By Busani Bafana
BULAWAYO, Jul 3 2023 – The United Nations General Assembly is convening a high-level meeting on Tuberculosis (TB) to get a political commitment for increased funding for programmes and research to end an old disease that today kills more people than AIDS and COVID.

TB, an infectious disease caused by Mycobacterium tuberculosis, kills 1.5 million people annually, according to the World Health Organization (WHO). Despite being curable at a relatively low cost, TB has remained a health burden, especially in developing countries, because of a combination of poor diagnosis and treatment and inadequate funding for research in developing new vaccines.

A coalition of TB organizations is calling on political leaders to raise their commitments to funding and ending TB. They call for a TB research and development funding boost to USD5 billion annually and ensure all national TB responses are equitable, inclusive, gender-sensitive, rights-based and people-centred.

In 2018, at the UN high-level meeting on TB, nations pledged to invest USD2 billion for TB research and USD13 billion annually for TB diagnostics, treatment and care by 2022. However, these commitments have not been met five years on.

Stronger political commitment to end TB is key, says Mel Spigelman, CEO of the TB Alliance, a nonprofit organization dedicated to finding faster-acting and affordable drug regimens to fight TB.

Mel Spigelman. Credit: TB Alliance

Excerpts:

IPS: While the world has swiftly responded to global crises such as AIDS and, recently, the COVID pandemic, TB has remained sidelined. Shouldn’t it trigger political action?

Mel Spigelman: One of the major issues with TB is it is very heavily a disease of the poor, and that is just the reality in terms of political will. Governments have become complacent about TB, which has been around for so long and kills more people than any other infectious disease.

IPS: What needs to be done to bring TB to global attention? Should we have a TB pandemic in America and Europe to take action?

MS: We need to continue what we have been doing in terms of raising awareness at the United Nations, for instance, with the preparations for a high-level meeting on TB. We need to ensure we bring TB to the front and centre of attention of the political forces and powers.

IPS: The issue of a stronger commitment to ending TB, where do we start?

MS: We need to start obviously on a global level raising the prominence and feasibility of ending TB and highlighting the difficulties that exist around the world with TB. We need to engage with high-income countries in what they can do in terms of financial resources and with low- and middle-income countries in terms of access to care in the healthcare system and participation in research and trials. Clinical trials are all done in relatively poor countries where we need to ensure that we are not only getting the commitment from a small number of countries around the world, which is really the situation now but from all the countries around the world. TB affects every single country in the world.

IPS: When we talk about high-level commitment, there is a question of putting money into programmes and research. Is this happening?

MS: Commitment means bringing in the money but also the issue of the status of the programmes within countries. We at TB Alliance, for example, have introduced a new regimen for Drug Resistance TB. It is a three-drug regimen called BPaL. This treatment has brought down the time it takes to cure drug-resistant TB from 18 months to 6 months while, at the same time, it has increased the cure rate up to 90 percent on all oral drugs. The treatment was first approved in the U.S. back in 2019 and in Europe in 2020. It is only this year that we are beginning to see significantly more uptake in the countries that have a problem.

IPS: Why has it taken so long for global uptake of the lifesaving drugs for TB?

MS: It is because we live in a world where innovations like this are uncommon and in countries where there are really a lot of intermediary steps which could be shortened considerably with the proper attention. This is where even the poorest countries could also play a major role by looking at the regulatory systems and health care structure on adopting new innovative treatments. It is the same with diagnostics. There are new diagnostics brought into the field that have not been taken up.

IPS: What kind of financial gap are we talking about for TB programmes and research?

MS: If we work at numbers that are coming out of the STOP TB Partnership and the World Health Organization and others, we are looking at a USD2.5 to USD3 billion a year shortfall.

IPS: The high-level Meeting on TB is coming up in September. Will you garner the political will and greater commitment towards funding for TB at this meeting?

MS: Am I convinced? No. Is it worth it? Yes, because it is certainly possible that it brings about what we are hoping for. Watching the number of people working tirelessly to increase the chances of this meeting raising the commitments (needed) indicates it will be successful.

