foreignpolicy--2020-07-06--China’s Superpower Dreams Are Running Out of Money

China ’ s Superpower Dreams Are Running Out of Money Seen from afar , China ’ s current all-fronts offensive gives the impression of a rising power on the march .
China is simultaneously starting a border skirmish with India , militarizing the South China Sea , cracking down on Hong Kong , pressuring Taiwan , confronting Japan over disputed islands , and quelling internal unrest—all while fighting a resurgent coronavirus outbreak .
At the same time , it is investing billions of dollars in a bid to dominate emerging technologies like artificial intelligence , quantum computing , and advanced @ @ @ @ @ @ @ the Belt and Road Initiative ( BRI ) , China ’ s $ 1 trillion program to build the transportation infrastructure for a China-centered world.How is it possible that a self-described developing country like China can finance a superpower rivalry with the United States ?
Running a global superpower is an expensive business .
The United States famously spends more on defense than the next 10 countries combined , yet the notion persists that its military is still underfunded and underequipped for its global superpower role .
And if the pundits are to @ @ @ @ @ @ @ lose its competitive edge without more investment in university research , advanced technologies , foreign aid , diplomacy , the United Nations , clean energy , and , of course , pandemic preparedness .
That ’ s just to name a few of the United States ’ superpower funding priorities .
The full list is much longer .
But if the United States—with an economy roughly 50 percent larger than China ’ s and a gross domestic product ( GDP ) per capita more than six times as great—can ’ t afford to @ @ @ @ @ @ @ China possibly afford to become one ?
Leaving aside the facts that China ’ s chief diplomatic allies are North Korea , Cambodia , and Ethiopia , that it is surrounded by potentially hostile nuclear-weapon states such as Russia and India , that its state-sponsored technology companies are widely distrusted outside China , and that Beijing has been widely blamed for allowing the coronavirus pandemic to spread to the rest of the world , how is it possible that a self-described developing country like China can finance a superpower rivalry with the United @ @ @ @ @ @ @ can ’ t .
Even before the coronavirus hit , China ’ s economic growth had slowed from double-digit rates in the early 2000s to 6.1 percent in 2019—if you believe the official figures , that is .
This figure is highly suspect , not least because the person who sets China ’ s annual GDP target , National Development and Reform Commission vice chairman Ning Jizhe , is the same person who , as director of the National Bureau of Statistics , is responsible for measuring GDP .
Independent modeling published by @ @ @ @ @ @ @ historically overestimated GDP growth by an average of 1.7 percent per year .
China ’ s officially reported tax revenues confirm this picture , growing at just 3.8 percent in 2019 , compared with 6.2 percent in 2018 and 7.4 percent in 2017 .
Yet as China ’ s financial means have become more restricted , its spending has continued on its old , profligate trajectory , growing 8.1 percent in 2019 .
The result has been a widening gap in China ’ s government budgets , with the officially reported budget deficit @ @ @ @ @ @ @ .
The International Monetary Fund puts the true figure of the government ’ s shortfall at more than 12 percent of GDP .
And this was before the coronavirus , during a period of supposedly healthy economic growth .
Hard figures for China are hard to come by , but it seems that the Chinese government was scaling back spending commitments even before the coronavirus hit .
You would hardly know it from the glowing project announcements , but China ’ s BRI funding commitments have actually been falling since 2017 .
And @ @ @ @ @ @ @ reality of China ’ s BRI spending is even more meager .
Chinese banks have virtually disappeared from BRI financing , leaving the cash-strapped government to shoulder the burden alone .
Meanwhile , projects have been shelved , scaled back , or delayed all across Asia .
Western critics of the BRI tend to interpret these problems in terms of the fear of indebtedness that these projects spark in recipient countries .
They rarely mention the indebtedness they induce in China itself .
So when Western media reported in December that China was @ @ @ @ @ @ @ on the stalled China–Pakistan Economic Corridor , they failed to mention that China is unwilling to finance the construction itself .
Similarly , China wants to build a new port in Myanmar , but it is reluctant to pay for it .
China signed a Transit and Transport Agreement with Nepal in 2015 but has yet to build a single mile of road or railway in the landlocked Himalayan country .
It ’ s the same story in Africa and Eastern Europe : China continues to announce grand projects but has been unwilling @ @ @ @ @ @ @ them off the ground .
China ’ s financing problems are nowhere more apparent—and less acknowledged—than in its military budgets .
Analyses from the Center for Strategic and International Studies suggest that Chinese defense spending may actually fall in real terms in 2020 .
Given China ’ s elevated pace of military operations on several borders , spending constraints must be putting serious pressure on acquisitions budgets .
It is impossible for anyone outside China ’ s defense establishment to know what is really going on , but circumstantial evidence suggests that many @ @ @ @ @ @ @ have been put on go-slow.It is impossible for anyone outside China ’ s defense establishment to know what is really going on , but circumstantial evidence suggests that many of China ’ s big-ticket weapons programs have been put on go-slow .
For example , China is believed to have built only 50 or so J-20 fifth-generation stealth fighters .
The J-20 program now seems to be experiencing serious development problems , limiting production for the foreseeable future .
This compares to America ’ s stock of 195 F-22 and 134 F-35 fifth-generation @ @ @ @ @ @ @ more than 100 F-35s , even after coronavirus delays .
Similarly , China once planned to deploy six U.S.-style aircraft carrier strike groups by 2035 .
Aside from the Soviet-surplus training carrier Liaoning , China currently has only one conventionally powered ski-jump carrier , with a second under construction .
Plans for four nuclear-powered carriers have been delayed indefinitely due to “ technical challenges and high costs.
” China says it will eventually develop fifth-generation fighter planes for deployment on aircraft carriers .
Meanwhile , the United States ’ F-35C carrier-optimized stealth fighters @ @ @ @ @ @ @ year .
Fighting India with sticks and stones on the high plateau of Ladakh comes cheap , but preparing to confront the United States in the Western Pacific is a very expensive proposition indeed .
It is likely to prove a luxury that a slow-growth , post-coronavirus China will not be able to afford .
Like a gangster flashing a wad of $ 100 bills , China makes a great show of its wealth and its willingness to spend it .
In reality , Beijing ’ s bank balance doesn ’ t match @ @ @ @ @ @ @ double-digit growth in Chinese GDP and government spending , outsiders are conditioned to believe that China ’ s financial resources are unlimited .
Having lived through China ’ s economic rise themselves , insiders are perhaps conditioned to believe it , too .
But no budget is bottomless , and China seems to have hit the buffers just as the coronavirus struck .
China ’ s leaders can at least save face by abandoning their GDP targets and blaming the virus for the inevitable austerity to follow .
But when the crisis is @ @ @ @ @ @ @ be a global superpower .
China may be forced to embrace a less-ambitious future .

