// archives

Archive for March 7th, 2018

Italy: The Migrant ‘Flood’

Lucky old Italy just got two Donald Trumps for the price of one. One of the big winners in last Sunday’s Italian election was the Five-Star Movement, whose 31-year-old leader Luigi di Maio has promised to stop sending out rescue boats to save migrants from drowning when their flimsy craft sink halfway across the Mediterranean. A “sea taxi service”, he calls it, and promises to send all the survivng illegal immigrants home.

So does Matteo Salvini, the leader of the League (formerly the Northern League), the other big winner in the election. “I’m sick of seeing immigrants in hotels and Italians who sleep in cars,” Salvini told supporters at a recent rally in Milan. He pledges to send 150,000 illegal migrants home in his first year in government.

It is not yet clear whether Salvini and/or di Maio will actually be in government. A coalition between the Five-Star Movement and the League would command a majority in parliament and is one possibility, but other combinations are also possible. However, it’s already clear that these two populists won more than half the votes on openly racist platforms.

‘Openly racist’? Di Maio and Salvini generally stop just a millimetre short of that, but Attilio Fontana, the senior League member who has just won the governorship of Lombardy, Italy’s richest region, has no such qualms. “We have to decide if our ethnicity, if our white race, if our society continues to exist or if it will be canceled out,” he said recently.

Now it’s true that 600,000 illegal migrants, mostly from Africa and the Middle East, mostly Muslim, and mostly young men, have arrived on Italy’s shores in the past four years, which was bound to startle the older residents. On the other hand, there are 60 million people in Italy, so that’s just one percent of the population. Why is that such a big deal?

You might as well ask why it’s such a big deal that an estimated half-million illegal migrants enter the United States each year. That is only one illegal immigrant per year for every 600 people who are already in the country. Half of those illegals aren’t even Mexicans, and yet Donald Trump won a lot of votes by promising to build a Wall on the Mexican border to stop them.

Both in the United States and in Italy, the real fuel behind the populist surge is high unemployment (the official US figure is a fantasy) and long-term stagnation in the incomes of the lower-paid half of the population. The immigration issue just serves as a visible symbol of the displacement so many feel as the economy pushes them to the margins.

The popular discontent and the political malaise cannot be cured by sending a few hundred thousand migrants home, even if that were easily done. In many cases, it is practically impossible.

The Mexican government currently cooperates with the US, so at the moment it is relatively easy to send illegal immigrants back across that border. The illegal migrants in Italy and other European Union countries are a quite different story, because their countries of origin will generally not want them back, and EU human rights laws make it hard to just give them parachutes and push them out of planes.

What we are seeing now, however, is a foretaste of the time when the migrant flows grow very large and the politics gets really brutal. In the not too distant future the Mediterranean Sea and the Mexican border will separate the temperate world, where the climate is still tolerable and there is still enough food, from the sub-tropical and tropical worlds of killer heat and dwindling food.

This is a regular subject of confidential discussions in various strategic planning cells in European governments, and also in the grown-up parts of the US government.Ten years ago a senior officer in the intelligence section of the US Joint Chiefs of Staff told me that the US army expected to be ordered by Congress to close the Mexican border down completely within the next twenty years. And he was quite explicit: that meant shooting to kill.

This was many years before Donald Trump came up with the Wall, and even today it’s still not needed. But one day it will be, because global warming will hit the countries closer to the equator far harder than the fortunate countries of the temperate zone, and the main casualty will be food production in the tropics and the sub-tropics.

So the hungry millions will start to move, and the borders of the richer countries in the temperate parts of the world will slam shut to keep them out: the United States, the European Union, Russia, South Africa, Australia. If you think the politics is ugly now, just wait

Of course, a miracle could happen. There could be early and very deep cuts in greenhouse gas emissions worldwide, so that most of the catastrophe never arrives. But I’m having trouble even believing in the Easter Bunny any more. This is harder.
To shorten to 700 words, omit paragraphs 4 and 9. (“Openly…recently”; and “The Mexican…planes”)

Only the Poor Die Screaming

7 January 2018

Only the Poor Die Screaming
By Gwynne Dyer

If you had a million dollars to spend (but not on yourself), where would it do the most good? Well, the cost to cover morphine or a morphine-equivalent pain relief treatment for all the sick children younger than 15 years who are in really serious pain in low-income countries would be just $1 million per year. About half of them of those children are going to die, but with morphine at least they wouldn’t die screaming.

