I’ve spent the past few days in Kyiv, Ukraine. One way and another, I’m travelling quite a lot at the moment, but all I tend to see is the inside of hotels and conference centres, so I was determined to do a tour of Kyiv. Unfortunately, by the time the allotted day came round, I was absolutely exhausted, so I haven’t seen nearly as much as I would have liked.
General impressions, though, are very good. The streets in central Kyiv are all very wide – probably fifty metres between buildings on the main roads – which means there is plenty of room to stroll through a city that was either not too badly affected by the ravages of communist architecture or is doing a good job of renovating itself. It also makes the city quiet, despite the heavy traffic. There’s plenty to see and do – the Museum of the Great Patriotic War is very interesting, and it’s lovely to walk along the Dnieper and see the islands in the river.
The Atlantic Treaty Association’s 55th General Assembly brought me to the Ukraine. Ukraine is, as we know, on a path that may, if the people desire it, take it into NATO. While it remains controversial, the people I met here, from the government and broader civil society, suggested to me that there is commitment to modernisation and Euro-Atlantic integration, whether or not that actually means signing up to the Washington Treaty or not.
The next few weeks see me in Macedonia, Slovakia and maybe Montenegro.
Conservatives for Patients’ Rights (CPRights) have a video up decrying government healthcare.
The NHS has its problems; no-one would say that it is perfect. However, it does a pretty damned good job and it does so regardless of someone’s ability to pay. While we don’t see the faces of private healthcare – or those who can’t afford it – it strikes me that there are some missing faces in the video; those who are happy with the NHS. There’s rather a lot of us.
The first face is Kate Spall, who says ‘if you have cancer in the UK today, you are going to die quicker than any other country in Europe’. The largest, pan-European, cohort-based study on cancer survival is EUROCARE. EUROCARE runs into the same problem that any other systematic review of cancer survival rates in Europe is going to; there are different recording systems between (and sometimes within) countries and some countries don’t keep records at all (the UK is pretty good; adult coverage in Germany is about 1.4%).
Nevertheless, the EUROCARE research suggests that Ms Spall is wrong.
Tables to show life expectancy of fatal cancer cases against % cured patients for country, age and date of diagnosis
While we are towards the bottom of the table, we are not at the bottom. In any case, this study does not take account of factors such as smoking, drinking, diet and so on. More information is on the latest results page.
A brief search on BBC News shows Ms Spall’s interest in cancer; her mother died from a rare form of kidney cancer. She managed to have Nexavar provided, even though “the drug, which can cost up to £40,000, is not a cure, but can help some patients”. Now, while my greatest sympathies are with Ms Spall, £40,000 is a lot to spend on a non-cure. Perhaps, in terms of QALYs, it was worth it; however, part of her objection was that the drug was available in some English health trusts. While I would certainly agree that there is not enough democratic involvement in NHS trusts, one of the effects of choice is, necessarily, variation. This seems like a poor choice – if you’ll excuse the pun – of ‘face of government healthcare’.
Next up is Katie Brickell. Despite asking for one at 23, Ms Brickell wasn’t given a smear test; by that time, she had contract cancer of the cervix. Again, my heart goes out to Ms Brickell, but this was a fluke. The evidence suggests that the smear test provides no benefit before about 25. If everyone were going in for a test whenever they were worried and there was no consideration about whether the test was appropriate, a lot of money would be needlessly spent on a lot of needless procedures.
Angela French says that it’s hard to get hold of new, expensive drugs on the NHS. Quite why this isn’t the case in the USA at the moment or, indeed, in any system that doesn’t have an unlimited budget is beyond me. Dr Karol Sikora makes the same point; quite why it is any less heartbreaking when a poor person in the US with insufficient insurance cannot afford a given drug is, again, beyond me.
The rest of the people featured are Canadian; I’ll leave them to one side as I don’t know enough to comment on the situation there. I would just note that no-one in the US is proposing a UK-style health service; rather, they’re going for different ways of amending insurance-based policies. The only system that exists like that at the moment is healthcare for the armed services which is, er, pretty good.