Seen from afar, China’s current all-fronts offensive gives the impression of a rising power on the march. China is simultaneously starting a border skirmish with India, militarizing the South China Sea, cracking down on Hong Kong, pressuring Taiwan, confronting Japan over disputed islands, and quelling internal unrest—all while fighting a resurgent coronavirus outbreak. At the same time, it is investing billions of dollars in a bid to dominate emerging technologies like artificial intelligence, quantum computing, and advanced semiconductors. And then there’s the Belt and Road Initiative (BRI), China’s $1 trillion program to build the transportation infrastructure for a China-centered world.How is it possible that a self-described developing country like China can finance a superpower rivalry with the United States?
Seen from afar, China’s current all-fronts offensive gives the impression of a rising power on the march. China is simultaneously starting a border skirmish with India, militarizing the South China Sea, cracking down on Hong Kong, pressuring Taiwan, confronting Japan over disputed islands, and quelling internal unrest—all while fighting a resurgent coronavirus outbreak. At the same time, it is investing billions of dollars in a bid to dominate emerging technologies like artificial intelligence, quantum computing, and advanced semiconductors. And then there’s the Belt and Road Initiative (BRI), China’s $1 trillion program to build the transportation infrastructure for a China-centered world.How is it possible that a self-described developing country like China can finance a superpower rivalry with the United States?
Running a global superpower is an expensive business. The United States famously spends more on defense than the next 10 countries combined, yet the notion persists that its military is still underfunded and underequipped for its global superpower role. And if the pundits are to be believed, the United States will lose its competitive edge without more investment in university research, advanced technologies, foreign aid, diplomacy, the United Nations, clean energy, and, of course, pandemic preparedness. That’s just to name a few of the United States’ superpower funding priorities. The full list is much longer.
But if the United States—with an economy roughly 50 percent larger than China’s and a gross domestic product (GDP) per capita more than six times as great—can’t afford to remain a global superpower, how can China possibly afford to become one? Leaving aside the facts that China’s chief diplomatic allies are North Korea, Cambodia, and Ethiopia, that it is surrounded by potentially hostile nuclear-weapon states such as Russia and India, that its state-sponsored technology companies are widely distrusted outside China, and that Beijing has been widely blamed for allowing the coronavirus pandemic to spread to the rest of the world, how is it possible that a self-described developing country like China can finance a superpower rivalry with the United States?
The simple answer is it can’t. Even before the coronavirus hit, China’s economic growth had slowed from double-digit rates in the early 2000s to 6.1 percent in 2019—if you believe the official figures, that is. This figure is highly suspect, not least because the person who sets China’s annual GDP target, National Development and Reform Commission vice chairman Ning Jizhe, is the same person who, as director of the National Bureau of Statistics, is responsible for measuring GDP. Independent modeling published by the Brookings Institution suggests that China has historically overestimated GDP growth by an average of 1.7 percent per year.
China’s officially reported tax revenues confirm this picture, growing at just 3.8 percent in 2019, compared with 6.2 percent in 2018 and 7.4 percent in 2017. Yet as China’s financial means have become more restricted, its spending has continued on its old, profligate trajectory, growing 8.1 percent in 2019. The result has been a widening gap in China’s government budgets, with the officially reported budget deficit reaching 4.9 percent of GDP in 2019. The International Monetary Fund puts the true figure of the government’s shortfall at more than 12 percent of GDP. And this was before the coronavirus, during a period of supposedly healthy economic growth.
Hard figures for China are hard to come by, but it seems that the Chinese government was scaling back spending commitments even before the coronavirus hit. You would hardly know it from the glowing project announcements, but China’s BRI funding commitments have actually been falling since 2017. And even these falling numbers are just promises—the reality of China’s BRI spending is even more meager. Chinese banks have virtually disappeared from BRI financing, leaving the cash-strapped government to shoulder the burden alone. Meanwhile, projects have been shelved, scaled back, or delayed all across Asia.
Western critics of the BRI tend to interpret these problems in terms of the fear of indebtedness that these projects spark in recipient countries. They rarely mention the indebtedness they induce in China itself. So when Western media reported in December that China was pressuring a reluctant Pakistan to resume work on the stalled China–Pakistan Economic Corridor, they failed to mention that China is unwilling to finance the construction itself. Similarly, China wants to build a new port in Myanmar, but it is reluctant to pay for it. China signed a Transit and Transport Agreement with Nepal in 2015 but has yet to build a single mile of road or railway in the landlocked Himalayan country. It’s the same story in Africa and Eastern Europe: China continues to announce grand projects but has been unwilling to offer enough money to actually get them off the ground.
China’s financing problems are nowhere more apparent—and less acknowledged—than in its military budgets. Analyses from the Center for Strategic and International Studies suggest that Chinese defense spending may actually fall in real terms in 2020. Given China’s elevated pace of military operations on several borders, spending constraints must be putting serious pressure on acquisitions budgets. It is impossible for anyone outside China’s defense establishment to know what is really going on, but circumstantial evidence suggests that many of China’s big-ticket weapons programs have been put on go-slow.It is impossible for anyone outside China’s defense establishment to know what is really going on, but circumstantial evidence suggests that many of China’s big-ticket weapons programs have been put on go-slow.
For example, China is believed to have built only 50 or so J-20 fifth-generation stealth fighters. The J-20 program now seems to be experiencing serious development problems, limiting production for the foreseeable future. This compares to America’s stock of 195 F-22 and 134 F-35 fifth-generation fighters, with continuing annual production of more than 100 F-35s, even after coronavirus delays.
Similarly, China once planned to deploy six U.S.-style aircraft carrier strike groups by 2035. Aside from the Soviet-surplus training carrier Liaoning, China currently has only one conventionally powered ski-jump carrier, with a second under construction. Plans for four nuclear-powered carriers have been delayed indefinitely due to “technical challenges and high costs.” China says it will eventually develop fifth-generation fighter planes for deployment on aircraft carriers. Meanwhile, the United States’ F-35C carrier-optimized stealth fighters are already in training for deployment this year.
Fighting India with sticks and stones on the high plateau of Ladakh comes cheap, but preparing to confront the United States in the Western Pacific is a very expensive proposition indeed. It is likely to prove a luxury that a slow-growth, post-coronavirus China will not be able to afford. Like a gangster flashing a wad of $100 bills, China makes a great show of its wealth and its willingness to spend it. In reality, Beijing’s bank balance doesn’t match its bling.
Having witnessed decades of double-digit growth in Chinese GDP and government spending, outsiders are conditioned to believe that China’s financial resources are unlimited. Having lived through China’s economic rise themselves, insiders are perhaps conditioned to believe it, too. But no budget is bottomless, and China seems to have hit the buffers just as the coronavirus struck. China’s leaders can at least save face by abandoning their GDP targets and blaming the virus for the inevitable austerity to follow. But when the crisis is over, the United States will still be a global superpower. China may be forced to embrace a less-ambitious future.


foreignpolicy--2020-07-06--Global Poverty Rampant Despite Sunny Talk, U.N. Finds

For 10 years , economists , the United Nations , and world leaders have celebrated a reduction in global poverty , heralded as “ one of the greatest human achievements of our time ” by then-World Bank Group President Jim Yong Kim in 2018 .
Those claims of victory appear to be misleading , at best .
A scathing new report published on Monday by Philip Alston in his parting shot as the United Nations special rapporteur on extreme poverty and human rights paints a world where poverty is rampant—yet undercounted , due to the World Bank ’ s reliance @ @ @ @ @ @ @ at a critical juncture , as the coronavirus pandemic is set to push half a billion people into poverty and is expected to double the number of people facing acute hunger to 265 million .
“ Even before COVID-19 , we squandered a decade in the fight against poverty , with misplaced triumphalism blocking the very reforms that could have prevented the worst impacts of the pandemic , ” Alston said in a press release issued alongside the report .
“ When combined with the next generation of post-COVID-19 austerity policies , the @ @ @ @ @ @ @ to the wealthy elites that has characterized the past forty years will accelerate , at which point the extent and depth of global poverty will be even more politically unsustainable and explosive , ” the report says .
Alston , who stepped down as special rapporteur in May , places much of the blame for misplaced global optimism on international institutions and economists ’ over-reliance on the World Bank ’ s international poverty line of $ 1.90 per day as the definition of extreme poverty .
In his six years as special rapporteur @ @ @ @ @ @ @ withering reports on global poverty—and the world ’ s richest countries , including the United States , were not spared his scrutiny .
The number of people living below the $ 1.90 threshold is down from 1.9 billion in 1990 to 734 million in 2015 , but even those who eke their way past the extreme poverty line may still struggle to secure basic necessities , such as food and housing .
“ The IPL [ International Poverty Line ] is explicitly designed to reflect a staggeringly low standard of living , well @ @ @ @ @ @ @ with dignity , ” says the report , which was presented to the U.N. Human Rights Council today by Alston ’ s successor , Olivier De Schutter .
“ It would be difficult to overstate the significance of this report .
It ’ s a direct , high-profile challenge to the dominant narrative about global poverty that has for so long been promoted by the U.N. , the World Bank , and international NGOs , ” said Jason Hickel , an economic anthropologist and senior lecturer at Goldsmiths , University of London .
@ @ @ @ @ @ @ per day as “ scandalously unambitious ” and argued that more realistic measures reveal the number of people living in poverty to be far higher and progress to be much slower .
The number of people living on less than $ 5.50 per day , the World Bank ’ s poverty line for upper-middle-income countries , has remained nearly stagnant since 1990 .
In 2018 , almost half of the world ’ s population lived on less than $ 5.50 per day .
“ With numbers like these on the table , it @ @ @ @ @ @ @ simply not working for the majority of humanity—and we need to face up to that fact , ” Hickel said .
The $ 1.90 global yardstick of extreme poverty is derived from an average of national poverty lines of some of the world ’ s poorest countries , but this has masked the significant country-to-country variance in the cost of living , and in most contexts it is well below national poverty lines .
Under the World Bank ’ s definition , Thailand has no one living in extreme poverty .
Yet 10 @ @ @ @ @ @ @ threshold , according to the country ’ s own definition .
“ The line is set so low and arbitrarily as to guarantee a positive result and to enable the United Nations , the World Bank , and many commentators to proclaim a Pyrrhic victory , ” Alston writes in the report .
“ The $ 1.90 poverty line has come under sustained criticism for many years , because , remarkably , it has no grounding in any empirical assessment of human needs .
As a measure of poverty , it is completely @ @ @ @ @ @ @ World Bank has different poverty metrics for middle- and high-income countries as well as multidimensional poverty measures .
“ But the reality is whenever you see the big statements coming out of the bank , or any of the big statements coming out of the U.N. , they ’ re based on the $ 1.90 a day measure , ” Alston said in an interview with Foreign Policy .
The World Bank did not immediately respond to a request for comment for this story .
The report also criticizes the U.N. ’ s @ @ @ @ @ @ @ economic growth as a rising tide to lift all boats .
Decades of strong economic growth have in many instances only further entrenched extreme inequality .
Between 1980 and 2016 , 27 percent of total real income growth was captured by just 1 percent of the world ’ s population , according to the 2018 World Inequality Report .
While many billionaires have become indispensable in international aid efforts , Alston writes , “ Philanthropy is less likely to expose and tackle unjust underlying structures.
” The reliance on the private sector and @ @ @ @ @ @ @ international institutions , he argues .
Alston proposes a number of systematic approaches to poverty reduction , including debt forgiveness , universal social safety nets , and a move beyond the foreign aid model toward a more progressive tax system .
Tax havens have enabled multinational corporations to put some 40 percent of their overseas profits beyond the reach of the tax system , costing countries some $ 200 billion each year in lost revenues .
“ Poverty is a political choice and will be with us until its elimination is reconceived as @ @ @ @ @ @ @ the report concludes .

