Showing posts with label development. Show all posts
Showing posts with label development. Show all posts

Wednesday, 4 December 2013

Taking action on the global health worker crisis

A couple of weeks ago I covered the importance of a well-trained, well-paid and well-respected human resources system in providing free universal healthcare globally. I analysed the challenges of doing so and examined some of the factors which can enable or inhibit good practice. Since then I’ve become aware of a new drive, flagged up by Health Poverty Action, which highlights the UK’s responsibility when it comes to global human resources in the field of health. It emphasises a developmental imbalance - with serious consequences for developing countries - created by the Western exploitation of global health worker labour.

Health Poverty Action has identified more than fifty countries, mainly in Africa and South Asia, which suffer from a “critical shortage of health personnel” while simultaneously carrying “a large part of the global burden of disease.” At the same time the increased necessity of long term care for ageing populations in European countries is creating strong demand for health workers, fuelling the migration of health workers to Europe from developing countries in today’s heavily globalised labour market.

Image of health worker in clinic in Tsumkwe in Namibia (c) Health Poverty Action

Health Poverty Action has been calling for the UK to “compensate developing countries for its role in the global health worker crisis.” There is a cached copy of the call here; I'm not sure what has happened to the plan to get supporters to write to UK MPs. The charity points to the shortage of health workers in developing countries and the UK's strong record of employing health workers who are originally from developing countries and migrate to the UK to work. HPA is not challenging people’s entitlement to move for work, to earn, to study and to create better lives, but instead seek simply to raise awareness of the consequences of the health worker shortage in developing countries. The responsibility for this must be on world governments engaged in large scale health infrastructure and planning. The shortage of health workers in developing countries results not only in poorer treatment there but in a variety of deficits which weaken the entire health system in the long term, from the under-staffing and under-maintenance of hospitals, clinics and rural health stations to poorer quality and less up to date training and education, the under-provision of medical equipment, the reduced chance of future investment when a future workforce cannot be relied upon and much more.

The charity adds,
It is estimated that 1 billion people [virtually all in developing countries] will never see a health worker, putting them at risk of dying from easily preventable diseases, from childbirth and basic health conditions.
The report Aid in Reverse challenges the UK government to play a conscientious and responsible role in ending the global health worker crisis, which Health Poverty Action labels a developing world “brain drain.” They suggest that in the UK the Departments of Health and International Development could work together on two complementary issues: first, treating the roots of the UK’s own shortage of health workers through better planning, training and education; second, giving something back to the developing countries whose health infrastructures are being weakened through lack – with severe ramifications for those nations’ own long term development – while they contribute so much to developed nations’ healthcare systems.

The challenge to developed nations who use the labour of talented health workers from developing countries to ensure their own citizens’ wellbeing is part of a pan-European initiative aiming to create a sustainable global health workforce. One of the main directives of the project is the implementation of a World Health Organisation Global Code of Practice on the International Recruitment of Health Personnel. The project’s tagline runs,





Bidisha is a Fellow of the 2013 International Reporting Project, covering global health and development.

Wednesday, 20 November 2013

"Every woman has basic human rights" The Circles empowering women for health, development, education and freedom from violence

Earlier this year I chaired a panel with Joan Smith, Baroness Helena Kennedy and the novelist Kishwar Desai. We were discussing male sexual violence in India, following the worldwide protests about the rape, torture and murder of a young woman in Delhi. The event, at The Nehru Centre in London, was held to launch Desai's latest novel Sea of Innocence, which tackles the same issue and also provides shocking details of the Delhi case which hadn't previously been revealed in the media. In its ability to combine a strong heroine with a thrilling plot and urgent contemporary issues, Sea of Innocence follows on from Desai's previous novel The Origins of Love, which looked at the Indian international surrogacy trade.

The conversation during the Sea of Innocence launch event was wideranging. We looked at all aspects of global rape culture, which transcends colour, religion, class, language, country, culture and hemisphere: the blaming of victims, the excusal of perpetrators, the prejudice against survivors of sexual violence, the silencing and abusing of survivors who speak out, extreme and perverse leniency towards perpetrators even when they are convicted. Male sexual violence, which is endemic, reflects, partially creates and also reinforces women's inequality, disempowerment and subjugation. This disempowerment is obvious in every area: in the discrimination against us in the workplace; in the exploitation of our labour, which is unpaid, under-paid, under-valued and over-consumed; in the denial of our rights over our own bodies; in the casual and constant judging, slandering, undermining and defamation which constitutes the majority of all comments made to and about women; in the way we are represented in mainstream culture, images, advertising and the media as silent pieces of nice-looking meat, pathetic and useless idiots or bitter, petty, malicious schemers; and in the strong resistance against female education, landholding, powerful visibility, money-making, public involvement, mobility in public spaces (which is delimited by harassment and threat), enfranchisement, leadership, influence, direction and presence. Writing specifically on rape culture, structural misogyny and gender inequality in India, there is a brilliant analysis by Tehelka Media which I urge everyone to read.

