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Nick Harvey spent 2007 and 2008 hitch-hiking from Europe to Asia, writing along the way, and becoming a leading voice on LGBTI (lesbian, gay, bisexual, transgender, intersex) issues in India. Since then he’s published dozens of articles – mainly for New Internationalist  – on both well-known and obscure international human rights issues from the plight of Tuaregs in Mali to the fight for democracy in Swaziland. As well as freelancing as a journalist, he’s currently the communications lead for the health charity Doctors of the World (Médecins du Monde) UK.

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Nick Harvey spent 2007 and 2008 hitch-hiking from Europe to Asia, writing along the way, and becoming a leading voice on LGBTI (lesbian, gay, bisexual, transgender, intersex) issues in India. Since then he’s published dozens of articles – mainly for New Internationalist  – on both well-known and obscure international human rights issues from the plight of Tuaregs in Mali to the fight for democracy in Swaziland. As well as freelancing as a journalist, he’s currently the communications lead for the health charity Doctors of the World (Médecins du Monde) UK.

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Out of sight, out of mind: refugees in purgatory

2014-11-13-Calaisrefugeesblog.jpg

A group of 20-30 Syrians were living in a ditch, nearby Calais, in the countryside. © Medecins du Monde

Unaccompanied Syrian children as young as 10 are living under tarpaulins in rain-sodden ditches far out in the countryside near Calais, France.

I met these children recently when I went to see how the charity I work for, Doctors of the World, helps the 2,000 or so migrants trapped in the Calais purgatory.

While most people know of the infamous ‘Jungle’ where the majority of migrants live near the port, few are aware of the other 20 or so settlements dotted around the region.

The first of these I saw was a squat in an old recycling yard. As we approached, big yellow letters loomed above us, rearranged to read ‘WE WANT FREEDOM.’

Inside, the scene was apocalyptic. Among the rubbish, debris and heavily graffitied walls were scattered tents and groups of men, mostly from Darfur, some from Syria and Afghanistan, huddled around fires playing cards, the smell of wood smoke clinging to everything.

Hussein, from Darfur, spent eight days at sea traveling from Libya to Italy, and was without food and water for three of those days.

‘I will be killed if I try to go back,’ he said. ‘David Cameron says “England is the best” and I believe him. So that’s where I’m going!’

Behind a nearby supermarket another group of 100 or so migrants live in a field. It had been raining for three days and the ground was like a Glastonbury mud bath. The camp had no running water or toilets and I was told that the migrants were barred from the supermarket.

Despite wearing only flip-flops and woefully inadequate summer jackets, the residents greeted us with smiles and handshakes.

‘London is the best city in the world!’ said Samir, an electrician from Darfur, after he heard where we were from. He had spent two weeks crossing the Sahara Desert with little food as part of his journey.

 I asked what it is like living here.

‘It is so terrible here,’ he said matter-of-factly, still smiling.

We had to drive far out into the countryside to a place near St Omer to visit the last, and most shocking, settlement, where a group of 20-30 Syrians were living in a ditch.

As we squelched down the remote muddy lane in the rain, it was hard to believe anyone could be living there. To our left were tilled fields, now just mud, and to our right were bushes leading down into a long ditch. I had turned up my trousers to the knees to avoid getting muddied and I thought I looked silly.

When we got closer a group of boys appeared from the bushes, with an adult. Recognizing our charity logo, they huddled beneath our umbrella. Only the adult spoke – he was from Aleppo, as were all the boys, who stood with bare feet on the tops of their wet and mud-caked shoes. I stopped thinking about my trousers.

The boys were aged between 10 and 15 and were muddied and unwashed, all there without their families. The 10-year-old was scratching because of scabies.

They took me down into the ditch beneath the tarpaulins to a small fire. They camped in this far-flung location because there was a service station nearby where they could try to board trucks.

‘There is so much we don’t have here,’ the adult told me. ‘But it is better than Aleppo.’

He added: ‘But we will not be here long’.

My French colleague later told me this was a common delusion, perhaps a necessary one, and that it usually took many months to cross the Channel.

So how could children be living for long periods of time in muddy ditches in a rich, supposedly civilized country such as France?

Part of the reason is that many of the refugees are distrustful of authorities, largely due to their experience with the French police, who are often the first point of referral for unaccompanied minors.

We hear regular reports of police brutality and harassment, such as arresting migrants, including women, and driving them long distances before dumping them by the motorway, forcing them to walk back. Police regularly destroy migrants’ property, including their phones, which are often the only connection people have to their families. They also beat them up.

‘They come early in the morning and chase us through the fields,’ says the adult. ‘When we come back all our things are broken’.

Walking back up the sodden path, I felt wet and cold, already sick of the mud and I could not wait to change my shoes and get in the car. I looked round at the boys standing in the drizzle; the youngest one was waving and it felt wrong to be leaving them there.

Back in my warm hotel room, I watched the rain through the window, knowing they were still out there, only a few kilometres away. The news that night featured reports from Syria and Sierra Leone, but nothing about the very real crisis happening here in Europe, just a short truck drive away from England.

Doctors of the World (Medecins du Monde) provides medicine and hygiene kits to migrants in Calais as well as building toilets and washing facilities.