“The Iraq war was a disaster” is a familiar refrain. Unfortunately, that doesn’t tell us very much. Do we mean the concept, the planning, the implementation, the strategy, the tactics, what? Or do we want an official stick with which to beat the government?
Were the problems with the Iraq war just the basis on which we went to war, or inappropriate equipment necessitating lots of UORs ?
Iain Dale asks why we should accept people who aren’t connected with Britain from Guantánamo Bay. These are my reasons why we should.
Firstly, it is in our strategic interest for two reasons. I will look at the morality and legality later, but it is enough to say that many states and people, friendly, neutral and hostile, regard both Guantánamo as immoral and the UK as very close to the United States. By acting to expedite the closing of Guantánamo, we are acting to right a perceived wrong. It also improves our standing within the EU and NATO if we can demonstrate an ability to act as an effective link or broker between the western and eastern sides of the Atlantic. I would add that there might well be (although I do not know this for a fact) people who would be repatriated to, say, Bosnia-Herzegovina. While I do not wish to impugn Bosnia-Herzegovina and am using it just as an example, I do not believe that it, or many other states, have the state-capacity to effectively monitor these people. If we look slightly more widely around the Balkans, the apparent ease with which people evaded the ICTY, I believe the point is proven. In the long-term, taking in detainees here is more secure than leaving them in limbo or Ruritania.
Secondly, it is expeditious. Whether Mr Dale likes it or not, President-Elect Obama has made it clear that Guantanamo is to be closed. As I mentioned, we are seen as close to the US in foreign policy terms. One of the big problems with Guantánamo was the lack of clarity as to what was going to happen to people held there. We now have a resolution; however, we will have to accept people who do not have an immediate connection to the US for a few reasons. One is that some states will not accept people who have a prior or stronger connection to them. We can exert more moral pressure on them to accept people from Guantánamo if we show how much we are doing; in any case, it will not work for everyone. There are some states that it would be wrong to ‘export’ these people to; they are those states that would torture them. They would go from a frying pan to a rather hotter fire and many of the problems we face because of Guantánamo would be reinforced.
Thirdly, it is morally right. Guantánamo was an abrogation of rights, poorly implemented and conceived, that took away some of our moral high ground and constitutes a serious threat to habeas corpus in the USA. Its closure rectifies at least some of those issues. Moreover, the USA is our friend and ally; if it seeks our support on this, given that the costs are minimal and the benefits great, I would have hoped it would have been a no-brainer.
If I may refer to the title of Iain’s post – “Guantánamo is a problem made in America” – I would contend that the problem may have been made there, but that does not relieve of us our obligations to justice and due process, or to our ally, or the effects its existence and the method of its closure may have on us.
In short, it is both morally right and in our strategic interest.
The UK’s commander in Helmand, Brigadier Mark Carleton-Smith, has said that we shouldn’t expect a decisive military victory in Afghanistan; I wholeheartedly agree. He should have added that there was never going to be a military victory in Afghanistan.
Setting up the Afghan government was never going to be enough, either. The international community needs to rally round and provide development support to build the institutions that will allow Afghanistan to run itself. A successful part of that has been the establishment of the Afghan National Army, which (I believe) now takes part in more than two-thirds of missions conducted under the ISAF or OEF banners. More work does need to be done, for instance, on the Afghan National Police. It is worth mentioning OMLTs (Operational Mentor Liaison Teams, or Omelettes), which remain attached to an Afghan unit after it has been set up and trained to provide ongoing training and advice.
NATO went into Afghanistan under an Article V1 commitment to prevent further attacks, on the US in particular, launched from Afghan territory by al Qaeda with the complicity of the then-government. The conflict was and is increasingly characterised by asymmetry; while there have been some ‘pitched battles’, insurgents are increasingly avoiding such conflicts. Instead, they are going after development work precisely because it is that work which wins hearts and minds and helps to develop the structures that Afghanistan needs. A good instance is the delivery of a hydroelectric power turbine to produce electricity for on the order of two million people. It took five thousand troops to safeguard its passage precisely because the Taleban were so determined to stop it arriving.