As UNIFEM states, "One woman in three will be raped, beaten, coerced into sex or otherwise abused in her lifetime." Male violence against women is so common that it has been described by the World Health Organisation as being "of epidemic proportions." Read the major, multi-national WHO study into domestic violence and see why they identify it as "a major public health and human rights problem throughout the world."

After the Sea of Innocence panel discussion I was approached by an impressive woman, Santosh Bhanot, who told me that she was involved in a project called The Circle, in affiliation with Oxfam. The Circle aims to address some of the fundamental issues and abuses which keep women worldwide in a state of disempowerment and inhibit our equality and our access to justice, rights and autonomy. Another underlying goal is to lift women out of poverty through gender empowerment.

The issue of poverty, often spoken of in general terms, is starkly gendered. According to Oxfam,

Of the 1.3 billion people living in extreme poverty worldwide, more than two thirds are women and girls.

Women and girls are the most disadvantaged of the disadvantaged, the most abused of the abused and the most exploited of the exploited. This has not arisen by some kind of unfortunate, fated magic but directly through the actions of patriarchal systems and many individual but misogynistically and patriarchally like-minded perpetrators, users and exploiters. When we defy all silencing and stigma to speak about what we have undergone we suffer the further grotesque abuse of being blamed for men's abuse of us, told that we deserve it, told that we brought it on ourselves by our own behaviour or told that we are lying out of malice to hurt men. We are then punished further by being slandered, marginalised or ostracised.

As Everjoice Win from ActionAid International, South Africa, states in a report about how helping women and girls is the key to ending poverty,

We believe that women are vulnerable and more impoverished compared to men because they have been systematically made vulnerable by years of violence, patriarchal power and control, as well as decades of inequitable laws and policies deliberately designed to put them in this position.

The Circle was founded in 2008 by Annie Lennox with the aim of connecting high profile, culturally influential women of expertise in various areas. A network of Circles will raise consciousness and money (here's the catch: money for Oxfam) to spend on a range of grassroots projects tackling everything from poverty to education to maternal health. They will also work "to reduce all forms of violence towards women, by helping to change attitudes."

The idea is that the various Circles support specific projects of interest but are all part of the wider Circle ethos of women helping women to change the world for everyone. A group called The Lawyers' Circle supports women's legal rights in Africa; The Music Circle raises money to protect women in the Democratic Republic of Congo; The Oxford Circle is looking at improving health and education in Niger and hopes to engage Oxford University and local city businesses in supporting this aim.

So far, significant money has been raised for a broad range of change-making initiatives. In Zambia the Circle project, working with Oxfam, is helping community schools. These are volunteer-run initiatives which provide vital education for one million Zambian children. However, those involved require more training and resources; the Circle's work in this area benefits 18,000 students in 25 schools and strongly supports the education of girls.

In Pakistan the We Can project is a grassroots initiative aiming to reach 800,000 people in combating "endemic" male violence against women, advocating for it to be reported and investigated and for a social shift which recognises male violence against women as abuse rather than normalising it and blaming victims rather than perpetrators.

The Circle has been working on improving maternal healthcare in Ghana, where 75 women a week die due to complications in pregnancy and childbirth. The focus here is on the provision of free healthcare to reduce maternal mortality. This is an achievable goal: other, non-Oxfam projects worldwide have shown the marked success of dedicated maternal mortality, pre- and ante-natal and newborn health projects. Please see my reports on Sierra Leone and Burundi and India for more details.

Two women's co-ops in Liberia have been helped to provide women with tools and training and empower them to bargain for better terms in a country in which, says Oxfam, "80% of ...women are unemployed." One little note to make here to correct that subtle patriarchal diss: these women, I can bet you, are employed. They are totally employed, to the point of exhaustion. They are employed in the never-ending, repetitive, back-breaking, all-consuming drudge labour of looking after the children, serving the men, running a household, cooking, cleaning and everything else - and these are all separate jobs - and their work is used and taken and exploited for free. They are paid nothing for their 24-hours, 7-day-a-week employment and it is callous and disrespectful to say that these same women are "unemployed." It is more accurate to say that they are exploited in an unjust situation. Despite the work they do, they are economically dependent on men and marginalised by them from economic power, political status, public influence and social clout. This exploitation and depletion of energy, financial and legal marginalisation and political discrimination mean that it is difficult for women to fight together for equality, rights and freedom from violence.