IPS: Many developing countries are also high TB burden spots where costs for diagnosis and treatment are high. Will the high-level meeting unlock funds, especially for Africa?

MS: The Global Fund plays a major role in ensuring that countries do not need to pay, and so there are other commitments to the Global Fund that are made by the wealthier countries, and that commitment then pays for LMIC countries’ adoption and use of drugs. Clearly, any innovation has to be affordable, and that is of great importance to us.

The new treatment we developed for DR-TB is cheaper than the old one. The new treatment and diagnostics do not necessarily have to be more expensive; they can actually save money. That is the reason why we need – on a global level – to invest in innovation because innovation, in the end, actually saves money.
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By Janine Morna
FLORIDA USA, Jul 3 2023 – All my life was wasted, said Anwar*, as he told me recently about his traumatic experiences living under the Islamic State (IS) armed group in Northeast Syria.

Around 2018, when Anwar was 14 or 15 years old, his father, a member of IS, forced Anwar to train with the group as a young teenager. He even made Anwar watch as he inflicted brutal punishments on people who broke IS’ rules.

The suffering was intolerable. Anwar tried to run away from his father and flee IS-controlled territory on multiple occasions. “I hated everyone,” he said.

In 2011, as the early versions of IS began to re-emerge in Iraq, the UN was quick to document violations the armed group had committed against children. That year, the UN Secretary-General included the group in the organization’s annual report on children and armed conflict, in which perpetrators of grave violations are named and shamed. The UN is required to negotiate action plans with parties listed in the report as part of efforts to stop and prevent the violations from occurring in future.

While the annual report is a powerful tool that prompts action in many contexts, it has had little impact on groups like IS, which are unlikely to engage in dialogue with the UN.

Over the last 11 years, numerous parties listed in the annual report can be classified as ‘persistent perpetrators’ — armed groups and forces that have appeared in the report for more than five consecutive years, and have failed to respond to reports on the violations they have committed against children. IS has been listed in the report for the last 13 years.

The UN Security Council has previously focused on the issue of persistent perpetrators, including by passing a resolution and holding an open debate in 2012 where they emphasized the importance of addressing violations committed by these groups and forces. It has also made efforts to promote sanctions against recalcitrant parties.

A young refugee boy, pictured in a temporary displacement camp in Kalak, Iraq, in June 2014. Credit: Amnesty International

Despite these initiatives, the UN Security Council and its subsidiary, the Security Council Working Group on Children and Armed Conflict (Working Group), could do much, much more to support meaningful accountability.

Domestic prosecutions of crimes against children

The Working Group, as the primary body carrying out the UN Security Council’s agenda on children and armed conflict, should strengthen its calls for the UN and its donors to help countries to develop and implement domestic legislation that criminalizes grave violations against children. It should also support national criminal justice systems to pursue accountability, in line with international fair trial standards.

Today, many prosecutions of non-state perpetrators of grave violations – like IS in Iraq and Syria, and Boko Haram in Nigeria – take place in domestic counterterrorism courts which, in many cases, fail to include crimes under international law, let alone crimes against children.

The Working Group must encourage the trial of individual members of these groups in national courts that are capable of adjudicating international crimes. Prosecutions could occur in the state where the crimes took place and, where relevant, in states that exercise universal jurisdiction – a legal principle whereby states can prosecute offenders of certain grave crimes irrespective of the location of the crime and the nationality of the perpetrator or victim.

When trials on crimes against children take place in counterterrorism courts, the relevant authorities must enable prosecutors and judges to draw on international law, provide sufficient resources to pursue the prosecutions, and ensure defendants can exercise their full fair trial rights.

In cases involving children associated with armed groups and forces, states should treat children who are accused of crimes during their association primarily as victims of violations of international law and not only as perpetrators, in accordance with international standards. Children should never be prosecuted for mere affiliation with an armed group or force.