While the higher echelons of the Taleban are under pressure, local groups are able to maintain opposition. This is largely because they use aggressive means with no regard at all towards loss of life, Afghan or otherwise. It is worth remembering, though, that a couple of years ago the Taleban were talking in terms of defeating the Afghan government in some parts of the country. They have failed. While the situation is not necessarily what I’d describe as ‘good’, the Taleban are being defeated as a coherent force.
As I said at the beginning, there was never going to be a military victory in Afghanistan. What military force can do is allow and support the autonomous developments needed for Afghanistan to run itself and thus prevent further attacks like 9-11.
xD.
1 – Article V of the North Atlantic Treaty, aka the Washington Treaty, runs:
The Parties agree that an armed attack against one or more of them in Europe or North America shall be considered an attack against them all and consequently they agree that, if such an armed attack occurs, each of them, in exercise of the right of individual or collective self-defence recognised by Article 51 of the Charter of the United Nations, will assist the Party or Parties so attacked by taking forthwith, individually and in concert with the other Parties, such action as it deems necessary, including the use of armed force, to restore and maintain the security of the North Atlantic area.
Any such armed attack and all measures taken as a result thereof shall immediately be reported to the Security Council. Such measures shall be terminated when the Security Council has taken the measures necessary to restore and maintain international peace and security.
A little while ago, I wrote a post here and on the Wardman Wire called ‘Help Zimbabwe from your chair’.
Lovemore Matombo and Wellington Chibebe, respectively the President and General Secretary of the Zimbabwe Congress of Trades Unions (ZCTU), were being charged with ’spreading falsehoods prejudicial to the state’. Those falsehoods are, in fact, criticisms they made on May Day of Mugabe’s government and telling the truth about the violence today in Zimbabwe.
The TUC, the UK equivalent of ZCTU, and ITUC, the international version, organised a mosaic depicting Lovemore and Wellington made up of faces of trades unionists from around the world. You can see it at WeAreZCTU.org. There are also tools to spread the word, add your support and to lobby for justice. There are model letters to send there as well.
The news that the UN Security Council has issued a statement condemning Robert Mugabe with the support of Thabo Mbeki’s South Africa is good news. After condemnation from Rwanda’s premier, Paul Kigame, and others, it seems that no-one in Africa, at least of any political substance, supports the Mugabe regime.
I think statements like this can make a difference. True, the protestations of the UK are batted away by Mugabe as propaganda from a would-be irredentist colonial power. It is much harder to dismiss that message if it comes from an African leader; the means by which some criticisms are deflected become useless. For such things to work, however, the criticisms need to reach the mass of the people. With no free press, poor electricity, hunger and flight across the country, it is of little surprise that the messages coming from Tshwane, Luanda and New York will not reach the people who need to hear them most.
Had Mbeki spoken out more forcefully while it could have made a difference, it might have encouraged Mugabe to leave. I may be being unfair; there was quiet diplomacy between Tshwane and Harare and it is impossible to know, until the history books are written, whether it was an idea that was never going to work or a gamble that didn’t pay off. It looks, though, like too little, too late.
Tiberius Gracchus writes about Chris Wickham and the use of methods of taxation to analyse the nature of a state or other polity. The argument certainly has legs and I think a comparative analysis of taxation systems could be an effective means of categorising states; however, it will not be a primary comparator.
I should say here that I have not read Wickham’s book, so I may be grossly unfair here.
The Spanish Empire in Latin America (I’m leaving the Spanish Indies aside) underwent various administrative changes between their origins in the sixteenth century and independence in the nineteenth century. These ranged from means of exploiting local resources (including humans) as effectively as possible through to complex bureaucratic and impositive systems that acted as states because of their distance from metropolitan Spain. These changes were brought about for various reasons – the need to develop Buenos Aires, preventing Viceroys from becoming too powerful, pacifying criollos by granting them audiencias. At various times, different amounts of money, in relative and absolute terms, flowed to Spain, in part due to Spain’s need for cash to fund its various activities (including trying to hang on to the Philippines).
