Tag: Ed Holt

Pharma Giant’s TB Drug Decision Welcomed, But Not All Developing Countries Benefit — Global Issues

Dr Abhijit Bhattacharya, MS, Central Hospital Kalla, Eastern Coalfields Ltd., assesses an x-ray of a TB patient. Credit: ILO
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Jul 21 (IPS) – In a surprise move, pharma giant Johnson and Johnson (J&J) has agreed not to enforce some of its patents on a lifesaving TB drug, making generic versions available in many low- and middle-income countries (LMICs).

Although on the WHO’s list of essential medicines and a cornerstone of much TB treatment, bedaquiline had not been available in many countries in part because of its high cost.

A deal agreed between J&J and the Stop TB Partnership will allow the latter to procure and supply generic bedaquiline to 44 low- and middle-income countries through its Global Drug Facility (GDF). It is expected the price at which these countries will then be able to buy the drug under the deal will be significantly lower than currently, and some experts have suggested it may also reduce the price of the drug for those countries not covered in the deal.

But patient advocacy groups say that while it is good news that many countries will now get the drug more cheaply, there remain some serious problems with the new deal as countries with some of the highest TB burdens in the world
are excluded. They are also unhappy that it does not address the enforcement of secondary patents the company has on altered formulations of the drug, which are in place in scores of LMICs until 2027.

Critics have called on J&J to declare it will not enforce any secondary patents on bedaquiline in any country with a high burden of TB and withdraw and abandon all pending secondary patent applications for this lifesaving drug.

“We hope this deal will help drive down the price of this drug for all countries. But it doesn’t go far enough. What would have been best would have been for J&J to abandon and withdraw all the secondary patents it holds or has applied for everywhere,” Lindsay McKenna, TB Project Co-Director at the Treatment Action Group (TAG), told IPS.

Advocacy organisations have for years been pressing J&J to reduce the price of bedaquiline.

First approved in 2012, it was the first new TB drug in over 40 years and was hailed as revolutionary in the fight against drug-resistant TB, cutting out the need to use often very toxic, intravenously administered drugs. Its use in patient regimens also produced vastly improved treatment outcomes.

But its high cost – initially USD900 per course even in low-income countries – meant that it was available to relatively few people in many low- and middle-income countries, which have some of the highest TB burdens in the world.

Its price has now come down but remains too high in the eyes of many experts.

According to global health charity Medicins Sans Frontieres (MSF), J&J currently prices the drug at USD1.50/day for an adult treatment (USD272/six months). But with scale-up and unrestricted generic competition, it says the price of bedaquiline could get closer to USD0.50 per day.

This would make a huge difference to cash-strapped TB programmes in poorer countries.

“Any penny that can be saved and which can be spent on something else related to TB, such as case identification, is of massive importance, especially in countries with high TB burdens,” Christophe Perrin, TB advocacy pharmacist at MSF, told IPS.

But even if the deal does bring the price down to that level, some of the countries which would benefit from purchasing the drug at a lower price will not be able to as they have been excluded from it.

Nine countries in the Eastern European and Central Asian region, which have some of the highest TB burdens in the world, are not covered by the deal because of an exclusive supply agreement J&J has with a Russian pharma firm.

“This deal is beneficial for those countries which can access it, but why are some countries excluded? Those that are excluded have some of the highest TB burdens in the world. It’s a real worry,” said Perrin.

The exclusion has infuriated senior health officials in some of the excluded countries. In a rare instance of its kind, the national tuberculosis (TB) programme (NTP) of Belarus sent an open letter to J&J demanding urgent action to improve equitable access to bedaquiline in Belarus, and all other countries with a high burden of TB.

“It is completely unfair that we will be excluded from this deal,” Dr Alena Skrahina, Deputy National TB Programme Manager, Belarus, told IPS.

Another high-burden country that will not be able to take advantage is South Africa. The country’s national procurement rules mean that it obtains bedaquiline directly from J&J.

Doctors and patient activists involved in the country’s fight against TB say South Africa’s inclusion in the deal would have been a huge boon to its efforts against the disease.

“Any money that can be saved could be used to expand diagnosis, public awareness, and use shorter TB treatment regimens, which is what we are looking to do here. Almost 95% of our patients are receiving bedaquiline, so a reduction in the price could have a massive effect. It would definitely benefit South Africa if it was included in this deal,” Dr Priashni Subrayen, TB technical director at the Johannesburg-based healthcare organisation Aurum Institute, told IPS.

Brenda Waning, head of the GDF, told IPS the deal was a good one for LMICs, but could also theoretically benefit countries not covered by it. It is widely expected that the competitive tenders in the deal will push the global price of the drug down as well.

“The deal is special in that usually when a company like J&J gives out licences it does so to a supplier, but this deal allows for multiple competitive buyers. We are expecting the price of bedaquiline to go down, although we won’t know by how much until the tenders happen. But a lower price is not the only benefit for countries. It will also mean more suppliers – the last thing you want to be doing is relying on a single supplier for a drug so there will be greater supply security – and whenever you have a price decrease, that frees up money which can be used for other things ,” she said.