The latest addition to the Circle network is The Asian Circle, which works alongside Oxfam in helping South Asian women. It was founded and is chaired by Santosh Bhanot, the woman I met at the Kishwar Desai event. The focus is wide: The Asian Circle will be pulling together high profile women to support projects in agriculture, education, disaster relief and management, poverty reduction and sustainable development.

The Asian Circle was launched at the Houses of Parliament on 7th November 2013 in an event chaired by BBC reporter Ayshea Buksh and featuring speeches by Southall Black Sisters activist and journalist Rahila Gupta (read some of her human rights focused pieces here) and Kishwar Desai.

Santosh Bhanot spoke at the launch of The Asian Circle:




This week she told me,

Our focus is to work towards change with the skills and talents of ...[the] women who are part of the Asian Circle, a group of passionate and highly influential women from all walks of life. I wanted to help women who have an unfair chance in life and I particularly have passion and energy to work with women in South Asia because of my roots [as a South Asian woman]. Every woman has basic human rights.

On my recent visit to India I saw the positive impact of programs by Oxfam working with vulnerable women. For instance, building support centres for women subject to domestic violence and providing mediation and legal support. More programs are needed, especially in the poorer states.
The first programme The Asian Circle is supporting is called "Promoting Violence Free Lives." According to the Indian National Family Health Survey Round III report of 2005-2006 and the Oxfam India 2010 Baseline Survey, the statistics are damning, as are the social values which have been revealed:

  • 35% of women suffer sexual or non-sexual violence in India
  • 72% of men believe male violence against women is justified
  • 68% of women believe that husbands are justified in beating wives

Rahila Gupta welcomes the connection between the feminism, profile and zeal of The Asian Circle and the structural support Oxfam can provide:
This is the launch of a very important initiative. If my last 24 years with Southall Black Sisters has taught me anything, it is this: funding, funding, funding. The time that we would like to spend delivering frontline services is spent instead on raising funds without which we'd have no money to deliver anything. So it's great that the Asian Circle aims to help Violence Against Women projects in India escape that vicious cycle.

The Asian Circle is focusing on the poorest states with a multi-tiered, thorough strategy: to build support centres in police stations for women who have suffered gendered violence; to engage community elders, young men and boys through educational initiatives to change their attitudes and their behaviour; and to develop networks of women working at a state level to make sure that domestic violence laws are implemented rather than ignored.

Kishwar Desai told me,
As someone who has been trying to raise awareness about some very disturbing gender issues in India for a while now, I am sincerely grateful to see the formation of The Asian Circle. My personal hope? That they will be the catalyst, eventually, for providing an international platform for Asian women, perhaps leading to a women's liberation movement in Asia.


Bidisha is a 2013 International Reporting Project fellow, covering global health and development.  

Friday, 1 November 2013

Nutrition and maternal, newborn and child health: joining the dots and looking beyond the Millennium Development Goals

A news bulletin sent around earlier this year by Dr Carole Presern, Executive Director of The Partnership for Maternal, Newborn and Child Health, threw down the gauntlet for the world community. At the time of the G8 summit – which I covered here in relation to the Enough Food For Everyone IF… campaign – the PMNCH highlighted the importance of nutrition. Since then I have found the work and the general approach of the PMNCH to be invaluable in joining the dots between various global health and development issues now that world leaders and development workers are considering a framework for initiatives extending beyond 2015.

The result of this summer’s discussions and presentations was the signing, by numerous international players, of the Global Nutrition forGrowth Compact, with up to $4.15 billion committed on this initiative up to 2020. Those who contributed to this strong pledge for a reduction in under-nutrition included the Bill and Melinda Gates Foundation, World Vision and Save the Children.

As Dr Presern writes,
Leaders should be especially motivated to see pledges result in measurable action. Bringing commitments to invest in nutrition under the umbrella of the Every Woman Every Child movement led by UN Secretary-General Ban Ki-moon would provide a useful framework for tracking their progress. We look forward to supporting efforts in this direction.
All of these issues are already very high on the international agenda. At the 66th meeting of the World Health Assembly in Geneva in May this year, global delegates passed a resolution to implement the recommendations of the United Nations Commission on Life-Saving Commodities for Women and Children and also discussed a first-ever action plan pertaining to newborn health to end preventable deaths, which will be realised at the 2014 World Health Assembly.

