise to anyone, for Pakistan in the pursuit of its myopic strategy and eternal quest for “strategic depth” in Afghanistan, does not wish for peace to return to Kabul. With the US set to finally exit Afghanistan by 2014 Pakistan is striving to move into the political and strategic vacuum which will ensue on the departure of the Americans with the assistance of a pro- Pak Talibani dispensation which may likely replace President Karzai’s current administration in Kabul. That former President Rabbani was, like the similarly assassinated Northern Alliance leader Ahmed Shah Masood, pro-India is not a mere coincidence but a craftily orchestrated stratagem of the ISI, which has been at the forefront of coordinating anti-US, anti-Karzai and anti-India forces all across Afghanistan Thus this assassination along with countless high-profile killings in Afghanistan in the last few months -- like the Governor of Kandhar (a half-brother of President Karzai), the former Governor of Oruguzan Province, the mayor of Kandhar, besides many other loyalists of President Karzai -- has been music to the ears of anti-US warlords like Gulbuddin Hekayatmar, the Afghani Taliban, the Haqqani network and Al Qaida elements supported and handled by the ISI. The Taliban has been frequently targeting not only Afghan government assets but also the US and British offices in Kabul, the Intercontinental Hotel and various Indian development projects in Afghanistan. The Indian embassy itself has been violently struck twice in the last three years with major blasts clearly masterminded by the ISI as has been confirmed by the Afghan President himself and the Afghani intelligence. Notwithstanding the US plan of finally exiting Kabul by 2014, the currently grave unstable political situation may prompt the US/ NATO/ISAF forces to retain a reasonable presence in Afghanistan even beyond this time-table. Perhaps, the next US President (Obama or a Republican after the presidential elections in 2012) may have to face graver realities of exiting Afghanistan in disgrace or to stabilise and then exit Afghanistan. It will be in the larger interests of peace and stability in the violent expanse called Af-Pak that the US only departs after a modicum of peace returns to this region and a stable, democratic and secular government is in place in Kabul which can administer a restive, violent and diverse nation like Afghanistan, now for many years a pawn in the re-enactment of the “Great Game” being played once again. The situation in Af-Pak distinctly impacts India which has withstood, for nearly two and a half decades, Pakistan-sponsored terror acts not only in Jammu and Kashmir but also in its entire hinterland with alarming regularity. In a similar diabolical manner the ISI has been regularly targeting President Karzai’s loyalists in Afghanistan employing its terror-driven “strategic assets”. India has had historical links with Afghanistan for centuries and for the last many decades has endeavoured to assist this impoverished land with a variety of development projects inviting the ire of Pakistani, which considers Afghanistan as its exclusive strategic backyard. As the leading power of South Asia and an emerging global player, India has a vital role to play in stabilising Afghanistan, which otherwise is of great strategic importance to us in more ways than one. India could endeavour to get the US, and more importantly, Iran and Russia to chalk out a common strategy for establishing peace in Afghanistan. Regrettably, the two other important players in this region, China and Pakistan, are not likely to submerge their own devious goals for the common good and thus any efforts to get them to cooperate for a common regional solution for Afghanistan may remain a distant dream. India must not think of getting involved militarily in Afghanistan but should consider giving certain military arms and equipment to the Afghan Army and the Afghan National Police apart from increasing its training commitments towards them. India has already given $1.5 billion aid and committed an additional $500 million to them during Prime Minister Manmohan Singh’s visit to Kabul in May this year. As India continues its soft-power forays towards the friendly Afghans, it will be prudent to reach out to Afghans of all hues and ethnicity, especially the restive Pashtuns and strive to galvanise all of them into seeking peace with each other, making them wary of the machinations of Pakistan and pitfalls of a slide towards increasing fundamentalism. India, unmindful of the myriad security and theological challenges it will face in working towards peace and progress in Afghanistan, has thus to shoulder a unique responsibility towards its currently troubled neighbour, especially bearing in mind its own unique place in South Asia. A seat on the global high table requires clarity in strategy, adequate economic clout and a political will embellished with adequate military muscle. Afghanistan is a basket case for the world in general, and India in particular, to ensure that the global war on terror reaches its successful conclusion and thus the world and India cannot fail in the rugged geography of the Hindu
Kush.
The writer was the founder Director-General of the Defence Intelligence Agency, India. The views expressed are personal.