For 10 years, economists, the United Nations, and world leaders have celebrated a reduction in global poverty, heralded as “one of the greatest human achievements of our time” by then-World Bank Group President Jim Yong Kim in 2018.
For 10 years, economists, the United Nations, and world leaders have celebrated a reduction in global poverty, heralded as “one of the greatest human achievements of our time” by then-World Bank Group President Jim Yong Kim in 2018.
If only.
Those claims of victory appear to be misleading, at best. A scathing new report published on Monday by Philip Alston in his parting shot as the United Nations special rapporteur on extreme poverty and human rights paints a world where poverty is rampant—yet undercounted, due to the World Bank’s reliance on outdated metrics.
The report comes at a critical juncture, as the coronavirus pandemic is set to push half a billion people into poverty and is expected to double the number of people facing acute hunger to 265 million.
“Even before COVID-19, we squandered a decade in the fight against poverty, with misplaced triumphalism blocking the very reforms that could have prevented the worst impacts of the pandemic,” Alston said in a press release issued alongside the report.
“When combined with the next generation of post-COVID-19 austerity policies, the dramatic transfer of economic and political power to the wealthy elites that has characterized the past forty years will accelerate, at which point the extent and depth of global poverty will be even more politically unsustainable and explosive,” the report says.
Alston, who stepped down as special rapporteur in May, places much of the blame for misplaced global optimism on international institutions and economists’ over-reliance on the World Bank’s international poverty line of $1.90 per day as the definition of extreme poverty. In his six years as special rapporteur, Alston has produced a series of withering reports on global poverty—and the world’s richest countries, including the United States, were not spared his scrutiny.
The number of people living below the $1.90 threshold is down from 1.9 billion in 1990 to 734 million in 2015, but even those who eke their way past the extreme poverty line may still struggle to secure basic necessities, such as food and housing.
“The IPL [International Poverty Line] is explicitly designed to reflect a staggeringly low standard of living, well below any reasonable conception of a life with dignity,” says the report, which was presented to the U.N. Human Rights Council today by Alston’s successor, Olivier De Schutter.
“It would be difficult to overstate the significance of this report. It’s a direct, high-profile challenge to the dominant narrative about global poverty that has for so long been promoted by the U.N., the World Bank, and international NGOs,” said Jason Hickel, an economic anthropologist and senior lecturer at Goldsmiths, University of London.
Alston described the threshold of $1.90 per day as “scandalously unambitious” and argued that more realistic measures reveal the number of people living in poverty to be far higher and progress to be much slower. The number of people living on less than $5.50 per day, the World Bank’s poverty line for upper-middle-income countries, has remained nearly stagnant since 1990. In 2018, almost half of the world’s population lived on less than $5.50 per day.
“With numbers like these on the table, it becomes clear that the world economy is simply not working for the majority of humanity—and we need to face up to that fact,” Hickel said.
The $1.90 global yardstick of extreme poverty is derived from an average of national poverty lines of some of the world’s poorest countries, but this has masked the significant country-to-country variance in the cost of living, and in most contexts it is well below national poverty lines. Under the World Bank’s definition, Thailand has no one living in extreme poverty. Yet 10 percent of Thais live under the poverty threshold, according to the country’s own definition.
“The line is set so low and arbitrarily as to guarantee a positive result and to enable the United Nations, the World Bank, and many commentators to proclaim a Pyrrhic victory,” Alston writes in the report.
“The $1.90 poverty line has come under sustained criticism for many years, because, remarkably, it has no grounding in any empirical assessment of human needs. As a measure of poverty, it is completely arbitrary,” Hickel said.
The World Bank has different poverty metrics for middle- and high-income countries as well as multidimensional poverty measures. “But the reality is whenever you see the big statements coming out of the bank, or any of the big statements coming out of the U.N., they’re based on the $1.90 a day measure,” Alston said in an interview with Foreign Policy.
The World Bank did not immediately respond to a request for comment for this story.
The report also criticizes the U.N.’s Sustainable Development Goals for their over-emphasis on economic growth as a rising tide to lift all boats. Decades of strong economic growth have in many instances only further entrenched extreme inequality. Between 1980 and 2016, 27 percent of total real income growth was captured by just 1 percent of the world’s population, according to the 2018 World Inequality Report.
While many billionaires have become indispensable in international aid efforts, Alston writes, “Philanthropy is less likely to expose and tackle unjust underlying structures.” The reliance on the private sector and nonprofits shifts responsibility away from governments and international institutions, he argues.
Alston proposes a number of systematic approaches to poverty reduction, including debt forgiveness, universal social safety nets, and a move beyond the foreign aid model toward a more progressive tax system. Tax havens have enabled multinational corporations to put some 40 percent of their overseas profits beyond the reach of the tax system, costing countries some $200 billion each year in lost revenues.
“Poverty is a political choice and will be with us until its elimination is reconceived as a matter of social justice,” the report concludes.


foreignpolicy--2020-07-06--The Midwives on the Front Lines

The Midwives on the Front Lines

KANDAHAR , Afghanistan—The maternity ward at Mirwais Hospital in Kandahar city in southern Afghanistan is one of the country ’ s busiest .
On a crisp February morning , women in pastel-colored burqas crowded the corridors outside the maternity ward clamoring to get in .
A woman in labor stretched out on a blanket with her young children beside her , waiting for a free bed .
Another woman perched on a stool guarded the doors , unwavering .
They flung open , and a new mother pushed through the crowd with a newborn .
The halls were filled with @ @ @ @ @ @ @ Habibi , 35 , a bright-eyed , wiry midwife , bustled around the maternity ward .
She was at the end of her double shift—24 hours of nonstop births , attending to young mothers from tribes across Kandahar .
At one bedside she checked a patient ’ s dilation , and at another she changed an IV bag—all while answering questions from concerned relatives .
Habibi is one of 38 midwives at the government-run Mirwais Hospital , where she has worked for seven years and delivered thousands of babies .
Midwives are some @ @ @ @ @ @ @ health care workers , fighting to ensure that women and babies survive childbirth in even the most marginalized rural areas .
“ I wanted to be a midwife and serve the women of my community because this profession is needed so desperately in Afghanistan , ” Habibi said .
Afghanistan has seen four decades of war , leaving its health care system overstretched , with limited coverage in conflict-affected areas .
Despite the peace deal signed between the United States and the Taliban in February , violence continues unabated .
Some of the @ @ @ @ @ @ @ workers , including at Mirwais Hospital : In 2016 , two armed militants dressed as doctors walked through the doors , and one patient was killed in the ensuing gunfight .
The World Health Organization reported 119 attacks on health care in Afghanistan in 2019 .
On May 12 , militants attacked a maternity ward at Dasht-e-Barchi Hospital in Kabul and killed 24 people , including 16 mothers , two newborns , and one midwife .
More than 20 people , including babies , were injured .
The attack lasted four hours .
@ @ @ @ @ @ @ but not one of the 16 mothers who remained exposed was spared : Three were killed in the delivery room .
In the wake of the attack , Médecins Sans Frontières , which ran the maternity ward , decided to cease operations and withdraw from the hospital—leaving women in the area without emergency obstetric care .
Across the country , the escalating violence has made health facilities harder to reach .
Mirwais Hospital serves 6 million people from five provinces , including many from areas where the Taliban are actively fighting government forces @ @ @ @ @ @ @ s only large-scale surgical facility , and since 1997 it has been supported by the International Committee of the Red Cross , receiving medicine , equipment , and staff training .
Its doctors and nurses work at the heart of the continuing Afghan conflict , with war casualties coming through the doors day and night .
Mirwais Hospital sees an average of 300 patients and as many as 90 births every day .
More than 27,000 babies were born at the hospital in 2019 .
Two-thirds of births in Afghanistan still occur at @ @ @ @ @ @ @ have no access to basic health clinics .
For decades , the country has battled one of the highest infant and maternal mortality rates in the world—particularly in rural areas , where as few as 3 percent of deliveries are attended by a skilled professional .
Postpartum hemorrhaging is the leading cause of maternal death .
“ Some women still give birth at home because the hospital is far away and there is no transportation .
But in a home delivery , complications like hemorrhaging are common , and many women and babies @ @ @ @ @ @ @ 30 , another midwife at Mirwais Hospital and a mother of three .
“ These complications could be easily addressed if these women were giving birth here at the hospital.
” Over the last two decades , the increasing presence of midwives has started to play a role in improving a mother ’ s and baby ’ s chance of survival .
Afghanistan ’ s maternal mortality rate has dropped from 1,600 deaths per 100,000 live births in 2002 to 638 deaths per 100,000 births in 2017 .
( Other estimates put the @ @ @ @ @ @ @ . )
The number of patients at Mirwais Hospital has increased in recent years , along with their expectations .
“ Women from across Kandahar heard that we have a delivery ward , and now they are all coming here .
Some travel for days and spend all the money they have to come to Mirwais , ” Habibi said .
“ There are not enough of us .
Every bed is full .
On the delivery ward every bed is full , and upstairs surgeons are doing back-to-back cesareans , often two @ @ @ @ @ @ @ don ’ t go according to the standards here .
One midwife has to attend to four or five deliveries at a time.
” Mirwais Hospital often takes on patients who have been unable to receive proper treatment from their local clinic—if they have access to a medical professional at all .
“ The midwives here have saved many women ’ s lives from very complicated and dangerous situations , ” Azimi said .
However , some complications are discovered too late .
“ Some women ’ s families don ’ t let @ @ @ @ @ @ @ the hospital is just far away .
In these cases , we are not able to address the complications in time , ” she said .
Beyond the maternity ward , Afghan midwives deliver other reproductive care to women , including disease prevention , breastfeeding guidance , and family planning .
In conservative Kandahar , providing such support is also challenging—and sometimes dangerous , with midwives facing threats from the community and even patients ’ family members .
Not all midwives have the support of their own families .
“ For some of @ @ @ @ @ @ @ allow them to come here , but they insist that this is the work they want to do , ” Azimi said .
“ They know how important it is for the community , and they manage to get the permission somehow , but every day they battle just to come into work.
” Afghanistan ’ s conservative social norms and the lack of access to education for women present other unique challenges for the midwives of Mirwais Hospital .
The average Afghan household has eight members , and women from conservative families @ @ @ @ @ @ @ , Habibi said .
Afghanistan remains one of the most dangerous countries in the world for women .
Violence against women is still commonplace , as is the expectation that a wife will provide her husband with many children .
Husbands and other male family members are often the biggest obstacle to family planning , so the midwives deliver targeted information to husbands and male relatives through screens in the waiting area .
Some subjects are sensitive : Talking directly to the men about birth control would not be appropriate for them or @ @ @ @ @ @ @ .
“ If there is something specific that we can ’ t say—such as advising the women to avoid sleeping with her husband for a certain period of time for health reasons—we tell the woman discreetly and then advise the patient to convey it to her husband later , ” Habibi said .
“ In this way , we often need to go through the women to educate the men.
” “ It ’ s not an easy job because the lives of many mothers and children are in our hands , ” @ @ @ @ @ @ @ very far away because they know that the hospital provides experienced midwives and legitimate medicine .
They trust our hospital , and they trust us .
”