At the Nutrition for Growth event in June, Justine Greening MP from the Department for International Development spoke about the importance of nutrition as a major development issue. She also outlined the financial pledges made by the international community of leaders in politics, social enterprise and business. She added,
Under-nutrition is stopping children and countries from reaching their full potential, accounting for the loss of billions of dollars in productivity. A strong and healthy workforce is vital if a country’s economy is to prosper. This means business and science taking a lead in fighting for good nutrition because we understand that better nutrition is the smart way to tackle extreme poverty, child mortality and economic underachievement.
What has to happen next is an integration of understanding between the issues – and, I would argue, an analysis of how gender inequality and sexist social values underpin many of the disadvantages, risks and problems covered.

The PMNCH’s own research provides a nuanced analysis of the relationship between nutrition, sustainable development and women’s and children’s health. Their findings were developed for the Open Working Group of the UN General Assembly in preparation for the formation of post-2015 development plans. They make a strong case for the importance of investment in nutrition for women and children as a major factor in ensuring sustainable development and its four pillars of economic development, environmental sustainability, social inclusion and peace and security; these criteria having been delineated by the UN System Taskforce on Sustainable Development.

This is about more than being hungry or not getting the right vitamins or minerals. Malnutrition and under-nutrition, rooted in long term poverty, inequality and disadvantage, have wideranging and interconnected health, social and economic consequences which do not affect just individuals but entire families, communities and generations. Their finding – spelled out in greater detail here, with references to specific studies – demonstrate myriad risks of malnutrition.

The report states,
Malnutrition contributes to disease and early deaths, especially for women and children. Malnourished women have lower birth weight babies resulting in children born into unhealthy, poorer families… and a lifetime of nutrition-related morbidity and mortality, which affects a woman’s own health and productivity and that of her offspring.
What is particularly interesting about the report is that it doesn’t just chronicle a problem, it also points to the benefits of action, stating that improved nutrition and greater health result in higher productivity. The findings are that women who are healthy, fed and working participate in the economy from a stronger position, both saving and investing. Healthy, well-nourished children have better mental development and learning skills and are more likely to stay in education and therefore to have a greater chance of earning more. The report points out that those who did not receive adequate nutrition in utero and in their earliest years “has been associated with reduced labor supply” and consequently lower adult incomes and therefore lower productivity at a mass level, across countries, where under-nutrition is widespread.

Whether or not you agree with this approach – that we should nourish human beings because they’ll then nourish capitalism more heartily instead of lying there like non labour producing duds - rather than seeing this as a human rights issue – it’s an interesting insight into the dramatic difference something as basic as nutrition can make.

There is also the cost of treating malnutrition:
  • In some  low-income countries, the direct costs of iron deficiency (disease and death) are as high as 0.57% of  GDP, while indirect costs (related to physical and cognitive losses) can reach 4% of GDP.8

As a final thing to think about, the PMNCH also considers the risks and consequences to the health and the economy of too much food (and of the wrong time), not just too little food. In environments where the issue is not lack of food but over-consumption of food which is not nutritional and involves many risky factors (processed and refined food, food containing many additives and few nutrients, food high in salt, sugar and trans fats) there is an ever-rising figure, currently up to 8% of healthcare spending, associated with obesity. In China, right now, the cost of dealing with obesity is actually more than the economic costs associated with under-nutrition.

Related articles:



 Bidisha is a 2013 International Reporting Project Fellow reporting on global health and development.







Wednesday, 25 September 2013

When free universal healthcare isn't free and isn't universal: a case study in TB treatment from Burkina Faso

As the term of  the current Millennium Development Goals reaches an end in 2015, healthcare workers and reporters worldwide are assessing the efficacy of different global health and development approaches over the last few years. The necessity of improving global health has been one of the highest priorities of development practitioners and activists, the touchstone being universal access and free access.

One project study, which aimed to provide free treatment for tuberculosis patients in Burkina Faso, caught my eye because it illustrates the subtle challenges and difficulties (as well as areas of success) which arise when it comes to the practicalities of delivering healthcare which is intended to be both free and universal. The findings of the research will be vital in shaping world healthcare policies when it comes to the treatment, control and prevention of TB after the timeframe of the current Development Goals.

Based on meticulous year-long research by Samia Laokri, Olivier Weil, K Maxime Drabo, S Mathurin Dembelé, Benoît Kafando & Bruno Dujardin, the study - an abstract is provided here by the World Health Organisation - demonstrates the flaws of a generalised or sweeping analysis, starting with the "theory [that] the removal of user fees puts health services within reach of everyone, including the very poor." They warn,
In the poorer countries of the world, where most people live on less than US$ 2 per day and expenditure on health care can plunge patients and their families into extreme poverty, the removal of user fees for health is seen as a matter of real urgency. Unfortunately, this is unlikely to be enough to ensure truly universal coverage.
A full version of the report is here and I have provided my overview and analysis below. 

