Sense of impunity emboldens autocrats to get rid of enemies
By SARAH EL DEEB and LEE KEATH
Thursday, October 11
BEIRUT (AP) — The disappearance of a prominent Saudi journalist raises a dark question for anyone who dares criticize governments or speak out against those in power: Will the world have their back?
Dictators and autocrats have always sought to silence dissenters, even ones that flee abroad to escape their grasp. They seem to only get bolder in turning to their playbook of detention, threats and killings.
That may in part be because, despite decades of talk of human rights in international circles, violations get only muted reproaches.
In the United States, the Trump administration avoids strenuous criticism of human rights abuses by allies, like Saudi Arabia, Egypt, Israel and the Philippines, or leaders it seeks to cultivate ties with, like Russia, China and North Korea.
President Donald Trump’s denunciations of “globalism” and tough stance against the International Criminal Court also have signaled that Washington has little interest in international enforcement against violators of human rights. Western countries have turned inwards, buffeted by rising xenophobic forces — and autocrats have either benefited from the vacuum or received outright support.
So when Turkish officials said they believed Saudi journalist Jamal Khashoggi had been killed last week after disappearing during a visit to his country’s consulate in Istanbul, there was good reason to wonder whether there would be serious repercussions.
So too when China detained the now former Interpol chief after capturing him midair — the latest Chinese figure to vanish only to appear in court, accused of corruption.
So too when Russia was accused of poisoning an ex-spy in Britain.
Often economic and diplomatic interests lead countries to overlook killings, even of their own citizens.
In one of the most chilling recent cases, an Italian postgraduate student, Giulio Regeni, was found dumped on the side of a road outside the Egyptian capital, Cairo, his body mutilated and his bones broken. Suspicion in Italy immediately fell on Egypt’s security forces, notorious for their use of torture. But nearly three years later, no one has been blamed, and while Italy says it continues to investigate, it has forged ahead with ties with Egypt, particularly with the development of a natural gas field off Egypt’s coast by Italy’s largest energy company, ENI.
Sara Kayyali, a researcher on Syria for Human Rights Watch, said Khashoggi’s disappearance “is not just sad, it is terrifying.”
“We are all taken aback by the lack of condemnation by any of our traditional allies for the acts that we are seeing happen, most recently with Jamal’s case. I think it is a very challenging time for all of us and our traditional allies are not around,” she said. “It looks like it is the age of impunity, but we won’t let it go.”
THE ARAB DIASPORA
After the wave of pro-democracy protests that shook the Arab world in 2011 came the backlash — brutal crackdowns. As millions from Syria, Iraq, Egypt and Libya left their home countries, autocrats have tracked the vocal critics among them.
The Khashoggi disappearance has shaken the large community of Arab exiles who found relative safety in Turkey, said an Egyptian dissident who fled his country after the 2013 massacre. He had met Khashoggi only days earlier. He said he is considering where to go next, adding that his wife just got a job in Saudi Arabia, but he’s afraid to go there. He spoke on condition of anonymity, fearing for his safety.
“It is a whole new level of dangerous,” he said. It harkens back to the days when Libya’s Moammar Gadhafi called his opponents in diaspora “stray dogs” and sent death squads to shoot them down in European capitals.
One prominent Libyan defector, Mansour al-Kikhia vanished from Cairo in 1993. His fate was unknown until 2012, a year after Gadhafi’s ouster and death, when his body was found in a freezer in an intelligence building in Libya.
A Bahraini dissident living in Britain, Sayed Alwadaei, said these days he was afraid for his wife when she had to go to the embassy to notarize legal representation for a pending trial against her at home.
“We did not trust that if she goes to the embassy, she will leave unharmed,” he said.
Bahrain’s Embassy in London dismissed Alwadaei’s concerns as “nothing more than a cynical attempt to exploit a current news story.”
Today’s dissidents have more tools to speak their mind from exile, making them more dangerous in the eyes of regimes back home. But the autocrats’ toolkit is also more diverse.
Those in exile in Turkey say their governments have infiltrated their circles, spying on them physically and through social media. One Egyptian activist said he fled his refuge in Turkey after nearly five years because government spies infiltrated the opposition TV station he had set up.
With the government gaining more ground in Syria, activists fear they will now be chased in diaspora.