Cooperating with the International Criminal Court and other international mechanisms

In situations where domestic legal systems are unable or unwilling to pursue prosecutions of crimes against children, the Working Group should explore opportunities to collaborate with the International Criminal Court (ICC) and other international justice mechanisms, such as the International, Impartial and Independent Mechanism (IIIM) on Syria or the Independent Investigative Mechanism for Myanmar to achieve accountability.

This type of collaboration was envisioned when the Working Group first adopted a list of actions it could take in response to grave violations against children. Effective cooperation between international justice mechanisms is critical to achieve a measure of comprehensive justice.

The Working Group’s engagement with the ICC has historically been limited, but it is now time to further develop connections between the two bodies. The Office of the Prosecutor for the ICC has welcomed opportunities to “strengthen cooperation with relevant actors” and earlier this year launched a public consultation to renew its policy on children that “will build upon new approaches… [to] affect meaningful change”.

In the past, some Working Group members have considered indicating when parties have likely committed a war crime or other crimes within the jurisdiction of the ICC. They have also explored the possibility of sharing their conclusions with the ICC, and arranging for the prosecutor of the ICC to share briefings with the Working Group.

Ten years ago, some members of the Working Group also considered, in the absence of a UN Security Council referral, inviting states that are party to the Rome Statute to refer situations to the ICC, in which armed groups or forces have committed grave violations against children. Unfortunately, deeply divided opinions about the ICC among Council members have, in the past, limited the adoption of these recommendations.

Children must be protected

On July 5, the UN Security Council will host its annual Open Debate on Children and Armed Conflict. The occasion offers all UN member states an opportunity to publicly commit to efforts to broaden and strengthen accountability for violations against children.

As a first step, member states should call for the UN Secretary General to, once again, identify persistent perpetrators in the annual reports on children and armed conflict, a practice that was stopped in 2017.

The Council has the power to take greater action in response to some of the world’s most egregious perpetrators of crimes against children. It is unacceptable that children like Anwar should have to wait so long for justice and accountability.

Janine Morna, is Thematics Researcher – Children, Amnesty International’s Crisis Response Programme

*Name changed to protect identity.

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By Mariela Jara
CALLAO, Peru, Jul 3 2023 – At five in the morning, when fog covers the streets and the cold pinches hard, Mercedes Marcahuachi is already on her feet ready to go to work in Pachacútec, the most populated area of the municipality of Ventanilla, in the province of Callao, known for being home to Peru’s largest seaport.

“If I don’t get up that early, I don’t have enough time to get everything done,” the 55-year-old woman tells IPS as she shows us the area of her home where she runs a soup kitchen that she opened in 2020 to help feed her community during the COVID pandemic and that she continues to run due to the stiffening of the country’s economic crisis.”When we came here in 2000 there was no water or sewage, life was very difficult. My children were young, my women neighbors and I helped each other to get ahead. Now we are doing better luckily, but I can’t use the transportation to get to the market; I can’t afford the ticket, so I save by walking and on the way back I take the bus because I can’t carry everything, it’s too heavy.” — Julia Quispe

Emerging as a special low-income housing project in the late 1980s, it was not until 2000 that the population of Pachacútec began to explode when around 7,000 families in extreme poverty who had occupied privately-owned land on the south side of Lima were transferred here by the then government of Alberto Fujimori (1990-2000).

The impoverished neighborhood is mainly inhabited by people from other parts of the country who have come to the capital seeking opportunities. Covering 531 hectares of sandy land, it is home to some 180,000 people, about half of the more than 390,000 people in the district of Ventanilla, and 15 percent of the population of Callao, estimated at 1.2 million in 2022.

Marcahuachi arrived here at the age of 22 with the dream of a roof of her own. She had left her family home in Yurimaguas, in the Amazon rainforest region of Loreto, to work and become independent. And she hasn’t stopped working since.

She now has her own home, made of wood, and every piece of wall, ceiling and floor is the result of her hard work. She has two rooms for herself and her 18-year-old son, a bathroom, a living room and a kitchen.

“I’m a single mother, I’ve worked hard to achieve what we have. Now I would like to be able to save up so that my son can apply to the police force, he can have a job and with that we will make ends meet,” she says.