The study I'm focusing on, which is part of a larger project [see points seven and eight here], is based on the findings of rounds of interviews with 242 patients who tested positive for pulmonary tuberculosis across the six rural districts of Bousse, Koupela, Ouargaye, Zabre, Ziniare and Zorgho and who were enrolled in the national TB control programme. As the writers state,
The median direct costs associated with tuberculosis were estimated at 101 United States dollars (US$) per patient. These costs represented 23% of the mean annual income of a patient’s household. During the course of their care, three quarters of the interviewed patients apparently faced “catastrophic” health expenditure. 
Their analysis of the cause of this US$101 direct cost is interesting: around US$ 45 of the cost was not down to the inherent cost of the medicines or treatments themselves, but to failures in the broader health system and policies; the researchers cites access, medical consultations, out of pocket expenses, unofficial payments to medical professionals and lost wages from their day jobs for both diagnosis and treatment (or even redundancy due to repeated absence). While individual patients bore these costs by strategising. economising and accommodating within their households and negotiating or receiving community and extended-family support, this accommodation weakened their overall economic standing and jeopardised their position in the long term. There was a likelihood of established savings being used, of families being forced to decrease consumption to save money, being forced into the sale of goods or services to raise money or to take out loans to raise money. When this seemingly small monetary figure accounts for nearly a quarter of each household's income, given the generalised socio-economic context of poverty or near-poverty amongst the population studied, there are grave consequences in terms of increased social inequality and economic instability; the stigma of suffering from TB; the 'social debt' incurred by help received by family members and the wider community; and a greater improbability of proper treatment being sought, for all these reasons. The illness itself increased instability, with the researchers citing an average loss of 45 days of work lost by sufferers across the research year from 2007 to 2008. 

The 23% percentage figure of annual income cited for TB treatment costs is alarming as the threshold for a definition of "catastrophic" expenditure which represents an excessive burden on a patient or their household in the rural low-income communities in the study, is 10%. The study analysed all the types of expenses and costs, including non-medical and non-financial costs, which arose as a result of suffering, diagnosis and treatment and identified various failures and weaknesses in the system. They include necessary services that were not covered by the free treatment package (which include diagnosis by spit sample, anti TB drugs and repeat smears to determine treatment outcome) and services that were not necessary but where payment was required. The report states,
Only 2% of the patients interviewed...reported that they had received completely free tuberculosis care. 
The challenges above, as well as other failures in patient treatment (such as extended time periods required for diagnosis and repeat procedures) explain why the rates of TB detection and cure are lower than might be hoped given the MDG and the adoption of international recommendations for TB control. The researchers state that what are necessary are solutions which pull in all practitioners, "political decision-makers, managers of health programmes and health services" to develop meaningful responses and suggest a number of measures including the decentralisation of diagnosis and treatment so that patients do not have to travel, improving community care to enable early detection, help for the poorest households, supporting healthcare providers and also supporting patients not just financially but socially and psychologically through dialogue with former patients. They also call for a rigorous assessment of 'free' healthcare systems with a multilayered analysis of economic and social consequences aimed at fine-tuning policy, identifying and rectifying faults in the system, guaranteeing efficiency and helping (rather than exploiting or exacerbating the problems of) the most vulnerable.



Bidisha is a 2013 Fellow for the International Reporting Project. She is reporting on issues of global health and development. 



Friday, 5 April 2013

Indonesia is just one example: introducing the International Year of Water Co-Operation


Image (c) UN
World Water Day was just a few weeks ago, on 22nd March, and this time around it’s part of 2013’s special International Year of Water Co-Operation. While I’ll write more about water, health and development in coming months, the poster below gives some impression of just how many individuals, informal groups, charities and organisations have been active in the fight to provide universal, accessible, clean and safe water for all the world’s population on World Water Day. 

Image (c) UN
At the same time, world leaders are meeting throughout the year to seek ways to co-operate and fund initiatives to make these goals a reality for everyone. On World Water Day itself there was a High Level Forum at the Hague and a High-Level Interactive Dialogue (love those crushingly literal antieuphemisms!) at the UN headquarters in New York and other summit meetings are planned in Stockholm, Tajikistan and Norway throughout the year.