KANDAHAR, Afghanistan—The maternity ward at Mirwais Hospital in Kandahar city in southern Afghanistan is one of the country’s busiest. On a crisp February morning, women in pastel-colored burqas crowded the corridors outside the maternity ward clamoring to get in. A woman in labor stretched out on a blanket with her young children beside her, waiting for a free bed. Another woman perched on a stool guarded the doors, unwavering. They flung open, and a new mother pushed through the crowd with a newborn. The halls were filled with the cries of newborn babies.
KANDAHAR, Afghanistan—The maternity ward at Mirwais Hospital in Kandahar city in southern Afghanistan is one of the country’s busiest. On a crisp February morning, women in pastel-colored burqas crowded the corridors outside the maternity ward clamoring to get in. A woman in labor stretched out on a blanket with her young children beside her, waiting for a free bed. Another woman perched on a stool guarded the doors, unwavering. They flung open, and a new mother pushed through the crowd with a newborn. The halls were filled with the cries of newborn babies.
Sitara Habibi, 35, a bright-eyed, wiry midwife, bustled around the maternity ward. She was at the end of her double shift—24 hours of nonstop births, attending to young mothers from tribes across Kandahar. At one bedside she checked a patient’s dilation, and at another she changed an IV bag—all while answering questions from concerned relatives. Habibi is one of 38 midwives at the government-run Mirwais Hospital, where she has worked for seven years and delivered thousands of babies.
Midwives are some of Afghanistan’s most vital front-line health care workers, fighting to ensure that women and babies survive childbirth in even the most marginalized rural areas. “I wanted to be a midwife and serve the women of my community because this profession is needed so desperately in Afghanistan,” Habibi said.
Afghanistan has seen four decades of war, leaving its health care system overstretched, with limited coverage in conflict-affected areas. Despite the peace deal signed between the United States and the Taliban in February, violence continues unabated. Some of the violence has targeted maternity hospitals and health workers, including at Mirwais Hospital: In 2016, two armed militants dressed as doctors walked through the doors, and one patient was killed in the ensuing gunfight. The World Health Organization reported 119 attacks on health care in Afghanistan in 2019.
On May 12, militants attacked a maternity ward at Dasht-e-Barchi Hospital in Kabul and killed 24 people, including 16 mothers, two newborns, and one midwife. More than 20 people, including babies, were injured. The attack lasted four hours. Ten women managed to find shelter, but not one of the 16 mothers who remained exposed was spared: Three were killed in the delivery room. In the wake of the attack, Médecins Sans Frontières, which ran the maternity ward, decided to cease operations and withdraw from the hospital—leaving women in the area without emergency obstetric care.
Mothers and relatives visit babies in incubators in the intensive care unit of the pediatric department at Mirwais Hospital on Feb. 17.
Across the country, the escalating violence has made health facilities harder to reach. Mirwais Hospital serves 6 million people from five provinces, including many from areas where the Taliban are actively fighting government forces. The hospital is southern Afghanistan’s only large-scale surgical facility, and since 1997 it has been supported by the International Committee of the Red Cross, receiving medicine, equipment, and staff training. Its doctors and nurses work at the heart of the continuing Afghan conflict, with war casualties coming through the doors day and night. Mirwais Hospital sees an average of 300 patients and as many as 90 births every day. More than 27,000 babies were born at the hospital in 2019.
Midwives staff the busy delivery ward at Mirwais Hospital in Kandahar, Afghanistan, on Feb. 18.
Two-thirds of births in Afghanistan still occur at home, and many rural Afghan women have no access to basic health clinics. For decades, the country has battled one of the highest infant and maternal mortality rates in the world—particularly in rural areas, where as few as 3 percent of deliveries are attended by a skilled professional. Postpartum hemorrhaging is the leading cause of maternal death. “Some women still give birth at home because the hospital is far away and there is no transportation. But in a home delivery, complications like hemorrhaging are common, and many women and babies die,” said Mazia Azimi, 30, another midwife at Mirwais Hospital and a mother of three. “These complications could be easily addressed if these women were giving birth here at the hospital.”
Mazia Azimi, left, and Sitara Habibi are longtime midwives at Mirwais Hospital.
Over the last two decades, the increasing presence of midwives has started to play a role in improving a mother’s and baby’s chance of survival. Afghanistan’s maternal mortality rate has dropped from 1,600 deaths per 100,000 live births in 2002 to 638 deaths per 100,000 births in 2017. (Other estimates put the current figure at 400 per 100,000 births.)
The number of patients at Mirwais Hospital has increased in recent years, along with their expectations. “Women from across Kandahar heard that we have a delivery ward, and now they are all coming here. Some travel for days and spend all the money they have to come to Mirwais,” Habibi said. “There are not enough of us. Every bed is full. On the delivery ward every bed is full, and upstairs surgeons are doing back-to-back cesareans, often two women at a time, and things don’t go according to the standards here. One midwife has to attend to four or five deliveries at a time.”
Azimi talks to a surgeon in the delivery ward at Mirwais Hospital on Feb. 17.
Mirwais Hospital often takes on patients who have been unable to receive proper treatment from their local clinic—if they have access to a medical professional at all. “The midwives here have saved many women’s lives from very complicated and dangerous situations,” Azimi said. However, some complications are discovered too late. “Some women’s families don’t let them come for checkups, or sometimes the hospital is just far away. In these cases, we are not able to address the complications in time,” she said.
Beyond the maternity ward, Afghan midwives deliver other reproductive care to women, including disease prevention, breastfeeding guidance, and family planning. In conservative Kandahar, providing such support is also challenging—and sometimes dangerous, with midwives facing threats from the community and even patients’ family members. Not all midwives have the support of their own families. “For some of them, their families don’t allow them to come here, but they insist that this is the work they want to do,” Azimi said. “They know how important it is for the community, and they manage to get the permission somehow, but every day they battle just to come into work.”
Women in labor wait in the corridor outside the maternity ward at Mirwais Hospital on Feb. 19.
A woman holds her child in the pediatric department at Mirwais Hospital on Feb. 17. This is the third hospitalization for the 2-year-old, who suffers from malnutrition.
Afghanistan’s conservative social norms and the lack of access to education for women present other unique challenges for the midwives of Mirwais Hospital. The average Afghan household has eight members, and women from conservative families balk at the idea of birth control, Habibi said. Afghanistan remains one of the most dangerous countries in the world for women. Violence against women is still commonplace, as is the expectation that a wife will provide her husband with many children. Husbands and other male family members are often the biggest obstacle to family planning, so the midwives deliver targeted information to husbands and male relatives through screens in the waiting area.
Some subjects are sensitive: Talking directly to the men about birth control would not be appropriate for them or for the midwives, according to Habibi. “If there is something specific that we can’t say—such as advising the women to avoid sleeping with her husband for a certain period of time for health reasons—we tell the woman discreetly and then advise the patient to convey it to her husband later,” Habibi said. “In this way, we often need to go through the women to educate the men.”
Midwife trainees prepare the labor ward for the first patients of the day at Mirwais Hospital on Feb. 18.
Despite the many challenges and risks, the midwives have no plans to leave their work at the hospital. Their patients need them. As dusk fell on Mirwais Hospital in February, Azimi walked out of the maternity ward with a newborn, and the men and children waiting outside jumped to their feet to get a peek—hoping that she was carrying their newest family member.
A father and son wait outside the maternity ward at Mirwais Hospital on Feb. 17.
A proud grandmother holds a newborn baby boy after he received his vaccinations in the maternity ward at Mirwais Hospital on Feb. 18.
“It’s not an easy job because the lives of many mothers and children are in our hands,” Azimi said. “Women come from very far away because they know that the hospital provides experienced midwives and legitimate medicine. They trust our hospital, and they trust us.”


foreignpolicy--2020-07-06--Will the Coronavirus Fuel Conflict?

Will the Coronavirus Fuel Conflict?

