Government must ensure medication is available and affordable

Government must address medication shortages and healthcare crisis More than a year after the Lebanese government removed subsidies on most medications, short-sighted policies and a lack of adequate social safety nets have left people unable to access or afford vital and life-saving medication, Amnesty International said today. The government has also failed to fulfil its commitments to support Primary Health Care Centres (PHCCs), which provide free and low-cost medication and have been facing high demand.

In a statement titled “Lebanon: Government must ensure medication is available and affordable”, the organization explains how the ongoing economic crisis in Lebanon, coupled with an underwhelming government response, has placed enormous strains on an already fragile health sector. With the Lebanese lira rapidly losing its value and the depletion of the Central Bank’s foreign currency reserves, the Ministry of Public Health (MoPH) announced on 9 November 2021 the lifting of foreign exchange subsidies on all medications except those treating cancer and some other chronic diseases with immediate effect. As a result of the lifting of subsidies, the prices of most medicines rose exponentially.

“People in Lebanon are facing unimaginable levels of suffering while trying to get their hands on life-saving medication. The Lebanese authorities, meanwhile, continue to shirk their responsibility to safeguard the right to health,” said Aya Majzoub, Amnesty International’s Deputy Director for the Middle East and North Africa.

“The Lebanese authorities must urgently address the medication crisis by increasing the budget for PHCCs, addressing shortages in subsidized and unsubsidized medications, strengthening social assistance programs, and implementing long overdue economic and financial reforms, necessary to safeguard human rights. The international community should increase funding to organizations providing affordable and accessible health services.”

Between 19 July and 12 August 2022, Amnesty International conducted research on the accessibility of medication across Lebanon. Researchers visited three PHCCs in Baalbek and Beirut and interviewed 23 individuals, including patients, pharmacists, health workers, health care officials, and NGO workers.

Exorbitant medicine prices amid an economic crisis

PHCCs, which are supervised by the Ministry of Public Health and managed by non-governmental organizations and local authorities, have become one of the few options available for residents seeking free or low-cost medication. However, despite a substantial increase in the number of people seeking their services, the centres did not receive an increase in funding, resulting in medication shortages.

The director of the medication program at an organization that supplies medication to PHCCs said: “The new prices of medications are out of most people’s reach. Sometimes prices [are] double the minimum wage”. A Ministry of Public Health official told Amnesty International that the number of patients accessing health services, including medication, at PHCCs had increased by 62% since 2020.

According to Caretaker Minister of Public Health Firas Abiad, the government reduced its total spending on the health sector by 40% between 2018 and 2022 without increasing the PHCC’s share to more than 3% of the health budget, meaning that funding for PHCCs has reduced in this period. In addition to the decrease in the amount of money allocated to the provision of affordable healthcare and medication, the currency devaluation meant that the money itself lost 95% of its value.

Severe shortages of life-saving medicine Cancer medications are one of the few categories of medicine that remain subsidized by the government. But across Lebanon, there are severe shortages of cancer medicines. Since 2019, the Ministry of Public Health has partially blamed the shortages on traders and smugglers who purchase the medicine at low subsidized rates and hoard them before selling them at inflated prices. The government’s attempts to combat this issue and hold those responsible to account are inadequate.

Fadia, a breast cancer patient, had to skip a radiotherapy session due to lack of medication. “I hear the same promise every time I don’t receive my medication. It’s always ‘next week’. It has been three months. I live in constant fear of not being able to find my next session’s medicine,” she said.

There are also acute shortages of unsubsidized medication as importers are unable to bring in the necessary quantities of medicine due to the country’s ongoing financial crisis.

A staff member at a local pharmaceutical company told Amnesty International that the supply of unsubsidized medication has been inconstant due to mounting debts owed to the manufacturing companies abroad. Foreign pharmaceutical companies, she said, would not send new orders until old bills had been settled. In July 2022, the head of the Syndicate of Pharmaceutical Industries in Lebanon said that local importers owed international pharmaceutical companies US$400 million. As a result, Lebanon’s pharmaceutical imports plummeted from USD 1.184 billion in 2020 to USD 750 million in July 2022.

Crises compounded in remote areas

Governorates located in remote areas or further away from Beirut are suffering disproportionately during the crisis, due to a lack of resources from the central government. Lebanon’s director of healthcare in Baalbek-Hermel governorate, which has one of the country’s highest poverty rates, told Amnesty International that most of the PHCCs in the governorate are inactive, even though they are expected to provide services to more than half a million residents and around 340,000 Syrian refugees living in the governorate.

He told Amnesty International: “Smaller healthcare centres in villages and towns are mostly closed due to the lack of personnel… People have to travel a long way and pay the increasingly insane cost of fuel to access better-equipped PHCCs located in the central areas. The painstaking heartbreak is when they travel all that way and don’t find their medications.”

An informal drug market

Amid sky-high costs and an unrelenting shortage of medicine, people explained to Amnesty International how an informal drug market has emerged. That means medications that are not accredited or authorized by the MoPH are imported from abroad through intermediaries, resulting in an uncontrolled supply of expired or counterfeit medication, with risks to people’s health.