To give some idea of the considerations and challenges which arise when looking at water and development I want to take USAID’s work in Indonesia as a case study, based on recently released details of their initiatives there as part of the $33 million, five-year IUWASH (Indonesia Urban Water, Sanitation and Hygiene) Project. In support of the country’s Millennium Development Goal (MDG) regarding improvements in water provision and sanitation, IUWASH reaches out across more than 50 municipalities, helping up to 2 million people in urban areas access safe water and improving sanitation for many others

According to USAID,
  • Around 40% of Indonesia’s urban households have access to clean water
  • Just over 50% have basic sanitation
  • In all, 75% do not have “adequate sanitation”
  • Poorer families are disproportionately affected – so, as in so many places, there is a gap in privilege, resources, access, opportunities and advocacy (that is, the clout to be heard and make social changes) between the richest and poorest. 

The principal barrier to safe, piped water in urban areas in Indonesia is financial: the installation and connection charge of between $150 and $300 might be as much as three months’ an average earner’s salary – USAID cite a typical example of a vegetable seller and mother of two from Jiyu, earning $2-$3 a day which barely covers essentials as it is. For those without access to piped water, water must be collected and carried from the nearest river or reservoir, a task which is extremely arduous, time-consuming and inefficient. One person can only bring as much water as they can carry. This must be shared amongst the family and amongst cooking, bathing and clothes-washing requirements.

A further difficulty is that in the implementation of a piped water network, a number of processes, vested interests and various groups must be aligned. Strategy, goals, budgets, funding, decisions and policy come from the government, with or without the collaboration of other governments, agencies or funds internationally; geographical planning, irrigation, building and the establishment of utilities, sanitation and facilities will all be handled by private businesses and so on.

Photo (c) USAID Indonesia project

With access achieved, the next issue to tackle is sanitation. USAID estimates that in Indonesia

  • only about 2% of urban households are connected to sewerage systems
  • up to 18% of urban dwellers must defecate openly, without facilities for the removal of waste
Here, the solution is consciousness-raising about sanitation issues and good practice, people’s unity in improving conditions for everyone and the importance of local leadership in effecting change among multiple households, encouraging families to build improved sanitation facilities like latrines, practice good hygiene (which can be as simple, but effective, as hand-washing, medicated cleaning products and the separate of areas for different tasks). The swift and obvious success of these often-simple measures – such as a steep decrease in rates of diarrhoea and an increase in general health – often inspires communities to go further in terms of grassroots local development, towards recycling and composting.

This is achieved through all parties pulling their weight. IUWASH and similar initiatives must bring together all these different parties to ensure long-term planning and delivery and create a new, different, sustainable future.

Bidisha is a 2013 Fellow for the International Reporting Project. She is reporting on issues of global health and development. 

Thursday, 28 February 2013

Testimony and development: think globally, act locally, think locally, act globally

(c) IRC maternal health project

I recently covered Untold Stories, a major exhibition of photographs of global urban refugees and a showcase of their testimonies, produced by the International Rescue Committee and featuring images taken by photographer Andrew O’Connell. Since the exhibition closed I’ve been thinking about the placing of these images, in the sleek, double-plus height, busy spaces of King’s Cross International Station. It’s either a striking juxtaposition, stopping Paris- and Brussels-bound travellers and their consciences dead in between eating a cake from Konditor and Cook, having a salmon platter at Le Pain Quotidien and buying overpriced disposable fountain pens from Paperchase. Or it’s just more visual wallpaper, another image from the global ad era, something for the eye to skim over, barely taking in the words or registering the general purpose – tearjerking international pain campaign – before getting on a train bound for somewhere more pleasant. 

As a second generation British Indian, I’ve always baulked at coverage that makes a show of the suffering of global others. Stricken-eyed orphans, hungry looking yet still undeniably cute; survivors and victims gazing out balefully, beseechingly, next to a large-fonted list of bad things that will happen to them if you don’t sponsor them for three pounds a month; a child just about to drink from a plastic tub of brownish water; a dazed toddler gazing up from a hospital bed it wouldn’t need to be in if only the correct vaccines and immunisations had reached it in time. The testimonies are true, as is the scale of each crisis and each issue, but coverage like this reduces each featured person only to the story of their suffering. The individual, although they are made an example of, becomes generic in the telling. The adverts and coverage do not tell us about their strengths and weaknesses, their likes and dislikes, their family, their friends, their locality, their ambitions. Instead, the individuals are broken down into a demeaning, generalized narrative. We know nothing of them but their pain and are shown nothing of their own drive, their own strength and resistance. Instead we are invited to feel like the heroic saviours of the powerless:

The farmer who can’t grow and sell enough crops for her family.

The baby who’ll die by the age of 3 if he doesn’t get the right treatment.