There’s now a cure for hepatitis C… but most can’t afford it

Pills

Dominique Godbout under a Creative Commons Licence

Picture the scenario: a disease is destroying your liver and there’s a chance you will die. There’s a cure but you can’t have it; it costs more than you earn. This cure can be made cheaply, but the company that developed it wants to make a huge profit. There are tens of millions more people like you. Hundreds of thousands of them die every year.

It sounds like some sci-fi dystopia but this is the situation the 150 million people who have the hepatitis C virus (HCV) find themselves in today. HCV is spread through blood-to-blood contact, mostly through shared needles. Around 350,000 people die of HCV-related liver complaints each year but new drugs have been developed within the last 6 months with cure rates higher than 90 per cent. Even though these drugs could be produced generically for as little as $68 for a 12-week course, big pharmaceutical companies such as Gilead are pricing it up to $84,000 – that’s $1,000 a pill.

‘Not only is eradicating HCV within our grasp, it’s something that could be achieved well within in our lifetime,’ says Leigh Daynes, executive director of Doctors of the World (Médecins du Monde) UK, which is campaigning to increase global access to the new HCV drugs. ‘Pharmaceutical companies need to work with us to get these essential, life-saving drugs to those that need them; thousands are dying each week they delay.’

Gilead, which was granted regulatory approval in 2013 for the leading HCV drug Sofosbuvir – brand name Sovaldi – plans to sell the drug for a reduced rate of around $2,000 in middle-income countries, where around three-quarters of the world’s HCV-infected people live. But even then most will still be unable to access the drug. Egypt – which has the world’s highest prevalence of HCV – is one such middle-income country that Gilead announced would be getting discounted treatments.

‘Gilead are only giving a discount to a restricted number of people who access public health centres in Egypt,’ said Chloé Forette, harm reduction and Hepatitis C advocacy officer at the launch of Doctors of the World’s report on access to HCV medicines. ‘For those forced to buy it privately it is likely to be 5 times more expensive.’

To put this in context, the monthly average salary in Egypt is $250.

Gilead may grant what’s known as a ‘voluntary licence’ for some low-income countries, meaning generic producers are given permission to make the drug and distribute it in these countries at a lower price. Most who need the drug globally, however, would remain excluded.

‘This licence is likely to be restricted to 60 countries, which would be the smallest-ever scope for a voluntary licence, excluding around 60 per cent of the people infected worldwide,’ says Chloe Forette. ‘And even in these countries many still won’t be able to afford it as there’s no international funding mechanism available to buy these drugs for people.’

The overarching reason why so many people will be excluded from being cured is not a pretty one. Industry analysts believe the demand for these treatments will translate into annual sales of $9.1 billion for Sovaldi alone by 2017. Those in the pharmaceutical industry often argue that high prices are necessary to pay for the drug’s research and development (R&D) costs. This is not the case for Sovaldi, which is an adaptation of an existing molecule. And even where R&D costs are high, these can be recouped – while also allowing for a healthy profit – from sales in rich countries alone.

Suggested ways to make the treatment affordable through generic competition include patent opposition – where the 25-year long monopolies on drugs are challenged – and compulsory licensing – where pharmaceutical companies are forced to allow others to manufacture the drugs so they can be made and sold for a reasonable price. The World Health Organization has called for a ‘multi-pronged’ approach to tackle the issue, which could include tiered price discounts, voluntary licensing and compulsory licensing.

‘There needs to be a global renegotiation about access to commodities when it comes to global public health threat,’ says Professor Michel Kazatchkine, UN General Secretary Special envoy for HIV and AIDS in Eastern Europe and Central Asia. ‘We have to consider all of the current means we have to bypass the very basic and fundamental contradiction between our international, intellectual property treaties and our treaties on human rights and access to health.’

Many of these battles regarding access to medicines have already been fought, with some success, by those calling for cheaper HIV and AIDS drugs since the 1990s, which is giving HCV activists hope. In 2000, antiretroviral HIV drugs cost $15,000 – meaning only 5 per cent of people in low- and middle-income countries could get them. Thanks to generic competition, 15 years later the same therapy can cost around $60 and more than half of people in these countries can access them.

Activists hope it will not be such a long struggle with HCV, especially as, unlike HIV, these treatments have the potential to cure the disease in a single short course.

‘We have an opportunity to eradicate the virus, so this is a chance to bring the debate back to the international level about our inability to deal with all the major public health issues such as HIV, TB, malaria, and hepatitis C,’ says Professor Kazatchkine. ‘People will continue to die in large numbers unless we completely rethink this fundamental contradiction between human rights and intellectual property.’

Every newborn deserves the royal treatment

Children is Madagascar

Madagascar: two children helped by Doctors of the World © Bruno Fert

Having very recently become a parent, I finally have something in common with William and Kate apart from my British nationality. It was not an ‘easy’ birth, if there is such a thing. In short, our little girl got stuck and needed to be wrested out using a suction pump. Her head was temporarily cone shaped as a result which made her look like a comedy alien.

So, while it was not exactly the Lindo wing of St. Mary’s, my daughter was lucky to be born in a well-equipped hospital with specialists on hand to ensure her big appearance was a success. But it got me thinking, what if we’d not made it to the hospital and there were no medical professionals to help? And I kept coming back to the same answer: my wife and child would likely be dead.