We have studied fragile states—countries with tenuous social contracts between governments and their citizens—for the past few years .
We recently updated our forecasts of the chances that countries will experience internal wars to include the exacerbating effects of the coronavirus .
We developed the forecasts using the University of Denver ’ s International Futures model , a statistical simulation of human and social development indicators .
The model draws on the International Monetary Fund ’ s projected GDP growth rates while incorporating assumptions about COVID-19 prevalence and mortality .
These GDP growth rates reflect declines in economic output and @ @ @ @ @ @ @ other significant drivers of internal war : poverty , health , trade activity , regime type , youth population size , and wars in neighboring countries .
Many countries were experiencing armed conflict before the pandemic , but the previous forecasts projected the number of global conflicts to start to plateau or even decline in 2020 and continue on that path .
Instead , the new forecast results from the model show that an additional 13 countries are likely to see new conflicts through 2022—an increase of 56 percent compared to the pre-pandemic @ @ @ @ @ @ @ responses , such as national lockdowns .
Based on historical patterns , we now expect 35 countries to experience instability between 2020 and 2022 , more than at any point over the past 30 years .
The pandemic-induced fragility could manifest in several ways .
In some countries , social distancing policies that restrict economic activity and falling commodity prices due to slumping demand will have devastating consequences for individual livelihoods and government revenues .
Countries that depend on food imports will likely experience shortages and rising prices as producer countries restrict exports @ @ @ @ @ @ @ and trigger famines .
Cash-strapped governments will be challenged to provide assistance , undermining trust in government .
Frustrated with declining incomes , some citizens could resort to violence and militancy .
Governments could crack down with greater repression and restrictions on rights .
Alternatively , as traditional patronage networks are disrupted by declining revenues , government elites may attempt rebellions to preserve their positions .
Afghanistan clings to hopes that peace talks between the government and Taliban will yield results after 18 years of war , but the pandemic is causing those @ @ @ @ @ @ @ Afghanistan hard , straining its few and inadequate medical facilities .
Since the outbreak began there , conflict has intensified , with the Taliban killing dozens of government soldiers and targeting health clinics .
In May , the Islamic State claimed a horrific attack on a maternity ward in Kabul .
The United States is pushing for a peace deal with the hope of withdrawing all of its forces before November , and it has also cut its foreign assistance by $ 1 billion .
Afghanistan ’ s GDP growth this year could @ @ @ @ @ @ @ estimates—to negative 3 percent , worsening poverty and economic prospects .
As the government struggles to adapt to a downward development spiral , grievances and support for the Taliban or Islamic State could grow—leading to further violence .
The long-running war in Syria , which has declined in intensity over the past year , could also see a resurgence of violence .
President Bashar al-Assad is facing a pandemic-related financial crisis—as are Iran , Turkey , and Russia , three of the main players in the conflict .
Fewer resources could limit the @ @ @ @ @ @ @ military and hold territories retaken from insurgent groups throughout the country .
In northeastern Syria , the Kurdish People ’ s Protection Units , or YPG , holds captured Islamic State militants in its prisons .
But fears of a coronavirus outbreak among the prisoners , along with reduced U.S. support in the Kurdish-controlled region , could portend prison breaks and the remobilization of Islamic State forces .
West Africa could see its existing conflicts worsen—as well as a contagion of conflict .
In the Sahel , Mali and Nigeria are already engaged @ @ @ @ @ @ @ Qaeda in the Islamic Maghreb , which could spread to neighboring countries .
Senegal , Ivory Coast , and Sierra Leone face income declines and increasing odds of conflict .
In Senegal , for example , the idle conflict with separatists in the Casamance region remains unresolved .
A cease-fire was renewed in April , but the pandemic ’ s economic shocks could worsen wealth inequalities .
While testing remains limited , the coronavirus hasn ’ t spread much yet across the continent—in part because community organizations are stepping up to assist .
@ @ @ @ @ @ @ could overwhelm government capacity and sap social spending , undermining public confidence and reopening the wounds of prior conflicts .
In eastern and southern Africa , Rwanda , Zambia , and Zimbabwe are expected to experience heightened fragility , but Burundi—which suffered a devastating civil war between 1993 and 2005—may be the most vulnerable .
The country saw democratic backsliding under the outgoing President Pierre Nkurunziza , who died suddenly last month just before his term was set to end .
He increased his repressive tactics and employed armed youth militias to marginalize @ @ @ @ @ @ @ contested the May election but accepted the Constitutional Court ’ s decision to declare ruling-party candidate Évariste Ndayishimiye the winner .
The turn of events could be an opening for unity , but future economic fallout could also restart tensions .
The pandemic is expected to cause Burundi ’ s annual GDP growth to slide this year from 5 percent in previous projections to negative 5.5 percent , exacerbating high levels of poverty .
The probability of conflict there will rise over the next two years from 37 percent in our original forecast @ @ @ @ @ @ @ , per our calculations using the International Futures model .
Lebanon is especially fragile among countries in the Middle East , and the coronavirus is pushing it to the brink by escalating the country ’ s worst financial crisis in decades .
In addition to its long-running refugee crisis stemming from the conflict in neighboring Syria , a collapsing currency and high debt have increased prices for staples .
The untested prime minister has struggled to cement an agreement with the IMF for assistance .
This has undercut the middle class and spurred @ @ @ @ @ @ @ Lebanese population lives in poverty .
Hezbollah has provided health services for political gains .
Some towns are successfully managing the spread of the coronavirus .
The Lebanese parliament passed a $ 300 million aid package in May to address the economic crisis , and the mandate for the United Nations peacekeeping mission in the south of the country was just renewed .
But with its mix of challenges , Lebanon ’ s potential for conflict remains high .
The IMF expects Lebanon ’ s GDP growth to decline in 2020 from a @ @ @ @ @ @ @ 12 percent .
We estimate that the probability of internal war will nearly triple over the next two years .
The United States has experienced the most coronavirus casualties worldwide—a crisis largely of its own making .
Mismanagement of public health care and politicized delays in instituting lockdowns could have cost as many as 54,000 lives through May , according to researchers at Columbia University .
The lockdowns have led to record increases in unemployment .
The prospect of election turmoil also looms , and the presumptive Democratic presidential nominee Joe Biden has @ @ @ @ @ @ @ use the crisis as a pretext to postpone or cancel the November election .
( Democratic Party officials are planning several contingencies for disruptions . )
Racist violence by state forces is also generating social unrest .
The police killing of George Floyd in May has prompted protests and calls for social justice across the country—leading the police to respond with further violence .
State government officials characterized the situation as “ urban warfare , ” while the secretary of defense called for governors to “ dominate the battle space ” of America @ @ @ @ @ @ @ military helicopters conducted shows of force against peaceful protesters , and military troops were used against the demonstrators .
African leaders have condemned the social problems in the United States , which could benefit from security sector reform and police demilitarization of the sort that African Union advisors often support in other countries .
A second wave of the coronavirus could follow the protests and nationwide reopenings , which could diminish trust in the government to mount an adequate public health response .
There were not many epidemics in the cases we sampled @ @ @ @ @ @ @ initiatives helped Kazakhstan to tamp down a diphtheria outbreak that peaked in 1995 and Botswana to manage its HIV/AIDS crisis beginning in 2002 .
In more recent epidemics , such as Ebola and Zika , effective and coordinated policy responses provided openings to boost citizens ’ trust in governments .
Policymakers in the United States and around the world have several options .
They can encourage countries to make positive reforms rather than resort to crackdowns .
Instead of withdrawing from the World Health Organization , as the Trump administration has , they @ @ @ @ @ @ @ vulnerable countries provide care for their citizens and manage the spread of the coronavirus and related health shocks .
The U.S. government can also speed up the implementation of the U.S .
Global Fragility Act , a law passed last year with bipartisan support that is slated to provide $ 1.15 billion of assistance for conflict prevention and peacebuilding to fragile countries over the next five years .
But without enduring efforts to address historical inequities at home , the United States may lack the legitimacy to assist with fragility abroad .
To @ @ @ @ @ @ @ fragile countries that may spill beyond borders , wealthier countries must step up in solidarity to do their part .

