By Aimable Twahirwa
KIGALI, Nov 13 2023 – In a newly established Centre of Excellence located in Masaka, a suburb of the Rwandan capital city, Kigali, an expanded lab, complete with innovative facilities and specialized instruments, is now giving surgeons a conducive environment to simulate how to perform minimally invasive surgeries.

French-based Institute for Research into Cancer of the Digestive System (IRCAD) played a major part in this initiative, the first ever on the African continent.

According to medical experts, in comparison to traditional open surgery, often requiring the patient to incur invasive large incisions, minimally invasive surgery procedures allow doctors to insert a camera through a small incision, or sometimes no incision at all.

Dr Alexandre Hostettler, head of the Surgical Data Science Team at IRCAD, pointed out that harnessing robotic and artificial intelligence is critical to enhance the capability of surgical treatment in Africa.

Robot-assisted minimally invasive surgery denotes the surgical technique where the robot-applied laparoscopic tools are remotely controlled by a human operator at a console.

“Performing surgeries using robotic assistance can be more comfortable for surgeons, as they can sit at a console rather than standing for extended periods, reducing physical strain,” he told IPS.

The center also aims to train medical doctors from across Africa about how to perform surgery using very small incisions, allowing the introduction of an endoscope connected to a camera with a magnified image leading to a very precise dissection of the operated organs.

Prof Jacques Marescaux, President and Founder of IRCAD, is convinced that the new center represents a turning point in surgical education and practice in Rwanda and sub-Saharan Africa. “The center is a catalyst for all African surgeons and computer scientists,” he said in an exclusive interview with IPS.

At the same time, Rwanda is striving to build an integrated medical service system that provides high-quality services and is efficient in medical facility management. Rwandan President Paul Kagame believes the key task is to keep investing significantly in public health infrastructure.

“The [new] Centre of Excellence is not serving Rwanda alone. It is serving Africa. It is also improving and taking beyond the talent we have in Africa to a much higher level,” Kagame said at the inauguration of the new facility, for which operations and running costs will be fully funded by the Government of Rwanda and IRCAD France.

Some medical experts observe that despite its numerous advantages over traditional surgery, especially the shorter hospital stay and less blood loss with lower overall costs, the new robotic surgery is not widespread in low- and middle-income countries, especially in Sub-Saharan Africa.

In addition, some researchers argue that computer-assisted navigation and robotics are sometimes challenging to use by perioperative nurses when caring for patients undergoing these procedures.

Dr Christine Mutegaraba, a surgeon from one of the private clinics in Kigali, told IPS that providing appropriate training remains critical for specialized medical practitioners to rely on these robotic surgery systems.

“Huge investment is also needed to ensure that clinics and other specialized referral hospitals are equipped with devices needed to perform these kind of surgical techniques,” Mutegaraba said.

According to the data from Rwanda’s Ministry of Health, laparoscopic was the sole type of minimally invasive surgical technique used by few medical practitioners across the country, and there wasn’t any formal training in place to develop the technical skills for additional doctors.

With the inauguration of the new center, both officials and health experts see hope in developing and advancing this technology, where specialized medical doctors will now be able to perform various kinds of surgeries.

While the introduction of innovative solutions in the health sector remains exciting for health officials, Marescaux points out that the new robotic technology is set to provide patients with high-quality medical services.

“We are working on building the largest team combined with computer scientists and surgeons in Africa,” he said.

Estimates by IRCAD show that access to surgical care in Low- and Middle-Income Countries (LMICs), such as countries in Sub-Saharan Africa, is still extremely limited, which causes a burden on the health care systems.

It said thanks to the center, African surgeons will not have to travel across the continent to receive the best training in surgery since it will be available right at home.

The 2022 World Health Organization’s study shows that strong measures are also needed to boost the training and recruitment of health workers in Africa.

Whereas the UN agency recommends that African countries significantly increase investments in building the health workforce to meet their current and future needs, new findings show that that the region has a ratio of 1.55 health workers (physicians, nurses, and midwives) per 1000 people.

Experts now believe that robotic technology will also lessen surgeon’s workload by efficiently managing the patient flow.

“As technology evolves, robotic systems are likely to incorporate more advanced features, integrating AI, augmented reality, and other technologies to aid the surgical process,” Hostettler said.

IPS UN Bureau Report

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By Alon Ben-Meir
NEW YORK, Nov 13 2023 – Unless Israel establishes an exit strategy and an end-game that will lead to a solution to the Israeli-Palestinian conflict in full coordination with the US and Saudi Arabia, the war against Hamas will only be another brutal violent episode that will prepare the ground for the next conflagration that will engulf the West Bank and potentially set the entire region on fire.