One prominent exiled Syrian, Rami Abdurrahman, who has monitored the war for years and has now become a British citizen, said he got word that a senior Syrian military official named him in meetings as the next target, “wherever I am.”
Russia has been accused of going after turncoat spies without paying much attention to borders and international norms.
In 2006, former Russian security officer Alexander Litvinenko, who fled to Britain and became a harsh critic of President Vladimir Putin, died after drinking tea laced with radioactive polonium-210 in London. Investigations concluded that Russia’s security service killed him, likely on Putin’s orders. The Russian government has denied any responsibility.
In March, former Russian spy Sergei Skripal and his daughter were found unconscious in the English city of Salisbury after being exposed to a Soviet-designed nerve agent known as Novichok. They spent weeks in critical condition but survived. Months later, a civilian died after being accidentally exposed to the poison.
British officials said the attack on the Skripals received approval “at a senior level of the Russian state” and announced charges in absentia against two Russian agents. The British government says it has evidence the men work for the Russian military intelligence agency. Moscow denies any role in the poisoning.
In retaliation, Britain, European Union countries and the United States expelled dozens of Russian diplomats, Britain put greater scrutiny on Russian funds, and Washington imposed limited financial sanctions. Still, Trump was reluctant to speak out strongly against the attack.
China’s President Xi Jinping has increasingly defied foreign governments and international rights groups, bolstered by his country’s global economic clout, military power and diplomatic weight. That’s raised concerns over the fate of civic society within the country, as well as the risks of appointing Chinese officials to positions in international organizations.
Xi has waged a broad anti-corruption campaign that has ensnared numerous political foes — including among Chinese communities outside the country.
The most recent to fall afoul is Interpol’s president, Meng Hongwei, who was taken into custody upon arriving in Beijing late last month. The Ministry of Public Security has since said that Meng, who left his post, was being investigated for accepting bribes and other crimes that were a result of his “willfulness.”
Such vague accusations are typical in China’s highly opaque judicial system that has jailed figures such as the dissident writer and late Nobel Peace Prize winner Liu Xiaobo.
Beijing-based independent political analyst Zhang Lifan said China’s handling of the Meng case undermines the leadership’s insistence that theirs is a country “ruled by law.”
“In China disappearance is something that happens quite often,” Zhang said. “It’s just that this time it was presented to the international public in such a special way.”
ASSASSINATIONS AND RENDITIONS
A tenuous place in the ruling dynasty is no protection: witness one of the most brazen instances of assassination in recent memory, when North Korean leader Kim Jong Un’s estranged half-brother Kim Jong Nam died in 2017 at an airport in Malaysia in an attack that authorities said used VX nerve agent.
In March, the Trump administration referred to it only indirectly, hedging perhaps with an eye to future diplomacy. Washington only determined that Pyongyang used chemical weapons, an apparent reference to the killing without going into any further detail.
Israel and the Palestinians have a history of assassinations. Israel’s Mossad killed several top PLO and Hamas leaders in the Arab world and Gaza, while a Palestinian splinter group attempted and failed to kill the Israeli ambassador to the United Kingdom in 1982. Palestinian militants assassinated Israel’s tourism minister in 2001. Tehran has blamed Israel for a series of slayings of top Iranian nuclear scientists earlier this decade.
During the post-9/11 ‘war on terror’ under President George W. Bush, the CIA program of “extraordinary rendition” and torture of suspects to secret “black sites” was a key U.S. strategy in neutralizing the enemy. More than 50 countries participated with some like Poland and Lithuania allowing the jails to be run on their territory.
And of course, the United States carried out the most noteworthy assassination of this century when Navy SEALs under President Barack Obama’s direction tracked down Osama bin Laden in Pakistan and killed him in 2011.
“It may take time, but we have long memories, and our reach has no limits,” Obama would say, in his last State of the Union address.
AP writers Tamer Fakahany in London, Vladimir Isachenkov in Moscow, Christopher Bodeen in Beijing, Hamza Hendawi in Cairo and Jon Gambrell in Dubai, United Arab Emirates, contributed to this story.
Trump: US investigators looking into missing Saudi writer
By CATHERINE LUCEY
Thursday, October 11
WASHINGTON (AP) — President Donald Trump said Thursday the United States is being “very tough” as it looks into a Saudi writer missing and feared murdered in Istanbul, adding “we have investigators over there and we’re working with Turkey” and with Saudi Arabia.