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Mangan in better times
by Lt-Gen Baljit Singh (retd)
WHEN on September 18, the international television focussed on Mangan, a lowly hamlet in the Sikkim Himalayas as the epicentre of a severe earthquake, my thoughts flashed back to mid-1903. That was when Mangan had been chosen as the last logistics staging base for the British Expeditionary Force (BEF) to Lhasa, primarily because the Teesta river valley here had a meadow vast enough for the BEF to camp in. Besides, it was the last habitation to commandeer yaks and ponies for the mission to Lhasa. This was also the occasion when officers and soldiers of the BEF (33 & 34 Sikh Pioneers and 2/8 G R) witnessed for the first time the spectacular sunrise over the Kanchenjunga, India’s highest and the world’s 3rd highest summit! It would inspire Claude White, the British Resident in Sikkim, to have a government rest house constructed on a knoll at Mangan, its bedroom window framing the “Five Treasuries of Great Snows,” as the five-fanged summit is called by the Lepchas, the true inhabitants of Sikkim. Over the next 20 years, Mangan would once again slide into anonymity till Major F M (“Hatter”) Bailey of the 34 Sikh Pioneers (BEF) assumed charge of the British Residency at Gangtok, in 1921. That is when Mangan truly became a name to reckon with both in the world of mountaineering and of natural history. In the intervening years Hatter Bailey had acquired such proficiency in Tibetan dialects that he chose to converse with the Dalai Lama without the presence of interpreters! Bailey’s sensitivity to Tibetan culture and empathy with its people so impressed the Dalai Lama that Bailey could call at the Potala without the usual protocol. It was, therefore, natural for the Foreign Office in London to harness Bailey’s good offices to obtain permission for the British to attempt the Everest summit. The permission was duly gained but Kathmandu refused the team transiting through Nepal! So Bailey was back to Mangan, both to arrange porters for the Everest expedition as also to enlarge the rest house, got constructed by White. He also added another rest house, five-day march up the Teesta valley, at Thanggu in the North. Over time, the occupancy registers maintained at Mangan and Thanggu became absorbing Everest memorabilia, of the first three attempts between WW I and II! During his frequent visits, Bailey also collected and catalogued many species of butterflies from Mangan unknown to science hitherto. Little wonder that today butterfly buffs place Mangan only second to Shillong as their Mecca! One wonders what the Lepchas (whose only space in the wide world lies around Mangan), would make of the terrible retribution now paid out to them by the earthquake. More than one lakh houses have been rendered unsafe and the count of the dead is far from certain,
yet.
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Healthcare needs to be accessible to all
Dr Ashok Jhingan
While scientific knowledge and health care products and services have advanced exponentially over the last generation, millions of people in India still die from preventable and curable diseases because they lack access to basic medicines and medical services. A four-point approach comprising awareness, acceptability, availability and adaptability needs to be adopted
THE desire for a healthy family, healthy society and a healthy country drives individuals and governments alike. Today, India might be termed as one of the rapidly growing economies amongst the developing countries but when it comes to the healthcare access in India, it still awaits a thorough consideration. A four-point approach comprising awareness, acceptability, availability and adaptability needs to be adopted to combat the poignant situation in the country. The healthcare facilities for Indian patients are largely unmet and hygiene, nutrition, wastage disposal, sanitation etc continue to be compromised. The situation is more critical in rural areas where people have limited access to information about preventive and curative measures as a result of which they suffer from multiple illnesses. Hence awareness about the new innovations, research, medicines and diseases becomes critical.
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Photo: Manoj Mahajan
Limited access
z
The healthcare facilities for
Indian patients are largely unmet and hygiene, nutrition,
wastage disposal, sanitation etc continue to be compromised.
z
The World Health Organisation
estimates that only 35 per cent of India’s population is able
to get essential drugs for common diseases.
z
More than a million Indians die
each year due to lack of proper treatment, most of them being
women and children.
z
Further, poor health impedes individuals’
ability to seek educational opportunities, to attain regular
employment and to reach full life spans.
z The
situation is more critical in rural areas where people have
limited access to information about preventive and curative
measures as a result of which they suffer from multiple
illnesses.
z
Hence awareness about the new innovations, research, medicines
and diseases becomes critical. If best healthcare service is the
ultimate goal then services must be available to the diverse
groups in society; fair play must be measured in terms of the
utilisation and outcomes of services.
z
All too often, the government’s perception has been that
healthcare is too costly and that by reducing prices, we have
somehow solved the problem. That unfortunately is not the case.
z
Focus on the role of the health system needs to be placed within
the broader and bigger context of the economic, social and
educational determinants of health. Improved water and
sanitation, food security, poverty reduction, and changes to
other structural factors, complemented by an equitable health
system, will help ensure greater equity in health for more than
a billion people.
z
The creation of a health consciousness and health literacy among
socially deprived individuals is an essential step to encourage
appropriate demand for available health services.
z
Several studies have concluded that it is not the affordability
factor that is the foremost barrier to healthcare access but
inadequate infrastructure that was denying patient access to
quality healthcare.