Every day, around 800 women die from causes linked to pregnancy and childbirth. And it will come as little surprise that the majority of these deaths occur in poor countries. What may come as more of a shock is the sheer size of the disparity: 99 per cent of all maternal deaths occur in developing countries, largely in sub-Saharan Africa and South Asia.

Most deaths are caused by severe bleeding, infections, high blood pressure, disease and unsafe abortions. And the vast majority are easily preventable. But they are not prevented for a host of reasons including inadequate healthcare facilities, scarce or poorly trained medical staff as well as lack of health education and people’s distance from health facilities.

The organization I work for, Doctors of the World, runs programmes in places with some of the highest maternal and child mortality rates and every day our volunteer health professionals hear stories about the precariousness of pregnancy and childbirth.

Take Noor, for example, a 25-year-old Syrian woman living with her three young children in a refugee camp in North Bekaa, Lebanon.

‘When I was eight months pregnant, I was stung by a scorpion and had to be taken to hospital,’ she told us. ‘We had to pay 100,000 Lebanese pounds [around $66] so that I could get some care. That’s a lot of money for me, but it was pay or die.’

The good news is things are improving. Since 1990, maternal deaths worldwide have dropped by almost half, perhaps because improving maternal health was one of the eight Millennium Development Goals adopted by the international community in 2000.

But over three million newborn babies still die each year, and 2.6 million more are stillborn. In 2012 it was estimated that over 200 million women worldwide still have unmet family planning needs and over 20 million women will resort to a high-risk abortion.

And it’s not just in poor countries where people have problems accessing healthcare. At the clinic Doctors of the World runs for migrants and other vulnerable people in East London, a third of our new patients had tried to register with a GP before coming to us and not succeeded. Two-thirds of our service users had difficulty accessing healthcare in the past year because they didn't know how, or they faced administrative barriers and were denied access.

The right to survive pregnancy and childbirth is implicit in the right to life, a fundamental right of women and children enshrined in all treaties, conventions and declarations made by the international community concerning human rights.

And this is your right wherever you’re from, whether you’re rich or poor, whether your blood runs red or blue.

Britain’s shame: evicted islanders lose in court

Chagos Islands
Many view the marine protected area around the Chagos Islands as a ploy to ensure people have no chance of returning Charles Sheppard and Anne Sheppard/University of Warwick, under a CC License

The legacy of one of the most despicable episodes in British history continued in controversial style this week. A British Government decision to create a marine park around the Chagos Islands that arguably prevents the former inhabitants from being able to return to their homeland has been upheld by the High Court of Justice.

In the late 1960s, those living on the Chagos archipelago – a cluster of coral atolls in the middle of the Indian Ocean – were forced by the British to leave so a US military base could be built on the largest of the islands, Diego Garcia. In 2006, the Chagossians won a case in the High Court which found they were entitled to go back to the islands, but this was overturned in 2008 after an appeal by the then Foreign Secretary, David Milliband. Then, in April 2010, the government announced the creation of a marine protected area (MPA) around these islands. Many view the MPA as a cynical ploy to ensure Chagossians have no chance of returning.

‘The MPA makes it very hard for us to go back,’ says Roch Evenor, spokesperson for the UK Chagos Support Association. ‘And even if we can go back the MPA prevents us from fishing, which we need to do to survive.’

The islands are part of the British Indian Ocean Territory and the marine reserve – the world’s largest covering a 545,000-sq-km area – was set up by the previous Labour government, ostensibly to protect the area’s wildlife and corals from industrial fishing and deep-sea mining. For this reason, some environmental groups are in favour of the ruling for the MPA to remain in place.

‘The world’s oceans have been drastically overfished in the last 30 years so it is of huge benefit to the Indian Ocean,’ says William Marsden, chair of the Chagos Conservation Trust. ‘It is an extremely good example given by the British government.’

But the government’s good intentions were brought into question by a US cable published by Wikileaks in December 2010, in which the UK Foreign and Commonwealth Office’s Director of Overseas Territories, Colin Roberts, reportedly said that the protected area should have ‘no human footprints’ or ‘Man Fridays’ and that such a reserve would make it ‘difficult, if not impossible’ for former residents to pursue their resettlement claims. A key moment in this week’s court case was when judges ruled that the cable, or copies of it held by the media, could not be used as evidence due to the Diplomatic Privileges Act, 1964.

‘We always had our suspicions but after the Wikileaks episode it became more black and white,’ says Roch Evenor. ‘It’s just another way of keeping us away from our homeland and dividing us.’

And divided they remain. Although many of the original 1,500 to 2,000 Chagossians who were removed from the islands have since died, their numbers have swelled to more than 4,000 in exile, with roughly half living in Britain and half living in Mauritius and the Seychelles. But while Chagossians in Mauritius generally believe the MPA to be a bad idea and remain deeply sceptical of the British government, some UK-based Chagossians – who mostly live in Crawley in southwest England – are more optimistic.

‘There is a deep confusion,’ said Allen Vincatassin, President of the Diego Garcia and Chagos Islands Council. ‘The government has highlighted that if we are allowed to return, the MPA would be adjusted so that we can fish, I believe they will make it good.’