“We think the access price may come down through these tenders, so these countries could, theoretically, get it at a lower price than previously,” she added.

But even if that does happen, it will not be enough for critics who say J&J must abandon secondary patents it holds, or has applied for, in any country.

Unlike primary patents, which protect a completely new chemical entity, secondary patents cover modifications of, medical uses, and dose regimes of the new compound, among others. Critics argue they form part of a practice of “evergreening” which extends companies’ monopolies on existing products and, crucially, makes it difficult for generic manufacturers to enter the market with a generic drug after the original patent has expired

J&J has secondary patents for bedaquiline in 44 countries which are not due to expire until 2027, but under the new deal with StopTB, those countries will now be able to obtain a generic version of the drug.

But they remain in place in those states – “if J&J were to suddenly pull out of this deal, these countries would be back to square one,” noted Perrin – and the company continues to actively pursue their implementation elsewhere.

Phumeza Tisile, a South African TB survivor who lost her hearing because of side effects of treatment with older generation TB drugs, said J&J, and other pharma companies, should immediately withdraw secondary patents and commit to not applying for them anywhere in future.

“This provides affordable medicine to people who need the drug helps people get generic versions of the relevant medicine at a very low cost,” she told IPS.

Pharmaceutical firms often argue that secondary patents are necessary to recoup the often very high costs associated with bringing a novel drug to the market and invest in the production of other new medicines.

J&J did not respond when contacted by IPS, but in a statement made as news of the deal broker last week, the company denied its patents had prevented people from accessing its drug and that the most significant barrier to treatment access for patients was the millions of undiagnosed TB cases every year.

Tisile, who works for advocacy group TB Proof, dismissed such claims, saying secondary patents may be denying people the drugs which they need to stop them dying.

“It’s greed,” she said. “Pharma companies make medicines to help people, but it never made sense to me that they make this medication so out of reach to people who actually need the medication the most, for them, it’s only profits. “This then can be very dangerous to millions of people who need the medication to survive. In this case, it should be patients before profits,” she said.

Others pointed out that the development of many new drugs is often funded by taxpayers – one study found that public investment into bedaquiline’s development was as much as five times that of J&J.

“It’s not a good faith argument to say that secondary patents are needed for a company to benefit from its investment in a drug. You could flip that round and say that the public needs to benefit from the investment they made into a drug,” said McKenna.

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Environmental Crisis Compounds Humanitarian Disaster Following Dam Destruction — Global Issues

The Destruction of the Nova Kakhovka dam in Ukraine has left thousands displaced and disastrous impacts on the environment. Credit: Ukraine Red Cross/Twitter
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Jun 23 (IPS) – As well as creating a humanitarian crisis, the destruction of the Nova Kakhovka dam in Ukraine has wrought enormous environmental damage which may never be undone, ecologists have said.

The collapse of the dam in the Kherson region on June 6 put more than 40,000 people in immediate danger from flooding and left hundreds of thousands without access to drinking water, according to Ukrainian officials.

The reservoir at the dam, which continued to drain days after the dam’s destruction, held 18 cubic kilometres (4.3 cubic miles) of water – a volume roughly equal to the Great Salt Lake in Utah – and was the source of fresh water for large parts of the south of the country.

The disaster – which Kyiv says was the result of Russian sabotage –  flooded scores of villages, towns and cities along the Dnieper River. Entire settlements were destroyed, with houses washed away or almost completely submerged by the floodwaters.

Although those waters have begun to recede in many places now, and the immediate risk from drowning has largely abated, other grave dangers remain, with Ukraine’s health ministry warning of the threat of water and food-borne diseases as dead bodies, chemicals, landfills, and waste from toilets could contaminate floodwaters and wells.

President Volodymyr Zelensky also highlighted a potential danger from anthrax as floodwaters may have disturbed animal burial sites, and Health Ministry officials told IPS that they were especially concerned about the risk of cholera in the weeks to come.

The death toll was at least 52, with Russia giving 35 in its territory and Ukraine saying 17.

And those who have been evacuated are unlikely to be able to return to their homes for some time, if at all, adding tens of thousands of already vulnerable people to the country’s ongoing crisis of internal displacement.

“There are already 5 million people internally displaced in Ukraine. This will put more strain on already stretched services,” Olivia Headon, spokesperson for the International Organisation for Migration, which is helping with rescue efforts in affected areas, told IPS.

But while the human toll of the disaster is becoming increasingly apparent, so too is its massive environmental impact.

Ukrainian Deputy Foreign Minister Andrij Melnyk has called the destruction of the dam “the worst environmental catastrophe in Europe since the Chernobyl disaster”, and many local experts believe the ecological effects will be felt for decades to come.

“Some ecosystems could recover within a dozen years from the flooding itself the drop in groundwater level upstream of the dam is permanent – unless the dam is rebuilt – so ecosystems will never recover,” Natalia Gozak, Wildlife Rescue Field Officer in Ukraine for the International Fund for Animal Welfare (IFAW), told IPS.

The area downstream from the dam – which includes three national parks – is rich in wildlife, some of it very rare.