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India is a densely populated country where a large number of people live without access to the basic education and primary health facilities. The situation is more complex in rural villages as compared to the urban areas. Convenient distance, eligibility beliefs, and people’s satisfaction are the prerequisite for better access to healthcare. Even if services are available, and there is a perception amongst people of them being not acceptable, the effort goes in vain. Increasing perspective on access to health care and quality of health care services is important. Acceptability of health care services needs to be best understood by all. Factors that affect access to knowledge, education, and information also alter the appropriate demand for health services by affecting health beliefs, perceptions of health and illness. These are further affected by sociocultural factors, such as gender, religion, and cultural beliefs. If best healthcare service is the ultimate goal then services must be available to the diverse groups in society; fair play must be measured in terms of the utilisation and outcomes of services. The growth of private healthcare sector is a boon as it ensures quality healthcare, however it adds to ever-increasing social dichotomy. There is a need for adaptability at all levels. Health care providers as well as people need to adopt a range of approaches customised to the different needs and changing situations of. Regularly consulting can help all focus on meeting the greatest needs. All too often, the government’s perception of healthcare has been that healthcare is too costly and that by reducing prices, we have somehow solved the problem. That unfortunately is not the case. Focus on the role of the health system needs to be placed within the broader and bigger context of the economic, social and educational determinants of health. Improved water and sanitation, food security, poverty reduction, and changes to other structural factors, complemented by an equitable health system, will help ensure greater equity in health for more than a billion people. The creation of a health consciousness and health literacy among socially deprived individuals is an essential step to encourage appropriate demand for available health services. Need for better accessProviding adequate access to medicines and health care is one of the most challenging issues that India is facing today. While scientific knowledge and health care products and services have advanced exponentially over the last generation, millions of people in India still die from preventable and curable diseases because they lack access to basic medicines and medical services. Disparities in health and healthcare remain pervasive and problematic. The World Health Organisation estimates that only 35 per cent of India’s population is able to get essential drugs for common diseases. Despite 60 years of independence, majority of citizens have very limited access to quality healthcare and have poor health indicators like low levels of immunisation and high infant mortality rates. More than a million Indians die each year due to lack of proper treatment, most of them being women and children. Further, poor health impedes individuals’ ability to seek educational opportunities, to attain regular employment and to reach full life spans. The cost of medicines has for long been a constant topic of policy debate with critics routinely pointing to prices of medicines as the major barrier to access to health. However, in reality this is not true. Medicine is just one of the many important links in the health care chain, along with providers, hospitals and clinics, and health insurance. These all work together to provide health together. Focusing on one aspect such as pharmaceuticals, while ignoring the other aspects, cannot solve the problem of access to healthcare. The barriers to access are significant and entrenched throughout the health care system. They encompass geographical barriers, socio-economic barriers and gender barriers with respect to resources. By resource, we mean availability to adequate healthcare facilities, availability of trained healthcare professionals and diagnostics. While geographic barriers refers to limited means of transportation and infrastructure, socio economic barriers constitute cost of healthcare, social factors such as the lack of culturally appropriate services, language/ethnic barriers, and prejudices on the part of providers. Gender discrimination makes women the less privileged section with regards to healthcare and more vulnerable to various diseases and associated mortality. There have been many efforts to reduce the access gap in the last few decades. One measure was price controls of medicines but that hasn’t quite proven effective as it is curtailing research into new medicines. Now several studies have concluded that it is not the affordability factor that is the foremost barrier to healthcare access but inadequate infrastructure that was denying patient access to quality healthcare. The jury is still out. Better lives through research and innovation The ability of a country to sustain its economic growth, increase the standard of living of its citizens, and improve human health and surrounding environment, directly depends upon the successful development and commercialisation of new products, processes and services. Considering the present healthcare scenario in India and the large disease burden, it is crucial to constantly innovate and develop new therapies that either improves health or reduces sufferings of patients. Around the world, a lot is being done in the field of drug development in order to ensure universal access to healthcare. With non-communicable diseases on the rise across the world, especially in developing countries like India, the global pharmaceutical industry has about new 1,350 new medicines in the making to tackle diseases such as cancer, diabetes and cardiovascular diseases and 400 new medicines for infectious diseases such as HIV, TB and malaria — all of which are in advanced clinical trials and may be needed by thousands of patients, sooner or later. For example next generation medicines under development to treat diabetes have the potential to reduce the frequency of insulin injection to once a week, unlike the present scenario where it needs to be taken every day. Some of the big advances in vaccine research are new ways to discover novel vaccines, manufacturing technologies and delivery systems. In the past, where vaccines were always administered through a needle nowadays people are working on needle-free delivery, including skin patches, oral vaccines, intranasal sprays and even vaccination via food. The fight against AIDS too has gathered pace in the last few years. With rigorous R & D being carried out in this field, a new class of anti-HIV medicines is being developed to protect cells from HIV infection by preventing the virus from attaching to new cells and breaking through the cell membrane. Unlike the present mode of treatment which suppresses the viral load by modifying the course of the virus life cycle. Developing new medicines and vaccines is neither cheap, nor easy. On an average, it takes about $1.3 billion to bring new medicines to the market which includes the cost of all the failures along the way. Only about 1 in 10,000 candidates ultimately makes it to the market. Moreover, a drug has to go through numerous steps to prove its efficacy and safety and a long clinical trial phase of drug development which can easily vary from 10 to 25 years on an average, which is why the majority of local pharmaceutical companies have decided not to take the risk of developing new medicines and instead focus on manufacturing older medicines initially developed by others. There is no doubt that innovation is not only essential for business productivity but also for the individuals, groups and society as a whole. The booster dose for medical innovation requires a pulsating and participative network comprising patients, medical centres, universities, pharma industry and most importantly the government. All the stakeholders, therefore, need to act in concert for constant growth of the industry so that ultimately patients can be the greatest beneficiaries.
The writer is Chairman, Delhi Diabetic Research Centre
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