The coronavirus pandemic has led to over 500,000 deaths and strained health care systems worldwide. But it has also had damaging knock-on effects for the global economy and governance. One increasing risk is that these effects will lead to more episodes of large-scale internal violence, including civil war.
The coronavirus pandemic has led to over 500,000 deaths and strained health care systems worldwide. But it has also had damaging knock-on effects for the global economy and governance. One increasing risk is that these effects will lead to more episodes of large-scale internal violence, including civil war.
We have studied fragile states—countries with tenuous social contracts between governments and their citizens—for the past few years. We recently updated our forecasts of the chances that countries will experience internal wars to include the exacerbating effects of the coronavirus. We developed the forecasts using the University of Denver’s International Futures model, a statistical simulation of human and social development indicators. The model draws on the International Monetary Fund’s projected GDP growth rates while incorporating assumptions about COVID-19 prevalence and mortality. These GDP growth rates reflect declines in economic output and can affect fragility by interacting with several other significant drivers of internal war: poverty, health, trade activity, regime type, youth population size, and wars in neighboring countries.
Many countries were experiencing armed conflict before the pandemic, but the previous forecasts projected the number of global conflicts to start to plateau or even decline in 2020 and continue on that path. Instead, the new forecast results from the model show that an additional 13 countries are likely to see new conflicts through 2022—an increase of 56 percent compared to the pre-pandemic forecast—due to the coronavirus pandemic and government responses, such as national lockdowns. Based on historical patterns, we now expect 35 countries to experience instability between 2020 and 2022, more than at any point over the past 30 years.
For fragile states, the consequences of the pandemic could reverberate into the future. First and foremost, wars wrought by instability are detrimental to the livelihoods and rights of citizens. Political instability also presents security threats for neighbors and other countries, as fragile states may become havens for terrorist actors or hosts to disease outbreaks.
The pandemic-induced fragility could manifest in several ways. In some countries, social distancing policies that restrict economic activity and falling commodity prices due to slumping demand will have devastating consequences for individual livelihoods and government revenues. Countries that depend on food imports will likely experience shortages and rising prices as producer countries restrict exports. These economic crises may worsen poverty and trigger famines. Cash-strapped governments will be challenged to provide assistance, undermining trust in government.
Frustrated with declining incomes, some citizens could resort to violence and militancy. Governments could crack down with greater repression and restrictions on rights. Alternatively, as traditional patronage networks are disrupted by declining revenues, government elites may attempt rebellions to preserve their positions.
Turkish army troops take position behind sand barricades aimed at blocking the road by Syrian protesters on the M4 highway, which links the northern Syrian provinces of Aleppo and Latakia, in Syria's northwestern Idlib province on April 13.
For some countries, such as Afghanistan, Algeria, Libya, Mali, Syria, Sudan, and Yemen, the new fragility risks could enflame simmering conflicts and ongoing crises.
Afghanistan clings to hopes that peace talks between the government and Taliban will yield results after 18 years of war, but the pandemic is causing those prospects to fade. The coronavirus hit Afghanistan hard, straining its few and inadequate medical facilities. Since the outbreak began there, conflict has intensified, with the Taliban killing dozens of government soldiers and targeting health clinics. In May, the Islamic State claimed a horrific attack on a maternity ward in Kabul. The United States is pushing for a peace deal with the hope of withdrawing all of its forces before November, and it has also cut its foreign assistance by $1 billion.
Afghanistan’s GDP growth this year could swing from 3.5 percent—based on previous IMF estimates—to negative 3 percent, worsening poverty and economic prospects. As the government struggles to adapt to a downward development spiral, grievances and support for the Taliban or Islamic State could grow—leading to further violence.
The long-running war in Syria, which has declined in intensity over the past year, could also see a resurgence of violence. President Bashar al-Assad is facing a pandemic-related financial crisis—as are Iran, Turkey, and Russia, three of the main players in the conflict. Fewer resources could limit the government’s ability to maintain its military and hold territories retaken from insurgent groups throughout the country. In northeastern Syria, the Kurdish People’s Protection Units, or YPG, holds captured Islamic State militants in its prisons. But fears of a coronavirus outbreak among the prisoners, along with reduced U.S. support in the Kurdish-controlled region, could portend prison breaks and the remobilization of Islamic State forces.
West Africa could see its existing conflicts worsen—as well as a contagion of conflict. In the Sahel, Mali and Nigeria are already engaged in conflicts against Boko Haram and al Qaeda in the Islamic Maghreb, which could spread to neighboring countries. Senegal, Ivory Coast, and Sierra Leone face income declines and increasing odds of conflict. In Senegal, for example, the idle conflict with separatists in the Casamance region remains unresolved. A cease-fire was renewed in April, but the pandemic’s economic shocks could worsen wealth inequalities. While testing remains limited, the coronavirus hasn’t spread much yet across the continent—in part because community organizations are stepping up to assist. But if it does spread, it could overwhelm government capacity and sap social spending, undermining public confidence and reopening the wounds of prior conflicts.
The pandemic also threatens to raise the risks in recent post-conflict states and other countries not experiencing conflict.
In eastern and southern Africa, Rwanda, Zambia, and Zimbabwe are expected to experience heightened fragility, but Burundi—which suffered a devastating civil war between 1993 and 2005—may be the most vulnerable. The country saw democratic backsliding under the outgoing President Pierre Nkurunziza, who died suddenly last month just before his term was set to end. He increased his repressive tactics and employed armed youth militias to marginalize the political opposition. The opposition party contested the May election but accepted the Constitutional Court’s decision to declare ruling-party candidate Évariste Ndayishimiye the winner.
The turn of events could be an opening for unity, but future economic fallout could also restart tensions. The pandemic is expected to cause Burundi’s annual GDP growth to slide this year from 5 percent in previous projections to negative 5.5 percent, exacerbating high levels of poverty. The probability of conflict there will rise over the next two years from 37 percent in our original forecast to 70 percent in the updated forecast, per our calculations using the International Futures model.
Lebanon is especially fragile among countries in the Middle East, and the coronavirus is pushing it to the brink by escalating the country’s worst financial crisis in decades. In addition to its long-running refugee crisis stemming from the conflict in neighboring Syria, a collapsing currency and high debt have increased prices for staples. The untested prime minister has struggled to cement an agreement with the IMF for assistance. This has undercut the middle class and spurred protests, as nearly half of the Lebanese population lives in poverty. Hezbollah has provided health services for political gains. Some towns are successfully managing the spread of the coronavirus.
The Lebanese parliament passed a $300 million aid package in May to address the economic crisis, and the mandate for the United Nations peacekeeping mission in the south of the country was just renewed. But with its mix of challenges, Lebanon’s potential for conflict remains high. The IMF expects Lebanon’s GDP growth to decline in 2020 from a previous estimate of 0.9 percent to negative 12 percent. We estimate that the probability of internal war will nearly triple over the next two years.
U.S. Park Police push back protestors near the White House on June 1, 2020 as protests against police violence and systemic racism continue.
Per our models, the United States is unlikely to see an internal war, but the pandemic’s economic and health effects are tragic, and the country is experiencing a new level of fragility and social unrest.
The United States has experienced the most coronavirus casualties worldwide—a crisis largely of its own making. Mismanagement of public health care and politicized delays in instituting lockdowns could have cost as many as 54,000 lives through May, according to researchers at Columbia University. The lockdowns have led to record increases in unemployment. The prospect of election turmoil also looms, and the presumptive Democratic presidential nominee Joe Biden has raised concerns that President Donald Trump might use the crisis as a pretext to postpone or cancel the November election. (Democratic Party officials are planning several contingencies for disruptions.)
Racist violence by state forces is also generating social unrest. The police killing of George Floyd in May has prompted protests and calls for social justice across the country—leading the police to respond with further violence. State government officials characterized the situation as “urban warfare,” while the secretary of defense called for governors to “dominate the battle space” of America’s streets. In Washington, military helicopters conducted shows of force against peaceful protesters, and military troops were used against the demonstrators. African leaders have condemned the social problems in the United States, which could benefit from security sector reform and police demilitarization of the sort that African Union advisors often support in other countries.
A second wave of the coronavirus could follow the protests and nationwide reopenings, which could diminish trust in the government to mount an adequate public health response.
As governments struggle to balance flattening the COVID-19 curve with softening the pandemic’s social and economic fallout, there are reasons for hope. In 50 representative cases of fragility and the policy responses that we studied, governments were quicker to introduce political reforms and provide economic support for their citizens rather than engage in political repression or economic punishment of political rivals.
There were not many epidemics in the cases we sampled, but international support for public health initiatives helped Kazakhstan to tamp down a diphtheria outbreak that peaked in 1995 and Botswana to manage its HIV/AIDS crisis beginning in 2002. In more recent epidemics, such as Ebola and Zika, effective and coordinated policy responses provided openings to boost citizens’ trust in governments.
Policymakers in the United States and around the world have several options. They can encourage countries to make positive reforms rather than resort to crackdowns. Instead of withdrawing from the World Health Organization, as the Trump administration has, they can support such institutions to help more vulnerable countries provide care for their citizens and manage the spread of the coronavirus and related health shocks. The U.S. government can also speed up the implementation of the U.S. Global Fragility Act, a law passed last year with bipartisan support that is slated to provide $1.15 billion of assistance for conflict prevention and peacebuilding to fragile countries over the next five years. But without enduring efforts to address historical inequities at home, the United States may lack the legitimacy to assist with fragility abroad.
To minimize harmful health and governance outcomes in fragile countries that may spill beyond borders, wealthier countries must step up in solidarity to do their part.


foreignpolicy--2020-07-06--‘America First’ vs. ‘The People’s Vaccine’