Marcahuachi worked for years as a saleswoman in a clothing store in downtown Lima, adjacent to Callao, and then in Ventanilla until she retired. Three years ago, she created the Emmanuel Soup Kitchen, for which the Ministry of Development and Social Inclusion provides her with non-perishable food.

Pachacútec, a poor settlement in the port municipality of Ventanilla, has 180,000 inhabitants from different regions of the country and districts of Lima, the Peruvian capital. The conditions of poverty and precariousness increase caregiving work, typically associated with women due to gender stereotypes. CREDIT: Mariela Jara / IPS

The community soup kitchen operates at one end of the courtyard that surrounds her house and offers 150 daily food rations at the subsidized price of three soles (80 cents of a dollar), which she uses to buy vegetables, meat and other products used in the meals.

Marcahuachi feels good that she can help the poorest families in her community. “I don’t earn a penny from what I do, but I am happy to support my people,” she says.

Her daily routine includes running her own home as well as ensuring the 150 daily food rations in the Emmanuel settlement where she lives, one of 143 neighborhoods in Pachacútec.

Various studies, including the World Bank’s “Rising Strong: Peru Poverty and Equity Assessment”, have found that poverty in Peru is mostly urban, contrary to most Latin American countries, a trend that began in 2013 and was accentuated by the pandemic.

By 2022, although the national economy had rallied, the quality of employment and household income had declined.

Mercedes Marcahuachi is a resident of Pachacútec, a large area in the province of Callao on Peru’s central coast characterized by poverty and inequality. During the pandemic she set up a soup kitchen in her home, to feed the poorest local residents in her neighborhood, which is called Emmanuel. CREDIT: Mariela Jara / IPS

In Pachacútec, in the extreme north of Callao, the hardship is felt on a daily basis.

Only the two main streets are paved, while the countless steep lanes lined with homes are stony or sandy. Cleaning is constant, as dust seeps through the cracks in the wooden walls and corrugated tin-sheet roofs.

In addition, food and other basic goods stores are far away, so it is necessary to take public transportation there and back, which makes daily life more expensive and complicated.

But these are unavoidable responsibilities for women, who because of their stereotypical gender roles are in charge of care work: cleaning, washing, grocery shopping, cooking, and caring for children and adults with disabilities or the elderly.

This is the case of Julia Quispe, who at the age of 72 is responsible for a number of tasks, such as cooking every day for her family, which includes her husband, her daughter who works, and her four grandchildren who go to school.

Julia Quispe, 72, continues to care for and feed her family, including making the long trip to the market to shop and feed her husband, daughter and grandchildren. She does so at the cost of her own poor health. But this resident of Pachacútec, a poor area near Lima, the Peruvian capital, responds that she has “never worked”, when asked. CREDIT: Mariela Jara / IPS

She tells IPS that she has uterine prolapse, that she is not feeling well, but that she has stopped going to the hospital because for one reason or another they don’t actually provide her with the solution she needs.

Despite her health problems, she does the shopping every day at the market, as well as the cooking and cleaning, and she takes care of her grandchildren and her husband, who because of a fall, suffers from a back injury that makes it difficult for him to move around.

“When we came here in 2000 there was no water or sewage, life was very difficult,” she says. “My children were young, my women neighbors and I helped each other to get ahead. Now we are doing better luckily, but I can’t use the transportation to get to the market; I can’t afford the ticket, so I save by walking and on the way back I take the bus because I can’t carry everything, it’s too heavy.”

But when it comes to talking about herself, Quispe says she never worked, that she has only dedicated herself to her home, replicating the view of a large part of society that does not value the role of women in the family: feeding, cleaning the house, raising children and grandchildren, providing a healthy environment, which includes tasks to improve the neighborhood for the entire community.

Moreover, in conditions of poverty and precariousness, such as those of Pachacútec, these tasks are a strenuous responsibility at the expense of their own well-being.