This could be wishful thinking as British governments past and present have failed to offer any meaningful concessions to Chagossians and this most recent court ruling continues in this shameful spirit. 

Novartis 0 – World’s Poor 1

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The ‘evergreening’ of drugs can push up prices epSos.de, under a CC License

If ever there was a court case that could save lives then this was it. On Monday 1 April the Indian Supreme Court stuck two legal fingers up at the Swiss pharmaceutical giant Novartis by ruling that the company could not patent the cancer drug Glivec.

As Big Pharma bosses watched their share prices fall with furrowed brows, health campaigners were celebrating a verdict that could have a massive impact on the ability of the world’s poor to access life-saving medicines.

Patents are a useful way of preventing competition, allowing pharmaceutical companies to keep their prices high. And even though a patent will typically last for 20 years, for many big companies this is not enough. So they often slightly modify the drug to get another 20-year monopoly, a trick known as ‘evergreening’.

This was true of Glivec (imatinib), which was already on the market, but Novartis argued its new version was more easily absorbable and therefore worthy of a fresh patent. But the India courts threw out the application on the grounds the new drug is not much different from the old version, ordering Novartis to pay costs.

This means that not only can Glivec continue to be produced cheaper in India – at a cost of around £115 ($175) per month, rather than the £1,700 ($2,590) Novartis price – but it sets a legal precedent for other drugs.

Due to its patent laws, India produces the majority of generic drugs for poor countries. Activists were concerned that if Novartis won this case the evergreening of drugs would increase across the board, pushing the price of important treatment for a wide range of diseases beyond the reach of those living in poverty.

Although this battle has been won, the war is far from over. Since 2005 HIV, tuberculosis and hepatitis C drugs have started to be patented in India meaning they will not reach the millions that need them in Africa and Asia for many years.

The big drug companies argue that patents are necessary to create profits and fund research into new drugs. But this argument is less convincing when applied to the Global South as the vast majority of profits are made in rich countries, with poorer countries seen merely as good potential for the future – regardless of how many people die in the meantime.

Although there is a long way to go in the fight for affordable medicines, activists all over the world should take heart from this legal victory. Sometimes the verdicts are just. Sometimes the good guys win.

Nick Harvey is a spokesperson for Doctors of the World UK.

My brush with the ‘health tourism’ media mafia

Doctor's hands with stethoscope
Migrants will have to wait for up to a year before being able to seek hospital treatment Alex E. Proimos, under a CC License

Lock up your medicines, the health tourists are coming! In a typically knee-jerk reaction to the Eastleigh by-election in the South East of England, the coalition government is – if you believe the media reports – considering a ‘profound shake-up’ of access to healthcare whereby migrants will have to wait for up to a year before being able to seek hospital treatment.

I was asked to appear on LBC Radio to discuss these developments in a debate hosted by shock jock Nick Ferrari, who is billed as ‘the man all politicians fear’. My research told me that Ferrari’s career highlights range from being the launch editor of Sky News to bringing to our screens topless darts and weather forecasts featuring a dwarf on a trampoline. More seriously, he’d also been reprimanded by the broadcasting standards commission for encouraging racism against asylum seekers.

My opponent would be a Dr Robert Lefever, a retired GP and regular Daily Mail contributor, who’d written articles with headlines such as: ‘If we don’t halt health tourism, our whole economy will bleed to death.’

This would be interesting.

Dr Lefever was actually mild mannered but typically vague about the ubiquity of so-called health tourism. When asked if it was possible to put a figure on how much it costs the British economy, he came back with: ‘I don’t think it is really, but many millions.’

Despite his hazy and subjective ramblings, Lefever was never interrupted and was referred to respectfully as ‘doctor’ throughout.

Then it was my turn. The air turned cooler as Ferrari’s sights honed in.

To be fair, I was able to get across my main point that health tourism being rampant in Britain is a myth. I was allowed to say less than two per cent of the service users at the London clinic we run to help vulnerable migrants had left their country because of health reasons and that almost half had no knowledge of the NHS or their right to healthcare. The real reasons people leave their country, of course, are to find work, to study, to flee persecution, among other reasons, not usually for free healthcare.

Then Ferrari threw in this curveball: ‘But if an elderly person, who’s paid tax his or her entire life, is not getting NHS care because someone who’s been here for half an hour is – that’s not fair is it?’

I wanted to say that this was a ridiculous straw-man scenario but as I began talking, Ferrari cut in: ‘But that’s not fair is it?’ His bluntness surprised me but I ploughed through and tried to make a point about the NHS constitution making it clear that healthcare should be available to all, regardless of status or ability to pay and…

‘But we can’t afford it, we CANNOT afford it,’ yells Ferrari.

This was not going quite as hoped.

I soldiered on, saying that early detection of illness among migrants actually saves money in the long run as it often precludes the need for much more expensive hospital treatment down the line. I mentioned that the idea that Britain is somehow unique in offering healthcare access to undocumented migrants is untrue as many other European countries offer similar access and…

‘You’re talking about migrants again, you’re obviously not listening,’ said Ferrari.

I was invited on to the show as the spokesperson for a charity that helps vulnerable migrants and now I was being told not to talk about vulnerable migrants. I made one last plea for reason about the scale of so-called ‘health tourism’ being nowhere near the worrying levels suggested by the likes of Dr Lefever, to which Ferrari replied that he has absolutely no doubt that health tourism exists and that his audience would prove it for him.