Trump spoke on “Fox & Friends” about Jamal Khashoggi, 59, a government critic who disappeared a week ago after entering a Saudi consulate in Turkey. The wealthy former government insider wrote columns for The Washington Post, including some critical of Crown Prince Mohammed bin Salman. He’d been living in the United States in self-imposed exile.
Turkish officials say they fear Saudi Arabia killed and dismembered Khashoggi but offered no evidence. Saudi royal guards, intelligence officers, soldiers and an autopsy expert were part of a 15-member team from the kingdom that targeted Khashoggi, Turkish media reported Thursday.
“We want to find out what happened,” Trump said. “He went in, and it doesn’t look like he came out. It certainly doesn’t look like he’s around.”
The president did not provide details on a U.S. investigation. Asked about a Washington Post report that U.S. intelligence intercepts outlined a Saudi plan to detain Khashoggi, Trump said, “It would be a very sad thing and we will probably know in the very short future.”
The Post, citing anonymous U.S. officials familiar with the intelligence, said Prince Mohammed ordered an operation to lure Khashoggi from his home in Virginia to Saudi Arabia and then detain him.
Saudi Arabia has called the allegation it abducted or harmed Khashoggi “baseless.” It has offered no evidence to support its claim the writer simply walked out of its consulate and vanished despite his fiancée waiting outside for him.
Decades of close U.S.-Saudi relations, which have only intensified under Trump, appeared in jeopardy by the suggestion of a carefully plotted murder of a government critic. Trump on Thursday described the relationship as “excellent.”
Pressure, meanwhile, mounted in Congress for the Trump administration to address the writer’s disappearance.
More than 20 Republican and Democratic senators instructed Trump to order an investigation under legislation that authorizes imposition of sanctions for perpetrators of extrajudicial killings, torture or other gross human rights violations.
Sen. Rand Paul, R-Ky., a longtime critic of the Saudi government, has said he’ll try to force a vote in the Senate blocking U.S. arms sales to Saudi Arabia. Sen. Chris Murphy, D-Conn., said it would be time for the U.S. to rethink its relationship with Saudi Arabia if it turned out Khashoggi was lured to his death by the Saudis.
Trump expressed reservations about withholding arms sales to Saudi Arabia. Speaking with “Fox News Night” Wednesday night, Trump warned such a move “would be hurting us.”
“We have jobs, we have a lot of things happening in this country,” Trump said. “We have a country that’s doing probably better economically than it’s ever done before.”
He continued: “Part of that is what we’re doing with our defense systems and everybody’s wanting them. And frankly I think that that would be a very, very tough pill to swallow for our country. I mean, you’re affecting us and, you know, they’re always quick to jump that way.”
Trump’s son-in-law, Jared Kushner, has been the Trump administration’s point person on Saudi Arabia. Trump visited Saudi Arabia on his first international trip as president and announced $110 billion in proposed arms sales.
The administration also relies on Saudi support for its Middle East agenda to counter Iranian influence, fight extremism and support an expected peace plan between Israel and the Palestinians.
Women with heart disease in sub-Saharan Africa face challenges, but stigma may be worst of all
October 11, 2018
Assistant Professor of Nursing, Case Western Reserve University
Cardiology Fellow Physician, Stanford University
Allison Webel has received funding from the National Institutes of Health, the American Heart Association, Gilead Sciences, and the Midwest Nursing Research Society.
Andy Chang was supported by a National Institutes of Health, National Center for Advancing Translational Science, Clinical and Translational Science Award (TL1TR001084). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Case Western Reserve University provides funding as a founding partner of The Conversation US.
Heart disease is the number one killer of women, claiming a female life every minute. Yet it is often seen as a “man’s disease.” This disparity is magnified in sub-Saharan Africa, where we have recently conducted an investigation into the experiences of women living with rheumatic heart disease.
Rethinking heart disease in the developing world
Another prevailing myth that we often encounter is that cardiovascular disorders are not a major issue in the developing world. To the contrary, heart disease is already the number one cause of death worldwide as well as in low- and middle-income countries.