The steep streets of Pachacútec are sandy or stony, which means there is constant dust in the homes, and women have to spend more hours cleaning in this densely populated settlement of Ventanilla, a coastal municipality neighboring Lima. CREDIT: Mariela Jara / IPS

Recognizing women’s care work

“Poor urban women have come from other regions and have invested much of their time and work in building their own homes, caring for their children and weaving community, a sense of neighborhood. They have less access to education, they earn low wages and have no social coverage or breaks, so they are also time poor,” Rosa Guillén, a sociologist with the non-governmental Gender and Economics Group, tells IPS.

“For years, they have taken care of their families, their communities, they do productive work, but it is a very slow and difficult process for them to pull out of poverty because of   inequalities associated with their gender,” she says.

She adds that “even so, they plan their families, they invest the little they earn in educating their children, fixing up their homes, buying sheets and mattresses; they are always thinking about saving up money for the children to study during school vacations.”

From the focus of the approach of feminist economics, she argues that it is necessary for governments to value the importance of the work involved in caregiving, in taking care of people, families, communities and the environment for the progress of society and to face climate change, investing in education, health, good jobs and real possibilities for retirement.

“Living here makes you feel like crying but what would that get me, I just have to get over it,” Ormecinda Mestanza, a resident of Pachacútec since 2004, tells IPS. She commutes daily to the Peruvian capital of Lima to work and earn a living, in trips that take between two and three hours. CREDIT: Mariela Jara / IPS

Ormecinda Mestanza, 57, has lived in Pachacútec for nine years. She bought the land she lives on but does not have the title deed; a constant source of worry, because besides having to work every day just to get by, she has to fit in the time to follow up on the paperwork to keep her property.

“It makes you want to cry, but I have to get over it, because this little that you see is all I have and therefore is the most precious thing to me,” she tells IPS inside her wooden shack with a corrugated tin roof.

Everything is clean and tidy, but she knows that this won’t last long because of the amount of dust that will soon cover her floor and her belongings, which she will just have to clean over again.

She works in Lima, as a cleaner in a home and as a kitchen helper in a restaurant, on alternate days. She gets to her jobs by taking two or three public transportation buses and subway trains, and it takes her two to three hours to get there, depending on the traffic.

“I get up at five in the morning to get ready and have breakfast and I get to work late and they scold me. ‘Why do you come so far to work?’ they ask me, but it’s because the daily pay in Pachacútec is very low, 30 or 40 soles (10 to 12 dollars a day) and that’s not enough for me,” she says.

Wood and corrugated tin roofing are the materials used in most of the houses in Pachacútec, an area in the north of the province of Callao, adjacent to the capital of Lima, as is the case of the home of Ormecinda Mestanza, who constantly worries that when it rains her house will be flooded by leaks in her roof. CREDIT: Mariela Jara / IPS

She managed to buy the land with the help of relatives. After working for a family as a domestic for 30 years, her employers moved abroad and she discovered that they had lied to her for decades, claiming to be making the payments towards her retirement pension. “I never thought I would get to this age in these conditions, but I don’t want to bother my son, who has his own worries,” she says.

According to official figures, in Peru, a country of 33 million inhabitants, 70 percent of people living in poverty were in urban areas in 2022.

And among the parts of the country with a poverty rate above 40 percent is Callao, a small, densely populated territory that is a province but has a special legal status on the central coast, bordered to the north and east by Lima, of which it forms part of its periphery.

The municipality of Ventanilla is known as a “dormitory town” because a large part of the population works in Lima or in the provincial capital, also called Callao. Because of the distance to their jobs, residents spend up to five or six hours a day commuting to and from work, so they basically only sleep in their homes on workdays, and very few hours at that.

Guillén says it is necessary to bring visibility to the workload of women and the fact that it is not valued, especially in poor outlying urban areas like Callao.

“We need a long-term policy immediately that guarantees equal education for girls and boys, and gives a boost to vocations, without gender distinctions, that are typically associated with women because they are focused on care,” says the expert.

She adds that if more equality is achieved, democracy and progress will be bolstered. “This way we will be able to take better care of ourselves as families, as society and as nature, which is our big house,” she remarks.