‘For those out there who have visited hospitals, fortunately I don’t too much – I don’t know about Mr Harvey – why don’t YOU tell ME the truth about health tourism,’ he said, cutting me off.

I didn’t feel the need tune back in to hear the various truths of the people who visit hospitals.

I was instead left to contemplate what had just happened and why.

Nick Harvey is a spokesperson for Doctors of the World, UK.

Syria’s civilians: when will the horror end?

A Syrian child stands in a makeshift graveyard
A Syrian child stands in a makeshift graveyard. Giorgos Moutafis

What many Syrians already knew has been made official. The country’s conflict has reached ‘unprecedented levels of horror’ according to UN peace envoy, Lakhdar Brahimi, speaking hours after dozens of bodies were found by a river in the northern city of Aleppo. The 71 dead – many with hands bound and with gunshot wounds to the head – can be added to the more than 60,000 others estimated to have already lost their lives.

And for those still living, this horror remains acute. Take Omar who was tortured for several days by Syrian government forces in a cell within Hama airport. Along with his brother, he was subject to an eclectic mix of cruelty, being repeatedly – and in no particular order – stripped, beaten, whipped, electrocuted, drugged and drowned. He was finally released after his family paid a large ransom. But the money came too late for his brother.

‘I had no political affiliation nor did my brother,’ he says. ‘I just want these people to go away and to be able to live in peace in my country. For my brother, it’s too late, may God look after him now.’

Faced with this daily dread, it’s no wonder people are looking to escape. As well as two million people being internally displaced in Syria, around 700,000 more have fled, mainly to Lebanon, Jordan and Turkey. The stories of how and why people leave are as varied as they are disturbing.

Khaled, 20, from Homs was on his way to university – the last thing he heard was a bang before bomb shrapnel flew into his brain. ‘I lost consciousness and I did not know until afterwards that a car had stopped to pick me up,’ he says. He was taken to a local hospital and later evacuated to Turkey. His brain is damaged and he has motor difficulties and trouble walking.

There are charities working in the region helping people like Khaled but the UN and Syrian government have granted authorization to only a select few NGOs to work within Syria. Many others are denied access, and are forced to provide aid from bordering countries. For instance, in Jordan, Doctors of the World, operates from the town of Ramtha, in King Abdullah Park and in the Zaatari camp, which now houses more than 35,000 Syrian refugees.

Although at times it feels like few are listening (UN envoy Mr Brahimi has said Syria is being ‘destroyed bit by bit’), Doctors of the World has condemned any violence against the population and has called on all parties involved in the conflict to respect the rules of international law in times of war, including respecting medical care providers and their ethical obligation to provide care.

But most of all we wish for the people of Syria that this misery will end soon.

Nick Harvey is a press officer at Doctors of The World.

Pharma vs India: a case of life or death for the world’s poor

It’s a worrying time for the poor and the sick. Two cases brought to India’s courts by transnational pharmaceutical companies could massively affect whether people in the Global South can access life-saving medicines. The most significant of these involves Swiss drugmaker Novartis which was refused a patent in India for its anti-cancer drug Glivec (imatinib) and is now challenging the country’s patent law.

There could be significant impact on access to medicines in countries such as India.

Irekia under a CC License

‘People are already dying because they can’t get treatment and if Novartis wins things will become worse,’ says Eldred Tellis, who runs a centre for drug users and people living with HIV in Mumbai. ‘They are targeting India because many quality generic drugs are produced here for many people.’

Thanks to India’s 1970 Patents Act, around one-fifth of the world’s generic drugs – containing the same active ingredients as a patented drug but made by a different company at a fraction of the price – are made in the country. As well as supplying India’s huge population, these drugs are shipped to poor countries around the world.

‘We source 80 per cent of our global HIV medicines, as well as other medicines, from India – as do the Global Fund,’ says Michelle Childs, Director of Policy and Advocacy at Médecins Sans Frontières (MSF). ‘So what happens in India can immediately affect other countries and set a precedent for them.’

The problem with patents

Novartis is challenging a clause in the Indian law, ‘Section 3d,’ that prevents drugs being patented that are modifications of existing drugs, a tactic known as ‘evergreening’ used to extend patent periods. The company originally failed to patent Glivec in India as it was discovered before the country was forced to start patenting drugs in 2005. The latest patent application is based on a salt form of Glivec (imatinib mesylate), which, although being easier to absorb, is arguably no more effective.

Studies have found the majority of global research and development (R&D) money is used to produce these minor variations, leading not only to high prices but a lack of genuinely new drugs.

‘About 85 per cent of all new drugs are proven to be little or no better, clinically, than existing drugs,’ says Donald Light, professor of comparative healthcare at the University of Medicine and Dentistry of New Jersey. ‘They are all better than placebo but they are not better than last year’s drug that was better than placebo.’

As these cases move through the Indian courts, the bottom line remains that they could significantly impact access to medicines for the world’s poor.

This is at odds with the pharmaceutical industry argument that the patent system is there to allow companies to receive more money to make new medicines. Producing new drugs is, they say, such an expensive business that only the big companies can afford to do it.