This shift has, in part, been due to ongoing successes in fighting contagious epidemics, particularly HIV/AIDS and childhood infections. Industrialization and economic development of low-income nations has brought more food security and decreased reliance on manual labor. Yet, these changes have fueled an increase in noncommunicable disease such as diabetes, high blood pressure and high cholesterol, leading to a surge in cardiovascular disease.
In contrast to their high-income counterparts, patients in poor countries are struck by, and die from, cardiovascular conditions at younger ages. Their health systems are often unprepared to combat the dual tides of infectious and noncommunicable illnesses. Furthermore, the causes of heart disease are somewhat different in poor countries, where the proliferation of “Western” maladies like heart attacks and hypertension are accompanied by “endemic” cardiovascular diseases of poverty such as rheumatic heart disease.
An old foe, revisited
Rheumatic heart disease is a preventable disorder that is a late effect of rheumatic fever, which ravaged Western Europe and the United States only a generation ago, but is rarely seen now in these settings. It is triggered by Group A streptococci, which causes strep throat. Some individuals will develop a systemic reaction known as acute rheumatic fever, which can permanently damage the heart valves.
In the developed world, acute rheumatic fever is rarely seen, because strep throat is regularly treated with antibiotics. In developing nations, however, appropriate medications are often missed or are financially unfeasible. Rheumatic heart disease afflicts up to 43 million people worldwide and leads to up to 1.4 million deaths each year. It can have terrible consequences, including heart failure, irregular heart rhythms and debilitating stroke.
Impact on women
Women of childbearing age with rheumatic heart diseases are especially vulnerable, as the disorder places them at increased risk of complications during pregnancy. Furthermore, the blood-thinning medications used to treat RHD can also raise the risk of miscarriage and maternal hemorrhage. Although pregnancy in this population is high-risk, only 3.6 percent of women with RHD of childbearing age are on contraceptives.
Our research group recently concluded a mixed methods study in Uganda of women of reproductive age living with rheumatic heart disease to better understand the lived experience of this population.
Several themes emerged: First, we discovered that female rheumatic heart disease patients understood that their disease increased their risk of complications and death during pregnancy. Nevertheless, they still felt pressure to take the risk, citing the societal pressures to have many children. In fact, 100 percent of our participants answered that society would look poorly upon a woman who cannot bear children.
Further, our findings suggest that it may not be women themselves who control reproductive decision-making: Male partners were usually drivers of reproductive intent, both directly (by petitioning their spouses for children) or indirectly (due to women’s fears of abandonment if unable to bear children). Tragically, 28 percent of participants reported that they had been left by their husbands or boyfriends due to perceived limitations in fertility, while 36 percent of participants confessed fear of abandonment by their male partners.
Compounding their challenges, participants suggested that contraception may be criticized, leading to poor adoption – a social norm previously reported in Uganda and its neighbors.
Perhaps the most striking finding, however, was that women living with heart disease experience considerable stigma. Because of its ubiquity, we do not consider cardiovascular conditions to be the source of much stigma in the developed world, yet it was spontaneously reported by our group. Several participants were suspected by friends and family of having HIV because they were observed taking medications for a prolonged period of time (as opposed to short durations for drugs such as antibiotics).
More surprisingly, our patients reported that they felt it may be preferable to have HIV than heart disease. They attributed this to the fact that having HIV may not limit their reproductive potential the way cardiac conditions do.
Building systems, targeting future efforts
In light of these sobering findings, our team also asked participants how they thought the current medical system could better serve their needs. First, patients suggested that health care providers discuss the reproductive consequences of the illness and its therapies. This concern has been echoed by women living with serious chronic disease in Europe as well. In addition, women stated that doctors should involve male partners and family members in discussions about heart disease.
To that end, Uganda’s health system has commissioned an initiative to better care for women of reproductive age living with heart disease. Uganda’s first Women’s Heart Center is a collaboration between cardiology and obstetrics, a multidisciplinary effort to cross-refer patients who are pregnant or plan to become pregnant and have heart conditions. From the lessons we learned from our study, we hope to incorporate family counseling and public awareness campaigns to fight stigma against cardiovascular disease in women.
Our study suggests that there is still work to be done in identifying the comorbidities and downstream outcomes of this population. These are areas of ongoing investigation for our team. Nevertheless, we are optimistic that there are opportunities for improved family and societal education programs and community engagement, leading to better outcomes and patient empowerment.