Richard, a 35-year-old man with Crohn’s disease, a chronic autoimmune disease of the digestive system, was forced to buy his medication from abroad after it became unavailable in 2021. Because it was unapproved by the Ministry of Public Health, hospitals refused to administer it, and the delays in treatment caused him to experience serious health complications.

Cancer patients are also “importing” their own chemotherapy drugs so they can continue treatment in hospitals. Other patients are rationing or substituting medicine to save money, with serious adverse health impacts.

“The Lebanese authorities must prioritize the availability, accessibility and affordability of medication — even in the face of financial challenges. The right to health cannot and should not be sacrificed,” said Aya Majzoub.

Source: Amnesty International

Eritrea: Crackdown on Draft Evaders’ Families

The Eritrean government has in recent months punished relatives of thousands of alleged draft evaders as part of an intensive forced conscription campaign, Human Rights Watch said today.

Eritrean security forces have been heavily involved in operations in support of the Ethiopian government since the outbreak of conflict in Ethiopia’s Tigray region in November 2020, and have carried out some of the conflict’s worst abuses. Eritrean authorities have conducted waves of roundups in Eritrea to identify people it considers draft evaders or deserters. Since September 2022, when Ethiopian and Eritrean forces carried out joint offensives in the Tigray region, the Eritrean government has inflicted further repression, punishing family members of those seeking to avoid conscription or recall, to enforce widespread forced mobilization, including of older men. Such punishment has included arbitrary detentions and home expulsions.

“Struggling to fill its dwindling fighting ranks, Eritrea’s government has detained and expelled older people and women with young children from their homes in order to find people it considers draft evaders or deserters,” said Laetitia Bader, deputy Africa director at Human Rights Watch. “Eritrea should immediately end its collective punishment of relatives of those who refuse to comply and instead focus on reforming its ruthless indefinite military service system.”

Eritrea has a policy of indefinite national service, including compulsory military conscription, which has been central to the government’s broader repression of its population since the 1998-2001 border war with Ethiopia, and its aftermath.

The statutory national service of 18 months was indefinitely extended to require all male and female adults under age 40 to be available to work at the direction of the state, either in a military or civilian capacity. In practice, adults older than 40 are also forced to serve. Despite the country’s 2018 peace deal with Ethiopia, the government has refused to reform this repressive system.

Once conscripted into the military, young men and women, some still minors, have very few options for discharge. As a result, they risk serious reprisals to escape what a United Nations Commission of Inquiry has characterized as “enslavement.”

Human Rights Watch interviewed 14 people who had recently fled Eritrea, relatives of people affected by the forced conscriptions and reprisals, as well as 11 journalists and other analysts, two of whom were inside Eritrea as the campaign took place. Human Rights Watch did not interview anyone still inside Eritrea for security reasons. Human Rights Watch also reviewed satellite imagery that corroborated important aspects of the accounts of those interviewed through mid-January 2023. In February, Human Rights Watch received reports of the return of some military units that had been sent to fight in Tigray, and of some reservists who had been at the border inside Eritrea.

The latest conscription drive started mid-2022, with the authorities targeting people considered draft evaders, including students who have dropped out of school to evade military training, as well as army deserters, some of whom already had served for years. Then, in mid-September, the government mobilized reservists, primarily men aged 50 through to 60, many of whom had been officially discharged from active military duty but continue to hold arms and are required to conduct guard duties. On September 17, Eritrea’s information minister told the media that only “a tiny number” of reservists were being called up, denying that the entire population was being called up.

During the latest mobilization drive, especially from September onward, the security forces have set up checkpoints throughout urban and rural areas. In addition, by working with the local officials, security forces have gone door to door, ostensibly to confirm eligibility for coupons that grant people access to subsidized goods, but in fact, to also identify draft evaders. They used the visits, people interviewed said, to identify discrepancies between the number of family members the coupon system said should be in a particular home and those of conscription age who were living there, often retaliating against family members who the authorities claimed had failed to track the missing people down.

Older parents as well as women with young children have been temporarily detained for days, some reportedly longer, and have been expelled from their homes during the government’s searches, Human Rights Watch found. A 71-year-old woman was evicted from her home in Asmara, the capital, because she was unable to confirm the whereabouts of one of her sons being sought by the authorities. Another son who lives abroad said:

My mother has some health issues, so the neighbors tried to plead with the authorities not to lock up the house after my first brother turned himself in. But when the second didn’t come, they shut up the house.

An Eritrean woman abroad whose relatives have also been evicted said: “The confiscation of homes, we’ve never seen this before. It’s an act of desperation.”

Despite a November cessation of hostilities agreement, signed between the Ethiopian federal government and Tigrayan authorities, Human Rights Watch continued to receive reports of ongoing roundups and reprisals through early 2023.

Many presumed draft evaders, rounded up near Asmara, were initially taken to the notorious, military-run Adi Abeito prison, northeast of the capital. Satellite imagery Human Rights Watch analyzed shows large crowds of people in the prison yard and surrounding areas of the prison from October 2022 through late January 2023. Relatives reported that many men were taken from the prison to their assigned military unit headquarters in this time period.