What Is Israel’s End-Game in Gaza?

As the Israel-Hamas war grinds on, the international call for a ceasefire or at a minimum a pause in the fighting for a couple of days to allow for the delivery of badly needed necessities is absolutely essential at this juncture. It is glaringly evident that there is growing international sympathy towards the Palestinians, given the magnitude of destruction and loss of life.

This humanitarian crisis of such incredible scale is overshadowing the unconscionable slaughter of 1,400 people in Israel and the kidnapping of 248 others. Sadly though, although Israel has the right to self-defense, the campaign to eradicate Hamas is increasingly resembling a war of revenge and retribution. It has caused tremendous destruction and human suffering.

After only four weeks, nearly 11,000 in Gaza are dead, one-third of them children under the age of 18, there is a horrifying scarcity of food, medicine, water, and fuel, and nearly half the population is now internally displaced.

This calamity is unfolding in front of our eyes and must stop, even temporarily, to help save the lives of many of the tens of thousands who are wounded, bury the dead, and avert wide-spread starvation. And even though a temporary cessation of hostilities benefits Hamas, it is still worth undertaking not only to alleviate the horrifying suffering of the entire population in Gaza, but also to open a window for negotiating the release of as many hostages as possible, especially all women and children, in exchange for the pause in fighting.

Whereas Israel’s stated goal from the onset was and still justifiably is the destruction of Hamas, Israel has not offered as yet any clear exit strategy nor endgame. Once Hamas is completely defeated, which is still a tall order, Israel with the support of the US and Saudi Arabia in particular will have to offer a sound alternative that meets the Palestinians’ aspiration and render Hamas irrelevant.

President Biden should demand that Prime Minister Netanyahu and his military brass develop, in coordination with the US, a clear exit strategy and an end-game consistent with Israel’s, the Palestinians’, and the US’ national interests.

The protests that have taken place across major cities in the US over the weekend, including Washington, DC, are arguably some of the biggest that we’ve seen in a long time. These calls for a ceasefire or a pause in the fighting for humanitarian reasons are exerting pressure on Biden to change his near-unconditional support of Israel’s war efforts, which he can no longer ignore. This is particularly important because the US’ unwavering support of Israel makes the Biden administration complicit to the unfolding tragedy, which is intensely criticized from the ranks of leading Democrats as well.

What should be the end game? I believe there are three possible scenarios, two of which are impractical in a sense that they will not lead to a permanent solution to the Israeli-Palestinian conflict.

Israeli control over Gaza

First, Netanyahu is claiming that he wants to maintain security over Gaza, but he’s not saying who will govern and administer the Strip. Does he want to reoccupy all of Gaza or just the northern half, which may explain why he wanted the Palestinians to head south. President Biden is very correct to suggest that the reoccupation of Gaza, be that in part or in full, will be nothing short of a disaster for Israel and will only guarantee the prolongation of the Israeli-Palestinian conflict.

Moreover, it should be emphasized here that given Israel’s experience in the occupied West Bank, maintaining security was only marginally successful at best as evidenced by the continuing violence between Israeli forces and Palestinians, which has been increasingly escalating.

Netanyahu is a fool to assume that he can maintain control over Gaza by establishing a security apparatus when the Hamas-affiliated militants in Gaza will subject the Israeli forces to terrorist attacks that will exact a heavy toll in blood and treasure. The violence in the West Bank will pale in comparison to what Hamas’ militants in Gaza will still be capable of doing against Israeli forces without an end in sight.

Resettling Palestinians in Egypt

The second option, which Netanyahu has been exploring with Egypt, would allow the settling of a few hundred thousand Palestinians in the Sinai; Egypt would assume administrative responsibility in Gaza while Israel maintains security. Egyptian President Sisi flatly rejected any future involvement with the Palestinians in Gaza, other than facilitating through the Rafah crossing the passage of people for justifiable reasons as well as the transfer of goods.

The Egyptian government considers Hamas a branch of the Muslim Brotherhood, which is outlawed in Egypt. For this reason, Egypt has also blockaded Gaza to prevent the infiltration of Hamas militants into the country.

Moreover, Egypt has troubles of its own. The economy is in a dire situation, and its concerns over security are mounting. Egypt simply does not want to add more to its domestic problems. Thus, they are not interested in any solution that will burden them with the Palestinians. That said, President Sisi was clear that regardless of how this war ends, a framework for a solution to the Israeli-Palestinian conflict must be established, otherwise it will be only a question of time when this war will invite another.

Transitional period for Gaza with UN supervision

The third option may well be more viable as it would entail a transitional period whereby the United Nations would assume responsibility. Administratively, as is well known, UNWRA has been on the ground for decades, providing aid and development services, including education, healthcare, microfinance, and job training.