As the world races to develop a vaccine to end the still-raging coronavirus pandemic , “ vaccine nationalism ” threatens both the near-term fight against COVID-19 and the longer-term prospects of multilateral cooperation .
Major countries , including the United States , China , France , Germany , and Italy , have been locking in agreements with pharmaceutical companies to develop and mass-produce vaccines for their own populations , raising concerns among smaller countries that they will be shut out of the market .
A competing effort led by the World Health Organization and a coalition of global health organizations @ @ @ @ @ @ @ as a “ people ’ s vaccine ” for poor and middle-income countries is struggling to line up sufficient funding among rich donors , who are reluctant to gamble billions of dollars on the development of vaccine candidates that may never succeed .
The effort to secure widespread distribution of effective vaccines is turning out to be a major test of multilateralism in an era when countries , or regions , are pursuing their own remedies .
The United States , which during previous pandemics used its influence to galvanize international responses , @ @ @ @ @ @ @ in fighting Ebola , HIV/AIDS , and malaria .
It has announced plans to withdraw from the WHO , and it is reportedly snapping up much of the world ’ s supply of the antiviral COVID treatment Remdesivir .
Even big European countries are locking in future vaccines first for themselves .
“ If we continue on the path we are on currently then multilateralism will have failed , ” said Thomas Bollyky , the director of the global health program at the Council on Foreign Relations .
There could be short- , @ @ @ @ @ @ @ vaccines , he said .
“ For the short and medium term , it will mean the pandemic rages unabated in countries without supplies .
For the long term , there will be consequences for reaching global cooperation on other matters , ” he said .
“ If we can ’ t cooperate in this context , it undermines the case for cooperating in other cases.
” Hoarding is a big concern , because even once successful vaccines are developed , health experts expect global supply shortages for the next 12 to 18 @ @ @ @ @ @ @ snap up limited supplies of vaccines for their own countries , health experts say it would be more effective to ensure that vulnerable populations worldwide can get the vaccine to prevent future resurgences of the pandemic .
“ We know for sure that there won ’ t be enough , ” said Mariângela Simão , the WHO ’ s assistant director-general for access to medicines and health products .
“ One certainty we have is that if we have one or two or three candidates they are not enough to vaccinate the entire @ @ @ @ @ @ @ we are aiming at priority populations to be vaccinated by the end of next year.
” Concern about the availability of vaccines comes as the coronavirus pandemic continues to rage , especially in the United States .
Worldwide , more than 10 million people have been infected and over 500,000 have died ; in the United States , around 3 million have been infected and more than 130,000 have died .
The United States marked its biggest-ever one-day total of new cases at more than 55,000 last week .
“ The worst is @ @ @ @ @ @ @ Ghebreyesus , the head of the WHO , said in a virtual briefing on Monday .
“ We all want to get on with our lives .
But the hard reality is this is not even close to being over.
” A cooperative approach to developing vaccines is important because developing vaccines is an inherently risky undertaking , with only a tiny fraction of preliminary vaccine candidates eventually proving successful in human trials .
Only about 7 percent of vaccines in the early stages of development are successful , and only 17 percent @ @ @ @ @ @ @ end up being successful , according to figures compiled by Gavi , the Vaccine Alliance .
Those figures give an edge to wealthy countries like the United States , which has hedged its bets by signing lucrative vaccine development and manufacturing deals with several companies .
But it is filled with peril for poor countries , which lack the resources to sign multibillion-dollar deals with pharmaceutical companies , or middle-income states that risk gambling on a small number of loser vaccines .
In April , the WHO , working closely with the European @ @ @ @ @ @ @ Foundation , and others , launched the Access to COVID-19 Tools Accelerator to coordinate a global campaign to develop diagnostic tests , medicines , or therapeutics to alleviate the severity of the disease , and vaccines to prevent transmission .
It aims to raise $ 31.3 billion , including $ 18.1 billion for the development of vaccines , from governments and private donors , to produce 500 million tests and 245 million therapeutic courses by mid-2021 , and 2 billion vaccine doses by the end of 2021 .
But it has raised only @ @ @ @ @ @ @ , and treatment so far , leaving an urgent funding gap .
Neither China nor the United States has contributed ; the White House point person on COVID-19 response , Jared Kushner , sees the multilateral effort as a competitor in the race for a vaccine .
The initiative ’ s vaccine pillar , known as the COVID-19 Vaccine Global Access Facility , or COVAX , seeks to pool resources among different countries , nonprofits , and international organizations to develop enough vaccines to cover the most vulnerable in each population , and @ @ @ @ @ @ @ COVAX is a grouping of several different global efforts to accelerate the search for new vaccines .
It includes the WHO , Gavi—created in 2000 and funded by the Gates Foundation , the United States , Britain , and Norway—and the Coalition for Epidemic Preparedness Innovations ( CEPI ) , which is funded by the Gates Foundation , the Wellcome Trust , Germany , Japan , and Norway .
“ COVID-19 is the biggest threat to global health security in a century , and the pandemic has shown that disease has no borders @ @ @ @ @ @ @ 11 “ discussion document ” detailing the COVAX technical plan .
“ Without a global effort that focuses on vaccinating the world ’ s key priority populations across all countries and quickly tackling disease outbreaks , the pandemic will continue to spread.
” “ The competition for vaccine candidates would lead to a global bidding frenzy , driving up pricing as countries ‘ panic buy , ’ ” the document added .
“ The substantial gaps in immunity to COVID-19 globally will result in continued & substantial waves of disease through at least @ @ @ @ @ @ @ disrupting societies and economies , ” other global health experts warned .
COVAX is championed by Singapore and Switzerland , which formed a so-called Friends of the Facility group to promote the multilateral approach .
Britain , Iceland , Japan , Norway , South Korea , the European Union , and New Zealand have joined the group , and others , including Australia and Canada , are expected to sign on .
The United States has not opposed the initiative , and there is some hope that it might provide some support in @ @ @ @ @ @ @ the United States has not contributed any funding to the COVAX initiative .
“ The COVID-19 pandemic demands a united and concerted response by all nations , ” Singapore ’ s Prime Minister Lee Hsien Loong said in a virtual summit on COVID-19 in early June .
“ I hope that this summit will help focus our minds and resources , and forge partnerships to promote ‘ vaccine multilateralism.
’ ” The initiative—which is still being negotiated with interested governments—is meant to forestall mass shortages of vaccines as during the H1N1 , or @ @ @ @ @ @ @ in the death of as many as 575,000 people in 2009 .
Manufacturers would be asked to seek minimal financial returns in the initial phase of the vaccine response , ensuring that priority populations would receive affordable doses .
In exchange , the companies would secure future commitments to sell additional doses .
The more countries invest in the project , the larger number of vaccine candidates it can afford to develop , increasing the odds of finding one or more successful vaccines .
So far , CEPI has reached agreements with pharmaceutical @ @ @ @ @ @ @ potential vaccines for COVID-19 , and efforts are underway to secure funding from governments , the private sector , and private health charities to fund an expansion of those efforts .
Earlier this month , the pharmaceutical giant AstraZeneca reached a $ 750 million agreement with CEPI and Gavi to support the manufacturing and distribution of 300 million doses of a vaccine , starting at the beginning of the year .
But more funding is needed to secure agreements with major manufacturers to produce vaccines .
“ The global vaccine requirements to control @ @ @ @ @ @ @ the scale of vaccine production needed , as quickly as possible , requires providing manufacturers with certainty of future financing and procurement , ” according to the COVAX paper .
The task of funding and distributing vaccines to the poorest countries will be left to Gavi , which has already built an extensive distribution network in more than 75 lower- and middle-income countries , but which has never tackled a crisis of this magnitude .
Meanwhile , the United States , in addition to seeking to stockpile antiviral treatments that could crimp availability @ @ @ @ @ @ @ has signed contracts with several pharmaceutical companies for vaccines , including Johnson & Johnson , Moderna Inc. , and AstraZeneca to purchase and manufacture billions of doses of vaccine .
“ There is not much discussion of world partnership , ” said Michael Collins , a research associate at the Council on Foreign Relations .
“ If I had to guess , the ‘ America First ’ approach is going to prevail with the vaccine procurement process.
” Under the White House ’ s Operation Warp Speed , led by Kushner , the @ @ @ @ @ @ @ million doses by January 2021 , suggesting it would seek to offer vaccines to low-risk individuals—not the approach that health experts say would be most effective at tamping down the global pandemic .
“ There is going to be scarcity , during that period of scarcity how much of those supplies are you going to use domestically ?
If you use them all , scarcity is going to last longer , ” said Bollyky , the global health expert .
“ If you focus on priority needs and share the rest , there @ @ @ @ @ @ @ for its part , seems to be charting a different course , potentially using vaccine development to boost its influence among developing countries .
In May , China ’ s President Xi Jinping said any vaccines his country produced would be a “ global public good ” and shared with poor countries .
“ This will be China ’ s contribution to ensuring vaccine accessibility and affordability in developing countries , ” Xi told the World Health Assembly at its virtual gathering .
China watchers say it would likely share the vaccine with @ @ @ @ @ @ @ Belt and Road Initiative .
Even Europe , for all its talk of broad multilateralism , is looking out for itself .
Germany , France , Italy , and the Netherlands struck out early to form their own purchasing alliance , called the Inclusive Vaccine Alliance .
The move rankled other European powers , including Belgium , which complained it was undermining EU efforts to purchase vaccines on behalf of all its member states .
French government officials , meanwhile , moved to quash an effort by the United States to line up @ @ @ @ @ @ @ potential vaccine produced by the French drugmaker Sanofi , calling it “ unacceptable.
” And Britain ’ s health minister protested that vaccines produced in Britain , where a University of Oxford lab has produced one of the more promising vaccine candidates , should be used to protect Britons .
“ The Europeans talk the rhetoric of multilateralism , but it remains to be seen if they are committed to it , ” said one senior diplomat .
Following criticism , France and Germany have since sought to assure countries that they will @ @ @ @ @ @ @ .
In April , French President Emmanuel Macron and German Chancellor Angela Merkel , along with the WHO , backed an $ 8 billion virtual fundraising event to raise money to produce vaccines for all countries .
“ We are talking here about global public property , about producing this vaccine and then distributing it all around the world , ” Merkel said .
The United States declined to participate in the fundraiser .