“Everyone has always lived with the dreadful feeling of the risk of being conscripted, but this is at a whole different level,” an Asmara resident said.

Some forms of conscription for military service are permitted under international human rights law. However, Eritrea uses violent methods including the threat of penalty and punishment for those who do not participate, and collective punishment of relatives. Officials also show a lack of respect for the right to conscientious objection and provide no opportunity to challenge arbitrary enforcement and the indefinite nature of conscription. These factors constitute abuse, Human Rights Watch said. International human rights law prohibits holding anyone criminally responsible for acts they are not responsible for.

International and regional officials should take concrete measures against Eritrea’s leadership for the ongoing repression. They should ensure ongoing scrutiny by the United Nations Human Rights Council, the African Commission on Human and Peoples’ Rights, and UN experts.

They should adopt and maintain targeted sanctions against individuals and entities responsible for serious abuses inside Eritrea, as part of broader targeted sanctions for Eritrean and other armed forces responsible for serious abuses in northern Ethiopia, tied to clear human rights benchmarks, Human Rights Watch said. Eritrea’s regional partners, including Horn of Africa and Gulf states, should press Eritrea to ensure meaningful changes to the abusive national service system, which has continued to drive Eritreans into exile.

“Eritreans from all walks of life are bearing the brunt of the government’s repressive tactics,” Bader said. “Eritrea’s regional partners and international actors should take action to end rampant repression.”

Source: Human Rights Watch

Already Complicit in Libya Migrant Abuse, EU Doubles Down on Support

Associate Director, Middle East and North Africa Division HananMSalah

This week, the European Union handed over in Italy a search and rescue vessel to Libyan authorities intended for abusive Libyan Coast Guard forces and promised four more, without any apparent attempt to vet the human rights practices of the coast guard, thus making the EU more complicit in human rights abuses in the Mediterranean.

While the single boat handed over by Olivér Várhelyi, the European Commissioner for Neighborhood and Enlargement is a pittance within an 800 million Euro project to “stop the illegal migration to Europe” from North Africa, it will tie the EU more directly to abuses that inevitably occur when the Libyan Coast Guards intercepts people at sea and brings them back to Libya.

For years the EU has abdicated its primary responsibility of search and rescue in the Mediterranean, where thousands of migrants and asylum seekers have died while attempting to reach Europe from North Africa, particularly Libya. Instead, the EU and member countries have chosen to furnish money, vessels, training, and aerial surveillance to abusive Libyan armed groups so they can intercept and forcibly return people to Libya. There, these migrants face systematic and widespread abuses including torture, arbitrary detention, forced labor, and sexual assault.

Dodging this reality, Várhelyi insists the aid will reduce deaths and trafficking in the Mediterranean and make Europe safer. “Libya can continue to count on Europe’s support,” he stated, adding that the EU can “expect [Libya’s] continued commitment to deliver tangible results on the ground.” The commissioner said nothing about the need to vet the human rights practices of the groups receiving EU support.

More than 24,684 people intercepted in the Mediterranean were forced back to Libya in 2022, and a staggering 25,313 at least have died in the Mediterranean since 2014.

To change this reality, the EU should stop supporting abusive militias and instead establish safe and legal pathways for migration. The EU and its member states should suspend cooperation with Libyan authorities until they ensure they are complying with the obligation not to return people to places where they face abuse, inhumane detention conditions, and lack of access to international protection. It is paramount the EU, with its significant means and technical capacities to take up its search and rescue responsibilities in the Mediterranean, focuses on saving lives and ensures people are disembarked in a safe port and never returned to the abuse they faced in Libya

Source: Human Rights Watch

Identification, Delivery and Empowerment Application (IDEA): An FAO ecosystem of applications to power livelihoods and agricultural assistance in food crisis contexts

To effectively deliver emergency and resilience assistance, the Food and Agriculture Organization of the United Nations (FAO) requires innovative and efficient tools.

To ensure the protection and secure management of beneficiary data, and delivery and tracking of assistance, FAO developed Identification, Delivery and Empowerment Application (IDEA), a digital ecosystem of applications. IDEA facilitates secure beneficiary registration, identity verification at the point of distribution, entitlements delivery and tracking, data reporting and visualization. IDEA builds on more than 10 years of development and implementation in Somalia to support the secured delivery of FAO’s large-scale and diverse portfolio in a complex operating environment.

5 main functions

beneficiary data registration and verification;

entitlements delivery and tracking;

reporting and visualization;

two-way communication with beneficiaries; and

monitoring.

Key features

• Built-in data protection and security measures that ensure the privacy of beneficiaries and the protection of their personal data.

• Flexible system that can be tailored to diverse needs and contexts of FAO country operations.

• Capability to support the delivery of multiple modalities of assistance: agricultural inputs, assets and equipment (whether through in-kind provision or electronic vouchers), cash-based interventions, service provision, early warning systems and training.

• All data secured by advanced password protection and end-to-end encryption. IDEA has a built-in granular level of user permissions, ensuring secure processing and data protection principles are used to safeguard the identities of the people served by FAO and its partners.

Source: Food and Agriculture Organization of the United Nations