‘These are potentially dangerous substances so you really need to do a lot of research,’ says Mark Grayson, deputy vice-president of Pharmaceutical Research and Manufacturers of America (PhRMA). ‘You need to do clinical trials, even after the drug is on the market; you need production plants to be sterile, drugs need to be safe, all these costs need to be borne and they are not cheap.’

What they fail to mention is that the majority of R&D for developing new drugs is publicly funded. This was the case for Glivec, which was also awarded ‘orphan drug status’ in the US, allowing Novartis to receive tax breaks that paid for a large proportion of the clinical trials.

e-MagineArt.com under a CC license

‘The vast majority of the original research on Glivec came from charities and the government,’ says Jamie Love, Director of Knowledge Ecology International (KEI), an intellectual property pressure group. ‘But at the very end Novartis comes in and gets a patent on it and makes a couple of billion dollars a year.’

These mammoth profits are generated by aggressive pricing. When this court case began in 2006, Novartis sold Glivec for $2,200 per person per month, while the generic version was produced in India for a tenth of that price. That companies could be facing such huge losses to generic competition has wound up the neoliberal press in the US with the Wall Street Journal calling it a ‘drug disaster.’

Countries are allowed by the World Trade Organization to produce generic drugs if there is a major public health imperative, a practice known as compulsory licensing. India issued its first compulsory licence in March, ordering German drugmaker Bayer to allow a generic manufacturer to make its cancer drug Nexavar (sorafenib) for one-thirtieth of the usual $5,000 price tag. India’s patent controller argued that not only had Bayer failed to make the drug ‘reasonably affordable’, it had failed to supply the drug in large enough quantities, a decision Bayer is challenging in the courts.

‘With a patent comes obligations, one of which is you make your medicine available in the quantities needed,’ says Michelle Childs.

Targeting the poor

As these cases move through the Indian courts, the bottom line remains that they could significantly impact access to medicines for the world’s poor. If both Novartis and Bayer win, the floodgates could open for companies to challenge the laws and licences that allow generic drug production.

With the vast majority of profits in the pharmaceutical sector being made in wealthy countries, why are poor countries being targeted so aggressively? The answer, like so many others, relates to inequality. While not currently profitable, poorer countries are seen as ‘emerging markets’ because of their burgeoning middle classes.

Most of the people affected by high drug prices will die knowing nothing about patents, laws, licences or pharmaceutical companies

‘The drug companies see India as a market of 100 million, although that’s less than 10 per cent of the population,’ says Jamie Love. ‘These are the people they care about, as they are the ones with enough money.’

This desire to keep the Indian élite onside may be why Novartis’s chairperson Daniel Vasella reportedly donated hundreds of ancient Indian sculptures to a Mumbai museum last month. But most of the people affected by high drug prices will never visit a museum. And most will die knowing nothing about patents, laws, licences or pharmaceutical companies.

‘The people we work with on the ground have no idea what’s going on right now in the courts,’ says Eldred Tellis. ‘But we do, and we know that Novartis losing is their best chance to live.’

Why do some conflicts get more media coverage than others?

In just a few seconds, the singing and whistling turned to screaming. Many of the women who had gathered to demand that Laurent Gbagbo, Côte d’Ivoire’s then president, step down were now on the floor, surrounded by pools of blood. In the background, military armoured personnel carriers sped from the scene with their smoking guns.

This massacre in March 2011, which left seven dead and more than 100 injured, was captured on video and released on YouTube. It was a prime candidate for global media attention and outrage... which failed to materialize.

Frozen out: some major conflicts such as this one in Côte d’Ivoire in 2002, don’t make the headlines.

Sven Torfinn/Panos

‘That video clip was a perfect storm – unarmed women being gunned down, the military clearly visible – but it received very little coverage,’ says Virgil Hawkins, author of Stealth Conflicts: How the World’s Worst Violence is Ignored. ‘The world was too occupied with the war in Libya, and Egypt had just had its revolution, so Côte d’Ivoire simply didn’t fit the bill in terms of context.’

Throughout history, many of the world’s deadliest conflicts, particularly those in Africa, have been frozen out of the mainstream media. Perhaps the ultimate illustration of this is the war in and around the Democratic Republic of Congo (DRC) that began in the late 1990s. More than five million people died as a direct result of this conflict, the vast majority from preventable disease and starvation, making it the deadliest in the past 50 years. Yet most of the world remained oblivious.

‘I don’t think there’s a better example of the lack of balance in international news coverage,’ says Guy Golan, Associate Professor of Public Relations at Syracuse University, New York. ‘This was called the “African World War” and the Western media almost completely ignored it.’

In the same period, major Western news corporations devoted 50 times more coverage to conflict in Israel-Palestine, which between 1987 and 2007 led to around 7,000 deaths.1 In 1999, the war in Kosovo, where around 2,000 people died, received more attention and aid money than all of Africa’s humanitarian emergencies combined.2 The border war between Ethiopia and Eritrea around the same time led to more than 100,000 deaths but coverage of it was negligible. We have seen how terrorist attacks on a Spanish train in 2004 and a London bus in 2005 led to an international media frenzy, but when more than 250 people were killed on a train bombed by rebels in Angola in 2001, the event received little, if any, airtime or column inches. The examples run on and on but the question remains: why, exactly, is some violence ignored?