That’s how a great many people died in the past: no pain relief, or aspirin at best, and so cancer victims, gravely injured people and many others spent their last days, weeks or months in agony. Everybody still dies in the end, but now they die with far less pain – in the richer parts of the world. Elsewhere, however, it’s still the Bad Old Days.

This is not because the pain-relief drugs are expensive: they are all off-patent and quite cheap. Yet according to a study published in October by The Lancet, one of Britain’s two leading medical journals, almost half the people who die each year are still dying in ‘serious health-related suffering’ (SHS), as the experts call it. Or agony, as the rest of us call it.

The Lancet went to the trouble of setting up a commission to look into this phenomenon because it just doesn’t make sense. Of the 56 million people who died in the world last year, 25 million experienced short- or long-term SHS before they died. And four out of five of those who died in great pain lived in developing countries. Yet it’s not just happening because they are poor.

All the rich countries except the United States have an average life expectancy above 80 years, but that’s not really a big deal. Middle-income countries like Jamaica, Vietnam and Algeria are all in the mid-70s and even half the countries of Africa have average life-spans above 70 years. It’s not their health services in general that are failing; it’s their palliative care and pain management in particular.

The contrast between rich countries and lower-income countries is far greater in pain control than in any other facet of medical practice. The average annual amount of morphine-equivalent opioids given to patients worldwide in 2010-13 was 298•5 metric tonnes. Of that small mountain of morphine, only 0•1 metric tonne – that is, one hundred kilogrammes – was given to patients in low-income countries.

So 25 million people die in great pain each year, and another 35 million live on in chronic pain and distress – all of which could be prevented for a very modest investment in pain-killing drugs and would require almost no new medical infrastructure. It is an astounding failure that at first seems almost impossible to explain. But there are explanations, of course.

Morphine is three or four times more expensive in most lower-income countres than it is in the rich countries. It doesn’t have to be that way, but the governments of those countries have not intervened to force prices down in the same way they did, for example, with the cost of retrovirals to control AIDS.

Why not? “I don’t think we have cared enough about poor people who have pain,” said Prof. Felicia Knaul, co-chair of the Lancet commission. “It doesn’t make them live any longer. It doesn’t make them more productive. It is simply the human right of not sufferng any more pain, and we don’t care about that for people who are poor.”

There are other reasons too, of course, like ‘opiophobia’ – the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community. It’s also known that some nurses are uncomfortable giving high doses of narcotics even if ordered to do so, for fear of being held responsible for the patient’s death (even when the patient is terminal). But Knaul is right: the fundamental reason is that we don’t care enough.

Okay, but who’s “we” in this case? It’s not the traditional suspects: selfish people in the rich countries. Nobody is getting rich from this massive and needless neglect. Those to blame are the political and medical leadership in the poor countries themselves, who have failed to give any priority to reducing the horrendous pain suffered by their poor fellow-citizens because that is not one of the metrics by which their success is measured.

Get the death rate down, and you’re a hero. Cure glaucoma and give people back their vision, or eliminate some parasite and get thousands of people back on their feet and working, and you’ll get honours and promotions. End the almost invisible distress of millions of humble people living out their last days in agony, and nobody will even notice. They’re not watching that.

The Lancet commission has proposed an Essential Package of drugs, equipment and training that would cost only $2 a year per capita and provide pain control for every citizen in lower-income countries, but it’s governments that actually have to do it, in collaboration with their own medical professions. Get your priorities right, and the rest will follow.
To shorten to 725 words, omit paragraphs 10 and 12. (“There…enough”; and “Get…that”)