The girl, first name only, trafficked, raped, bought, sold, impregnated, beaten, abused.

The boy stitching plimsolls by the side of the road, forced to sleep on the street.

The girl denied education, doomed to be taken and used for sexual and other manual labour.

The family whose nearest hospital is an eight mile walk away.

I sit on the Tube and cringe: is this what people in this country think of us? And by us I mean all the non-whites, the former colonised, the far-away, the different-from-them. It’s humiliating to see one’s own (historic) country and those of many others represented as backward, violently misogynistic, agonisingly poor, superstitious, class-ridden, corrupt, intractably problematic, unable to help itself. It’s embarrassing to think about the way other cultures are so often misrepresented, in Western art, culture and media, as depraved, eroticised, exoticised, criminal, subjugated, chaotic, oppressed, self-sabotaging, primitive, violent and more. And it’s easy, being bi- or multicultural, living in a city as visually diverse and mixed as London (even if, if you look at who really holds power in all sectors, the image is strongly un-diverse in terms of sex, race and class), to forget how little people know of the many different societies beyond their own national borders, how few people get under the skin of other countries through equal friendship with others, how few people speak or read other languages. The solicitations, which are meant well, are targeted at people who often know little about other countries or cultures except what they have seen on the news, what they are fed in entertainment-industry films and novels or simply what they have heard in the air – a mixture of myths, fantasies, suppositions and stereotypes which are insulting at worst and limiting at best. The adverts and campaigns often replace people’s ignorance with extreme, galling patronage. We are invited to feel for survivors and victims but not feel outraged, as we should, about the deliberate actions of the perpetrators or the extreme injustice and exploitation which underlie inequality. The help the adverts elicit is accompanied by a sense of personal smugness and cultural superiority. Yet the only way you can understand a culture and drop your own sense of superiority is to participate in it fully and as an equal, not a patron, exploiter, client or dominator.

It’s also easy to point to finger at other nations’ problems without recognizing that many of those same problems are strongly prevalent within the UK too and that the prejudices and inequalities which keep them in place are common across seemingly different cultures. Gender prejudice, gender violence, racial prejudice, racial violence, class prejudice, class violence; these are present to a greater or lesser degree in all cultures regardless of the predominant colour, religion or language of the majority of the people. The terrible consequences, in terms of opportunity, treatment and advantage, as a result of the gap between richer and poorer; the scale of sexual violence including endemic harassment, sexual exploitation and the consequent ignoring or denying of victims and excusal of perpetrators; endemic levels of women killed by current or ex partners; trafficking; labour exploitation, low pay, unstable employment and inequality; problems of hunger; problems of housing; problems of literacy. These are all issues here in the UK, as elsewhere.

And so, in the morass of pain, suffering and need, we return to the power of individual testimonies, specific case studies and concrete examples as a way of making issues which are so widescale as to be overwhelming feel real at last. Humanity needs to put names and faces to social problems; we need to attach a story to an issue; we need to be convinced emotionally and not just factually. And so there’s testimony after testimony, home-made video after witness photograph exhibition, statements, confessionals, documentaries, archives. It’s only through putting a human face onto inhumane circumstances and treatment, adding flesh and blood to advocacy and arguments, that grassroots change really happens.

There are many obstacles. In the case of sexual violence in particular there is widespread and tragic denial of the existence, reality and scale of the issue; the disbelieving, denial, punishment and ostracisation of victims; leniency, excusal and condoning of perpetrators; and a denial about the way entire cultures collude across the board in the undermining and sexual objectification of women and girls, from our extreme under-representation as speakers, leaders and experts in all areas of powerful public life to our over-representation as silent objects used to sell consumer goods from yoghurts to shampoos and the way our bodies are used, bought, sold and bartered as sources of sexual, domestic and other labour for others’ benefit; and so on and so forth, as I’ve written in a million articles a million times. Even when survivors of sexual violence are believed, people have a hard time facing the reality of the scale of the problem, the truth of the situation and its systematic, entrenched, values-based origins. They prefer to recast sexual violence as either a tragic anomaly; an inevitable consequence of war which will never change; or a private, ambiguous, personal, shadowy, domestic matter whose mysterious truth none can fathom. At the heart of all this is an absolute inability to face the reality of what perpetrators choose to do, how many of them there are, how common it is, and what that says about how much and how violently women are hated. For more on the most extreme and distressing examples of this, with a trigger warning, look at Women Under Siege.