Although it has not been involved in the running of Gaza itself, UNWRA is very familiar with the scene in Gaza. It is familiar with the population’s needs, the prevailing socio-economic conditions, and the day-to-day problems Gazans face. UNWRA is in the best possible position to assume greater responsibility under a modified and expanded mandate, provided that it receives the manpower and the funding necessary.

In conjunction with UNWRA’s added administrative responsibilities, it will be necessary to establish a peacekeeping force to be in charge of security. This force ought to be comprised exclusively of the Arab states that are at peace with Israel, namely the United Arab Emirates, Saudi Arabia, Jordan, Bahrain, and Morocco, as well as Egypt.

It should be made clear that although post-Hamas the West Bank and Gaza should be governed by the Palestinian Authority (PA), this should not and in fact cannot happen for at least a year to 18 months following the establishment of a UN administrative authority in Gaza.

During this period, the Palestinians in both the West Bank and Gaza would prepare themselves politically for a new election. The current PA is corrupt to the bone; President Abbas is rejected and despised by the majority of Palestinians and must go. Only a new, fresh, and uncorrupt newly-elected leadership that enjoys the confidence of the people can succeed.

On the Israeli side, no one should hold their breath waiting for Netanyahu and his gang of zealous coalition partners to agree on anything that even resembles an independent Palestinian state. Once the war ends, Netanyahu will face an inquiry about the unprecedented disaster that took place under his watch and he will have to resign or be ousted. Here too, a new government will have to be established in Israel which must commit itself from the onset to a two-state solution.

Once the above two prerequisites are in place, the UN administrative authority will then relinquish its role and responsibility to the PA.

The Arab states should condition their commitment to provide a peacekeeping force upon Israel’s acceptance of a two-state solution. That is, once such a peacekeeping force is created, the process of peacebuilding ought to commence in earnest toward that end. Any interim solution must be used only as a vehicle toward a final resolution, otherwise it would serve as nothing less than a respite from waiting for another disaster to unfold.

The role of the US and Saudi Arabia

Saudi Arabia and the US can play a major, in fact indispensable, role in this regard: The US has and continues to be the ultimate guarantor of Israel’s national security, and President Biden has done more than any of his predecessors in this regard and demonstrated that in the most unambiguous way by his unflagging support of Israel.

He must make it very clear (and is in a position to do so) to Netanyahu or his successor that the US’ unwavering support bears considerable political cost to America both domestically as well as internationally. Many countries around the world view the US as complicit to the unfolding horror in Gaza. President Biden must put in place a framework for a two-state solution, which he has been advocating for many decades.

The negotiating peace process will certainly take more than year to complete. 2024 is an election year in the US, but regardless of who the next president might be, Biden will have to stick to the plans because another Israeli-Palestinian conflagration will inescapably involve the US. It’s time for the US to put its foot down, no longer give Israel carte blanche to do as it pleases, and condition further support, financial and military, to genuine efforts to negotiate in good faith and reach a peace agreement.

Saudi Arabia can complement the US initiative with its own most significant role by seizing on the breakdown in the Israeli-Palestinian relations and offering an unprecedented breakthrough to bring an end to the conflict. The Saudis should make it clear that once the war ends, they will be ready to normalize relations with Israel on the condition that a new Israeli government agree to a two-state solution and negotiate continuously until an agreement is reached.

This war must end, leaving Hamas dramatically weakened and in disarray. But Hamas’ ultimate defeat will not be on the battlefield, it will be by creating an alternative to Hamas’ governance from which the Palestinians will greatly benefit. That contrast ought to be made clearly and immediately to demonstrate to the Palestinians that Hamas was not only the enemy of Israel but the enemy of ordinary Palestinians. Yes, all Palestinians in Gaza want to live in peace and prosper but were deprived of living a normal life because of Hamas’ violent resistance to Israel, squandering every resource to fight Israel while leaving the people despairing and hopeless.

Israel should not prolong this tragic war by even one unnecessary day. Indeed, if this war lasts another month or two, it is almost certain that 20,000 to 30,000 Palestinians, mostly innocent civilians, and scores of Israeli soldiers will be killed. The continuation of the terrifying death and destruction in Gaza along with Israeli losses will only deepen the hate, enmity, and distrust between Israel and the Palestinians and make a solution to the conflict ever more intractable.

Every Israeli should ask him/herself the painful question: do we want to memorialize the death of 1,400 innocent Israelis butchered by Hamas by killing, however inadvertently, 20,000 Palestinians? Is that how the Israeli victims should be commemorated? This is something that every Israeli needs to think about.