As the world races to develop a vaccine to end the still-raging coronavirus pandemic, “vaccine nationalism” threatens both the near-term fight against COVID-19 and the longer-term prospects of multilateral cooperation.
As the world races to develop a vaccine to end the still-raging coronavirus pandemic, “vaccine nationalism” threatens both the near-term fight against COVID-19 and the longer-term prospects of multilateral cooperation.
Major countries, including the United States, China, France, Germany, and Italy, have been locking in agreements with pharmaceutical companies to develop and mass-produce vaccines for their own populations, raising concerns among smaller countries that they will be shut out of the market. A competing effort led by the World Health Organization and a coalition of global health organizations to secure what is being referred to as a “people’s vaccine” for poor and middle-income countries is struggling to line up sufficient funding among rich donors, who are reluctant to gamble billions of dollars on the development of vaccine candidates that may never succeed.
The effort to secure widespread distribution of effective vaccines is turning out to be a major test of multilateralism in an era when countries, or regions, are pursuing their own remedies. The United States, which during previous pandemics used its influence to galvanize international responses, has largely abdicated the role it played in fighting Ebola, HIV/AIDS, and malaria. It has announced plans to withdraw from the WHO, and it is reportedly snapping up much of the world’s supply of the antiviral COVID treatment Remdesivir. Even big European countries are locking in future vaccines first for themselves.
“If we continue on the path we are on currently then multilateralism will have failed,” said Thomas Bollyky, the director of the global health program at the Council on Foreign Relations.
There could be short-, medium-, and long-term consequences of hoarding vaccines, he said. “For the short and medium term, it will mean the pandemic rages unabated in countries without supplies. For the long term, there will be consequences for reaching global cooperation on other matters,” he said. “If we can’t cooperate in this context, it undermines the case for cooperating in other cases.”
Hoarding is a big concern, because even once successful vaccines are developed, health experts expect global supply shortages for the next 12 to 18 months. Rather than see wealthy countries snap up limited supplies of vaccines for their own countries, health experts say it would be more effective to ensure that vulnerable populations worldwide can get the vaccine to prevent future resurgences of the pandemic.
“We know for sure that there won’t be enough,” said Mariângela Simão, the WHO’s assistant director-general for access to medicines and health products. “One certainty we have is that if we have one or two or three candidates they are not enough to vaccinate the entire world at the same time. So we are aiming at priority populations to be vaccinated by the end of next year.”
Concern about the availability of vaccines comes as the coronavirus pandemic continues to rage, especially in the United States. Worldwide, more than 10 million people have been infected and over 500,000 have died; in the United States, around 3 million have been infected and more than 130,000 have died. The United States marked its biggest-ever one-day total of new cases at more than 55,000 last week.
“The worst is yet to come,” Tedros Adhanom Ghebreyesus, the head of the WHO, said in a virtual briefing on Monday. “We all want to get on with our lives. But the hard reality is this is not even close to being over.”
A cooperative approach to developing vaccines is important because developing vaccines is an inherently risky undertaking, with only a tiny fraction of preliminary vaccine candidates eventually proving successful in human trials. Only about 7 percent of vaccines in the early stages of development are successful, and only 17 percent of those that reach trials on humans end up being successful, according to figures compiled by Gavi, the Vaccine Alliance.
Those figures give an edge to wealthy countries like the United States, which has hedged its bets by signing lucrative vaccine development and manufacturing deals with several companies. But it is filled with peril for poor countries, which lack the resources to sign multibillion-dollar deals with pharmaceutical companies, or middle-income states that risk gambling on a small number of loser vaccines.
In April, the WHO, working closely with the European Commission, the Bill and Melinda Gates Foundation, and others, launched the Access to COVID-19 Tools Accelerator to coordinate a global campaign to develop diagnostic tests, medicines, or therapeutics to alleviate the severity of the disease, and vaccines to prevent transmission.
It aims to raise $31.3 billion, including $18.1 billion for the development of vaccines, from governments and private donors, to produce 500 million tests and 245 million therapeutic courses by mid-2021, and 2 billion vaccine doses by the end of 2021. But it has raised only $3.4 billion for vaccines, tests, and treatment so far, leaving an urgent funding gap. Neither China nor the United States has contributed; the White House point person on COVID-19 response, Jared Kushner, sees the multilateral effort as a competitor in the race for a vaccine.
The initiative’s vaccine pillar, known as the COVID-19 Vaccine Global Access Facility, or COVAX, seeks to pool resources among different countries, nonprofits, and international organizations to develop enough vaccines to cover the most vulnerable in each population, and thus keep future outbreaks under control.
COVAX is a grouping of several different global efforts to accelerate the search for new vaccines. It includes the WHO, Gavi—created in 2000 and funded by the Gates Foundation, the United States, Britain, and Norway—and the Coalition for Epidemic Preparedness Innovations (CEPI), which is funded by the Gates Foundation, the Wellcome Trust, Germany, Japan, and Norway.
“COVID-19 is the biggest threat to global health security in a century, and the pandemic has shown that disease has no borders,” according to an internal June 11 “discussion document” detailing the COVAX technical plan. “Without a global effort that focuses on vaccinating the world’s key priority populations across all countries and quickly tackling disease outbreaks, the pandemic will continue to spread.”
“The competition for vaccine candidates would lead to a global bidding frenzy, driving up pricing as countries ‘panic buy,’” the document added.
“The substantial gaps in immunity to COVID-19 globally will result in continued & substantial waves of disease through at least end-2021, straining health systems and further disrupting societies and economies,” other global health experts warned.
COVAX is championed by Singapore and Switzerland, which formed a so-called Friends of the Facility group to promote the multilateral approach. Britain, Iceland, Japan, Norway, South Korea, the European Union, and New Zealand have joined the group, and others, including Australia and Canada, are expected to sign on. The United States has not opposed the initiative, and there is some hope that it might provide some support in the future. But so far, the United States has not contributed any funding to the COVAX initiative.
“The COVID-19 pandemic demands a united and concerted response by all nations,” Singapore’s Prime Minister Lee Hsien Loong said in a virtual summit on COVID-19 in early June. “I hope that this summit will help focus our minds and resources, and forge partnerships to promote ‘vaccine multilateralism.’”
The initiative—which is still being negotiated with interested governments—is meant to forestall mass shortages of vaccines as during the H1N1, or swine flu, pandemic, which resulted in the death of as many as 575,000 people in 2009. Manufacturers would be asked to seek minimal financial returns in the initial phase of the vaccine response, ensuring that priority populations would receive affordable doses. In exchange, the companies would secure future commitments to sell additional doses. The more countries invest in the project, the larger number of vaccine candidates it can afford to develop, increasing the odds of finding one or more successful vaccines.
So far, CEPI has reached agreements with pharmaceutical companies to develop more than a dozen potential vaccines for COVID-19, and efforts are underway to secure funding from governments, the private sector, and private health charities to fund an expansion of those efforts. Earlier this month, the pharmaceutical giant AstraZeneca reached a $750 million agreement with CEPI and Gavi to support the manufacturing and distribution of 300 million doses of a vaccine, starting at the beginning of the year. But more funding is needed to secure agreements with major manufacturers to produce vaccines.
“The global vaccine requirements to control the pandemic are vast, and achieving the scale of vaccine production needed, as quickly as possible, requires providing manufacturers with certainty of future financing and procurement,” according to the COVAX paper.
The task of funding and distributing vaccines to the poorest countries will be left to Gavi, which has already built an extensive distribution network in more than 75 lower- and middle-income countries, but which has never tackled a crisis of this magnitude.
Meanwhile, the United States, in addition to seeking to stockpile antiviral treatments that could crimp availability for the rest of the world, has signed contracts with several pharmaceutical companies for vaccines, including Johnson & Johnson, Moderna Inc., and AstraZeneca to purchase and manufacture billions of doses of vaccine.
“There is not much discussion of world partnership,” said Michael Collins, a research associate at the Council on Foreign Relations. “If I had to guess, the ‘America First’ approach is going to prevail with the vaccine procurement process.”
Under the White House’s Operation Warp Speed, led by Kushner, the United States is seeking to acquire 300 million doses by January 2021, suggesting it would seek to offer vaccines to low-risk individuals—not the approach that health experts say would be most effective at tamping down the global pandemic.
“There is going to be scarcity, during that period of scarcity how much of those supplies are you going to use domestically? If you use them all, scarcity is going to last longer,” said Bollyky, the global health expert. “If you focus on priority needs and share the rest, there will be more available.”
China, for its part, seems to be charting a different course, potentially using vaccine development to boost its influence among developing countries. In May, China’s President Xi Jinping said any vaccines his country produced would be a “global public good” and shared with poor countries. “This will be China’s contribution to ensuring vaccine accessibility and affordability in developing countries,” Xi told the World Health Assembly at its virtual gathering. China watchers say it would likely share the vaccine with countries participating in Xi’s signature Belt and Road Initiative.
Even Europe, for all its talk of broad multilateralism, is looking out for itself. Germany, France, Italy, and the Netherlands struck out early to form their own purchasing alliance, called the Inclusive Vaccine Alliance. The move rankled other European powers, including Belgium, which complained it was undermining EU efforts to purchase vaccines on behalf of all its member states.
French government officials, meanwhile, moved to quash an effort by the United States to line up an exclusive agreement to purchase the first potential vaccine produced by the French drugmaker Sanofi, calling it “unacceptable.” And Britain’s health minister protested that vaccines produced in Britain, where a University of Oxford lab has produced one of the more promising vaccine candidates, should be used to protect Britons.
“The Europeans talk the rhetoric of multilateralism, but it remains to be seen if they are committed to it,” said one senior diplomat.
Following criticism, France and Germany have since sought to assure countries that they will support broad distribution of any future vaccine. In April, French President Emmanuel Macron and German Chancellor Angela Merkel, along with the WHO, backed an $8 billion virtual fundraising event to raise money to produce vaccines for all countries.
“We are talking here about global public property, about producing this vaccine and then distributing it all around the world,” Merkel said.
The United States declined to participate in the fundraiser.