Wars in Africa are of little interest to the West because they are happening to people too far away, who are too different, living in countries that are not ‘important’ enough

Virgil Hawkins argues that several factors influence whether a conflict gets covered in the media, including its political significance and its proximity, both geographically and culturally, to the nation covering it.

‘Most importantly, the conflict has to be of national and political interest,’ he says. ‘It also makes a difference if it is happening nearby and people are able to identify with it. If we see people in cars and large buildings getting bombed, we are more likely to identify with it than if the same thing is happening to people in mud huts.’

The idea of national interest includes strategic military and economic concerns – are they a military or terrorist threat; do they have oil? – whereas the ability to identify can be affected by language, religion or historical ties, but is all too often reduced to such crude measures as skin colour. Black-on-black violence in Africa seems to hold little interest to the Western world, but throw in a Caucasian angle (such as white farmers being forced from their land in Zimbabwe in 2000), and international limelight is likely.

Political parallels

Along with national interest is how ‘interesting’ your nation is.

‘If a nation is a "core nation" – a large, economically powerful nation such as the US, China, Russia, Germany and so on – then it’s more likely to receive coverage from the international media,’ says Golan. ‘If you are a “peripheral nation”, a small developing country, the chances of receiving international coverage are very low, unless something extraordinary happens.’

Forced to flee – civilians from the DRC leave their homes to escape conflict between the army and rebel soldiers.

James Akena/Reuters

So, it is suggested, wars in Africa are of little interest to the West because they are happening to people too far away, who are too different, living in countries that are simply not ‘important’ enough. But some argue that the amount of interest shown may have less to do with a nation’s power or importance and more to do with the general contours of the global political system. Back in 1984, James Larson, author of Television’s Window on the World, found that two-thirds of US international news coverage was focused on the Soviet Union, with Africa, Latin America and Asia receiving hardly any attention.

‘The script of Western news media has historically reflected the orientation of the Cold War conflict itself,’ says Steven Livingston, Professor of Media and Public Affairs at the George Washington University. ‘Take Vietnam in the 1960s and 1970s, and Central America in the 1980s – as soon as the soldiers left, so did the news cameras.’

The US-centric media script arguably shifted to the Gulf in 1990 when Iraq invaded Kuwait (tellingly, there was not the same media outrage a decade earlier when Saddam’s forces invaded Iran) before diverting to Bosnia and Kosovo. After 11 September 2001, Afghanistan had its turn in the limelight, followed by Iraq (again) and, later, Libya, with Israel-Palestine on hand as a reliable diversion throughout. Such a busy schedule left little time for the Western media to keep track of wars in, say, Liberia, Angola or Algeria, where the death tolls were in the hundreds of thousands.

Mirroring the élites

But it’s not just whether conflicts are covered but how they are covered which, according to several high-profile academics, is affected by the relationship between the media and the élite Western powers. In the 1990s, Professor Lance Bennett found that those working in the media – as part of what he called ‘indexing theory’– would invariably ensure that their point of view on a given topic closely mirrored those expressed by government élites.3 While the press and other lesser actors could add their own viewpoints, they would usually fall within the accepted range of argument already set out by the government.

‘People can see a video of an atrocity in Africa and still not be outraged or even sufficiently moved to want to know more about it’

‘I struggle to find examples of where the media have disagreed strongly with domestic policymakers about who the bad guy is in a particular situation,’ says Hawkins. ‘If you are a media corporation you simply do not want to go against your home government on a foreign affairs issue as it’s going to be bad for business. It could lead to a boycott or even reporters being abused or attacked.’

While this ‘patriotism sells’ view of the media as a flag-waving mirror of government policy rings true in many cases, this relationship may also be the result of the day-to-day pressures of media production.

‘Much of it is driven by the news culture and the nature of news cycles,’ says Steven Livingston. ‘Journalists are looking towards the next 24 hours, so rather than hunt around for their own stories they end up going with whatever happens to be on the agenda of the government press office that day.’

This focus on the practical side of media coverage has led some to argue that more mundane issues, such as access – which can be thwarted by transport infrastructure, security issues or legal restrictions – will affect whether that conflict gets covered.

A Congolese woman lies hurt during clashes in the run-up to presidential elections in DRC, 2011.

James Oatway/Panos

‘Twenty years ago I wondered why we were paying much more attention to Somalia than Sudan, so I went to both countries to try to find out,’ says Livingston. ‘It seemed to be a matter of pure logistics: it was simply much easier to get in and out of Somalia.’

But in this age of near-ubiquitous connectivity, citizen journalism, mobile phones and rampant social media, the problem of access may have become less of an issue. As we saw with Kony 2012, groups and individuals, however misguided, can promote issues to a massive degree through social spheres. Networks such as Wikileaks and Twitter can circumnavigate the prerogatives of state powers. Less and less remains secret. Even in North Korea, one of the most closed countries in the world, the fact that more than a million people own mobile phones was arguably why its leaders admitted to a missile launch failure in April.

The case appears strong, but could this idea that technology is changing the old order merely be an illusion? ‘Everyone’s talking about the Facebook revolution and the power of YouTube, but look at the massacre of those women in Côte d’Ivoire,’ says Hawkins. ‘People can see a video of an atrocity in Africa, that no-one can mistake for anything but an atrocity, and still not be outraged or even sufficiently moved to want to know more about it.’