These changes never dealt with the legacy of previous attempts to cement Spanish rule in Latin America. The expansionist nature of Spanish colonisation of Latin America was based, in no small part, on the religious fervour of Ferdinand and Isabela, codified by the Inter Caetera Papal Bull, that saw the Christianisation of southern Spain – al-Andalus – and the New World as goals that justified all manner of action and reward, including the pillaging of those areas. This resulted, from the beginnings of empire, in local authorities being a mixture of civil, military and religious power. Anyone connected to the chain of command had control over the minds of local inhabitants in a particularly potent manner; the stage was set for the caudillismo that still plagues parts of Latin America in the form of today’s clientelism.
However, it is much easier to see that with hindsight. Many of the actions that were taken in the Spanish Empire ended up reinforcing the problem and making it easier for sections to to be hived off. Not least of these was the setting up of audiencias below the viceregal level in an attempt to counter the grievances that led to local bosses setting taking too much power to themselves that ended up consolidating the problem. In short, the nature of the taxation system is based on how the state is perceived by the taxer not how the state actually is. This can be further qualified by the fact that states rarely give up forms of raising revenue; the federal income tax in the US might be an indicator of a solidified, federal polity when it was in fact brought in to raise funds during the Civil War. The use of taxation in this instance is descriptive rather than prescriptive, and needs to be used as such in analyses of states.
Your article (It was murder: the Chávez version of liberator’s death, November 17) neglects the importance of Bolívar’s last days to any interpretation of his impact on Latin America. Reviled by the educated classes and with just a few friends who remained loyal, Bolívar was leaving for Europe when he died. He considered himself a failure, believing that “those who have served the cause of the revolution have ploughed the sea”. David Cole
London
First published letter. The original article is here.
I agree with Ewan Watt that the US House of Representatives’ Foreign Relations Committee should not have recognized the Armenian Genocide as such, but perhaps for slightly different reasons. Ewan is, in foreign policy terms, very much a realist and I do agree that the results of the Committee’s decision have already been profoundly negative – Turkey has summoned its ambassador to Washington back to Ankara for ‘a week or ten days of consultation’ but has stopped short of a recall. With US troops deployed in Iraq, a country that borders Turkey, Turkey’s strategic position and role and the desire not to alienate a country that teeters between West and East or to fuel the continuing problems between Turkey and Armenia – Karabakh and Baku-Ceyhan for instance – it seems like a poor decision.
Nevertheless, fiat justicia ruat coeli stands as a principle; if it is just, I feel it should be done, even though the consequences are uncomfortable, shall we say; to do otherwise is hypocritical and leads to a host of problems in international relations.
I question why the Committee felt the need to address the issue at all. Ewan also identifies the answer – special interest lobbying – but the implications haven’t been thought through. There are many other crimes – some committed by the US – that could be condemned.
More importantly, it is not the role of a Government to decide what history is; there can be no official version without grave risk of a government interfering unjustifiably in the process of discussion and debate. Equally, as Nye Bevan put it, ‘this is my truth; tell me yours’; whether ordained by the state or not, there is no one, true version of history, only arguments that are more or less persuasive. When the arguments are emotionally and geopolitically loaded, officially recognising a term can only cause problems and is, from a state, philosophically invalid.
As a note, I think it is wrong to use a category to encompass the Armenian Genocide and the Holocaust; they are both sui generis, IMHO.
Today we are not considering whether the Armenian people were persecuted and died in huge numbers at the hands of Ottoman troops in the early 20th Century. There is unanimity in the Congress and across the country that these atrocities took place. If the resolution before us stated that fact alone, it would pass unanimously. The controversy lies in whether to make it United States policy at this moment in history to apply a single word – genocide – to encompass this enormous blot on human history.