Sometimes the resistance comes down to cultural prejudice – a feeling of not understanding and not wanting to interfere or get involved with a society which is seen wrongly as ‘other’, subject to its own laws and logic, somehow different and therefore inscrutable. And equally there is a laudable desire not to patronise. Over the last few years, as I’ve been working and writing a lot on the Middle Eastern revolutions, meeting countless female activists who have worked for changed for years, who lead demonstrations and organisations. They bemoan the western media’s obsession with the oppression of Arab women, veiling and not veiling, sexual assault and sexual harassment, as though these latter two issues are not totally endemic in the UK as well as in the Middle East, Latin America, Europe, Northern America, India and wherever else you look. The problems of the world seem to hide in open view, supported by our prejudices, our willful blindness, our excusal of perpetrators and our deep denial.

Sometimes resistance to global appeals comes down to simple apathy, selfishness, insularity or outright pessimism. People do not use their power for change, because they are convinced of their powerlessness. They think an enterprise is doomed to fail before it has begun, and so they doom it to fail with their own unwillingness, tepid support and lacklustre participation.

Yet this pessimism is misplaced. The problems of the world have not arisen by magic or by chance and are not kept in place by magic or chance. They are specific problems which can be solved in specific ways. Those who benefit from inequality, injustice and exploitation rely on the apathy of bystanders. To laugh cynically at the large scale of the problems identified for solution is to behave as though the world can only change for the worse, not the better. During the course of the year, as part of my International Reporting Project fellowship, run by Johns Hopkins University and funded by the Bill and Melinda Gates Foundation, I will be focusing on issues in support of the MillenniumDevelopment Goals for 2015. These are:

  • To end poverty and hunger
  • Universal education
  • Gender equality
  • Child Health
  • Maternal health
  • Combating HIV/AIDS
  • Environmental sustainability
  • Global partnership
Do I believe that it’s possible to save the world? Yes. If it can transform negatively it can transform positively. This requires believing survivors, fighting perpetrators, challenging preconceptions, changing society, educating the very young, supporting the weak, breaking the dominators, investing money, creating lasting infrastructures and forming organisations which are structurally and ideologically different from those created by exploiters and power-holders. To say the world cannot be saved is to give the bad guys a free pass to do exactly what they want, to make a mockery of others’ constructive efforts and to deny one’s own power to influence events. I believe that something good is better than nothing good, that speaking up is better than staying silent to protect perpetrators and that a tidal wave of change starts with the smallest ripple.

There are millions of people in the world – usually, those who have relatively little themselves – who are working and have been working tirelessly for years to transform the lives of people in their own communities. Although they are assisted by the same organisation, they do not get exhibitions in King’s Cross, major funding for their beautiful photographs or international coverage which boosts their career, enables lots more exciting international travel and promises a strong culturally legacy once their working days are done. They are not hailed as intrepid, globe-trotting heroes bearing witness, constructing powerful testimony, standing up for human rights. They have no names, or rather no cultural Name. But here they are:

  • The village women in the South Kivu province in the Democratic Republic of Congo forming groups called village savings and loan associations (VSLAs). The women members put their small household earnings toward the group’s broader goals. When there’s enough cash in the box, a member can take out a loan to start her own business — like a tailoring shop, the purchase of a small plot of land to farm and raise animals. When the business makes money she begins to repay that loan back into the cash box to fund another woman’s ideas.
  • The 30 new health facilities and 2,500 newly trained community health workers supported by the IRC in South Sudan, where the country’s decades long civil war has left the region without a functioning healthcare system and few trained medical personnel. Currently, more than 2,000 out of every 100,000 pregnant women in the new nation die during childbirth.
  • The necessity of bringing healthcare closer to remote communities by enabling trained community health workers to travel with families as they migrate. For example in Turkana, Kenya, is one of the world’s poorest regions, frequent droughts have left inhabitants dependent on food aid. Malnutrition rates are estimated to be around 22 per cent, leaving children too weak to fight off illness. Consequently, many children die from preventable or treatable illnesses such as fever, malaria and diarrhoea. With about 80%of people being nomadic, many families find accessing healthcare difficult due to their mobile lifestyle. These problems are compounded by a severe shortage of facilities and qualified health professionals. 
  • The strengthening of strained healthcare facilities in Syria’s neighbouring countries, like the 2 new health centres in the cities of Ramtha and Mafraq in Jordan, to help the million-plus people fleeing the violence in Syria. As IRC emergency response coordinator Tom McNelly explains, “These people crossed the border with nothing but their clothes. They have no money to pay for treatment or medicine - and we supply both, at no cost to them.”


Related articles:




Statistics and specific project details © IRC with thanks. To donate to these projects via the IRC please click here

Bidisha is a 2013 Fellow for the International Reporting Project. She is reporting on issues of global health and development.