Like a football game

One reason this footage was mostly ignored could be that people had little background knowledge of events in Côte d’Ivoire because of a lack of media coverage: the classic vicious circle. It was also a complicated situation: the massacre was not an isolated incident but arose from tensions that had been simmering since the country’s civil war in 2002.

Similarly, the conflict in and around DRC, which involved nine nations, all with competing and overlapping stakes, was highly complex. Hawkins argues complexity is one of the deciding factors in whether wars become news.

‘It’s similar to a football game. If you want to make sure people will come and watch, you should only have two teams and one ball and the rules should be clear’

‘It’s similar to a football game,’ he says. ‘If you want to make sure people will come and watch, you should only have two teams and one ball. Both sides should be wearing uniforms and the rules should be clear. Once you start adding extra balls or people start taking off their jerseys or moving the goalposts, then you start losing people’s interest.’

Linked to this is the ability to sympathize. If there can be a clear-cut ‘good-versus-evil’ frame – particularly if the ‘evil’ side can be personified in a single figure such as Saddam Hussein, Joseph Kony or Slobodan Milosevic – then it will attract more attention not only from the media, but from NGOs and policymakers alike.

‘It’s like a Hollywood movie,’ says Hawkins. ‘You have to have your bad guy, your good guy and a bunch of innocent victims and, of course, the bad guy must lose at the end.’

Also ‘like a movie’ is the fondness of news outlets for coverage to be sensational. Research suggests that the extent to which an event is ‘dramatic’ will go a long way towards determining whether it becomes news. Explosions are sensational. The crashing of planes into buildings which later collapse is sensational. The destruction of a city by the most powerful military machine in the world using ‘shock and awe’ tactics is sensational. The slow starvation of entire communities forced to flee from violence into inhospitable jungles and deserts, however, is just not sensational enough.4

Nick Harvey is a human rights journalist from Northampton, England.

  1. ProCon.org
  2. Virgil Hawkins, Stealth Conflicts, London. Ashgate.
  3. Bennett, W L, ‘Toward a Theory of Press-State Relations in the United States’, Journal of Communication 40 (2), Spring 1990.
  4. Virgil Hawkins, ibid.

Ex-Israeli soldier intent on Palestinian citizenship


Andre Pshenichnikov being restrained at the funeral of Shahid Mustafa Tamimi, a Palestinian man killed by Israeli soldiersPhoto by Oliver Weiken/EPA..

Andre Pshenichnikov was working on a software project for the Israeli military when he came across something both bizarre and depressingly familiar. The test video the project used was a film of Palestinians being shot by Israeli soldiers.

‘It’s so deeply ingrained it was just seen as normal,’ he says. ‘The denigration of Palestinians is common throughout Israeli society; their lives are seen as having less value, as expendable.’

This was just one of the many experiences that convinced Andre, a former Israeli military programmer, that he no longer wanted to be Israeli.

‘It is my opinion that those with Israeli citizenship are part of the crime of occupation because by remaining citizens they tacitly support the system of occupation and apartheid,’ he says.

Andre, who is now 23, emigrated to Israel from Russia when he was 13. After completing three years of mandatory military service, he enlisted in the Israel Defense Forces Signal Corps and served an additional year and a half as a career soldier. But during this time his opinions changed dramatically and in an unprecedented move he is attempting to fully renounce his Israeli citizenship to become a Palestinian.

But it’s not proving easy. Andre was arrested in May after he was found living in the Dheishe Refugee Camp near Bethlehem. The camp is in the Palestinian ‘Area A’, which comprises 18 per cent of West Bank. Under full security control by the Palestinian Authority, it is out of bounds for Israeli citizens. Between interrogations he was held in a small cell on his own, where he remained 24 hours a day for eight days before being released on bail.

‘For three of the days I was in a room without any windows and I was beaten up once, but it was bearable,’ he says.

He told his police interrogators that he believes the concept of a Zionist state is not valid and that Israel is the representative of Western power interests in the Middle East. He told them that he wanted to break all ties with Israel. For this, the police accused him of being a member of the Popular Front for the Liberation of Palestine (PFLP).

‘Andre only said he believed in the ideas of the PFLP, not that he was a member, so they couldn’t press those charges,’ says Andre Rosenthal, Pshenichnikov’s lawyer. ‘They were trying to get 15 more days to interrogate him but eventually they had to let him out on bail.’

Yet he still faces charges relating to being in Area A and is waiting for his trial date. In the meantime he is forbidden from returning to where he was living. Close ties between the Palestinian Authority and Israel meant it took just a phone call to have Pshenichnikov arrested in the street in the middle of the day.

‘The Palestinian Authority picked him up, but they are subcontracted by the Israeli authorities – they’re basically a wing of the Israeli authorities,’ says Andre Rosenthal.

If nothing else, Pshenichnikov hopes his trial will highlight Palestinian oppression and the real nature of the relationship between the Palestinian Authority and the Israeli government.

‘I believe everything in this world is possible and even if I’m not able to get citizenship, the process itself is very important,’ says Pshenichnikov. ‘It will show the world that Israel, not the Palestinian Authority, is really in control of the West Bank.’

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