Yes, Israel can and will win every battle against Hamas, but it will lose the war unless a peace process between Israel and the Palestinians begins once the war comes to an end, under the auspices of the US and Saudi Arabia, which must lead to a two-state solution.

For more information on how a sustainable peace agreement based on a two-state solution can be reached, please refer to my essay in World Affairs https://journals.sagepub.com/doi/full/10.1177/00438200211066350
“The Case for an Israeli-Palestinian-Jordanian Confederation: Why Now and How?”

Dr Alon Ben-Meir is a professor of international relations at the Center for Global Affairs at NYU. He teaches courses on international negotiation and Middle Eastern studies. [email protected]

IPS UN Bureau

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By Naureen Hossain
UNITED NATIONS, Nov 13 2023 – One month into the war in Gaza, Palestine has already seen major setbacks in development that will have severe ramifications for the people of Palestine that will impact any future efforts toward its economic recovery.

A new report from UNDP and the UN Economic and Social Commission for West Asia (ESCWA) has projected the fallout of Palestine’s socioeconomic development as the conflict in Gaza enters its second month. Titled The Gaza War: Expected Socioeconomic Impacts on the State of Palestine, the joint report warns that the loss of life and infrastructure because of the conflict and military siege will have long- and short-term consequences on the entire state and will see a serious regression in development that would take years for the state to recover from. 

Since October 7, military operations in the Gaza Strip have caused dramatic downward trajectories in the state’s economy, public infrastructure, and development.

Rola Dashti, the Executive Secretary for UN-ESCWA, remarked on the “unprecedented deprivation of resources” since the conflict escalated. In a press briefing, she warned that this deprivation of resources, including public services, health, utilities, and freedom of movement, are emblematic of multidimensional poverty.

Over 45 percent of housing has been destroyed by bombardments; 35,000 housing units have been totally destroyed, and 212,000 units have been partially damaged. Over 40 percent of education facilities have been destroyed, which has left over 625,000 students with no access to education.

The report estimates that Palestine’s GDP is expected to decline by 4.2 percent within the first month of the war. A further loss of GDP is expected by 8-12 percent if the war continues into the second and third months. The poverty level is also expected to rise to 20-45 percent. These projections were predicted for the duration of the war, going on up to three months. As the economic value is largely centralized in the Gaza Strip and the West Bank, it will have a ripple effect across the region. Unemployment in Gaza was already an issue, with a rate of 46 percent, compared to 13 percent at the West Bank. Yet, since the start of the war, around 390,000 jobs have been lost. The continued military involvement has already caused disruptions to trade and the agriculture and tourism sectors.

Other effects of the war, such as a reduction in trade and investments, will only further add to the overall insecurity of the State. There is also the risk that investors will take a more cautious approach when the region displays such volatility. The impact on neighboring countries would be to redirect resources from development to expanding security.

Hospitals have been contending with repeated attacks since the start of the war while keeping operations going as supplies dwindle. Sixteen out of the 35 hospitals in Gaza have been forced to suspend their operations due to fuel shortages. This included Al-Awda Hospital in northern Gaza, the only hospital that was providing maternal health services, where 80 percent of its patients were women and children. On Wednesday night, a spokesperson announced that the hospital would be forced to close down operations due to fuel shortages.

The threat to their safety and disruptions to education, healthcare, housing, and employment have already forcibly displaced over 1.5 million people in Palestine in just one month. The number of fatalities in this current conflict has now exceeded 10,000, including 4,104 children. It stands in stark contrast to the death toll during the major conflict in 2014, which capped at 2251. As Dashti told reporters, “There are faces behind these staggering numbers.”

Assistant Secretary-General and Director of the Regional Bureau for the Arab States for UNDP Abdallah Al Dadari mourns the loss in overall human development. These compounding losses and setbacks will “bring [Palestine] back to 2005, in terms of development”, he said.

Should a ceasefire be put into effect, even immediately, the time for recovery will be long and complex. Al Dadari remarked that rebuilding the lost infrastructure would be a challenge. He added that efforts toward a “top-down reconstruction” that did not include the participation and consideration of the Palestinian people would have “structural deformities” shortly thereafter. Many of the facilities, including hospitals, support centers, and schools, were established and supported by humanitarian organizations, such as UNRWA. Palestine is dependent on these facilities and on humanitarian assistance.

The UN report concludes that post-war recovery efforts should take a different approach, one that will not only deal with the immediate humanitarian and economic needs of the affected civilians through funding. The root causes of the conflict and the tensions in the region must be addressed, Dashti said. With a guarantee from all involved parties, is there a possibility for what the UN calls sustainable peace?

IPS UN Bureau Report

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