Local environmental groups estimate that hundreds of thousands of animals have been affected by the dam’s destruction and that tens of thousands have been killed.

They fear a loss of endemic endangered species – areas home to nearly all known locations of the rare ant species Liometopum microcephalum, as well as 70% of the world population of Nordmann’s birch mouse (Sicista loriger), have been flooded.

Meanwhile, ecosystems which were already endangered are now having to deal with either too much or too little water and could disappear.

Ecologists are also worried about a massive loss of bird life while the draining of the reservoir at the dam will also result in major freshwater fish stocks in Ukraine being lost.

The loss of water from the dam reservoir and the major canals it served also spells an end to water supplies for land used to grow crops and other produce which feeds not only Ukrainians but many millions in developing countries too. Forty percent of the World Food Programme’s wheat supplies come from Ukraine.

“In future years, the greatest impact will be seen in southern agricultural areas, which are now left without water supplies. These areas will already have changed next summer depending on what adaptation measures are possible and what action is taken,” said Gozak.

She added that in areas where irrigation channels are no longer being filled from the reservoir, agriculture will stop. “It is possible there will be desertification ,” she said.

The IFAW says this drying of land will subsequently affect local microclimates and cause temperature shifts, while wind erosion will blow sand and soil all over neighbouring areas, impacting both people and nature.

Meanwhile, there are other long-term environmental threats.

Pollution is one as floodwaters have washed an estimated 150 tons of machine oil has been washed as far down as the Black Sea, according to Ukrainian officials. Huge oil slicks have also been seen on the waters in Kherson city’s port and industrial facilities.

And there have been warnings that parts of the river and surrounding lands may now be full of mines.

Some areas of Ukraine have been heavily mined since the start of Russia’s full-scale invasion last year, and it is believed the floodwaters dislodged many of them.

While there have been reports of some exploding as they hit debris on their way downstream, many are likely to have remained unexploded and covered in silt and mud or buried under other debris.

International rescue groups say that finding where they are and then demining them would be a very slow process, even without the ongoing war.

“We’re mapping the likelihood of where the mines were and where they might end up. The area around the dam was heavily mined to stop an amphibious assault, and we don’t know precisely how many mines there are. There could be thousands of mines involved, but we hope not tens of thousands,” Andrew Duncan, a weapon contamination coordinator for the International Committee of the Red Cross (ICRC), told IPS.

“If the fighting stopped and we were able to get into the area, it would be a case of all reasonable effort being made to locate the mines. But this is a very slow process. Any affected land will be out of commission for years,” he added.

But that is not all.

About 150 kilometres upstream from Nova Kakhovka is the Zaporizhzhia Nuclear Power Plant which draws its cooling water from the dam’s reservoir. The reactors at the plant, which had been under the control of Russian forces since early on in the war, had been shut down prior to the disaster, but they still needed water to cool them and prevent a nuclear catastrophe.

While officials at the International Atomic Energy Agency (IAEA) have said that alternative sources, including a large pond next to the plant, can provide cooling water for a number of months, the disaster has highlighted the potential for an even greater catastrophe at the site, others say.

Ukrainian nuclear scientist Mariana Budjeryn, Senior Research Associate at the Project on Managing the Atom, Harvard Kennedy School, told international media: “If the Russians would do this with Kakhovka, there’s no guarantee they won’t blow up the reactor units at the Zaporizhzhia plant that are also reportedly mined – three of the six. It wouldn’t cause a Chernobyl, but massive disruption, local contamination and long-term damage to Ukraine.”

Regardless of what may or may not come to pass at the nuclear plant, the effects of the dam’s destruction will be felt by both people and nature for a long time to come.

Olena Kozachenko (NOT REAL NAME), an office worker from the Korabel district in the Kherson region, told IPS: “We’re all going to have to live with the dangers, such as dislodged mines, for a long time after the flooding.”

Gozak added: “The human toll of the disaster is probably greater than the environmental toll it will take years and years for ecosystems and habitats to get back to how they were if it can happen at all.”

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Tuberculosis Risk Factors Exacerbated by Climate Change — Global Issues

A doctor talks to a TB survivor at a clinic in Manilla,
Philippines. Credit: Getty Images for TB Alliance
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, May 02 (IPS) – While there is no established causal relationship between climate change and tuberculosis (TB), studies have begun to highlight the potential impact its effects could have on the spread of the disease.

Undernutrition, HIV/AIDS, overcrowding, poverty, and diabetes have all been identified as TB risk factors that are worsened by climate change. Worryingly, many countries with high burdens of TB, including, for instance, drought-hit Ethiopia, Indonesia, Kenya, and Peru, have suffered from the kind of extreme weather associated with a heating planet.

But despite vying with COVID-19 for the grim distinction of the world’s deadliest infectious disease, claiming 1.6 million lives in 2021, TB is not often talked about in connection with climate change, with the link often overlooked by policymakers.

TB experts say this must change as the climate crisis accelerates.

“The effects of climate change, such as its impact on migration, for instance, are getting attention. What we want to see is for that attention to also get drawn to its effects on TB,” Maria Beumont, Chief Medical Officer at TB Alliance, a global nonprofit organisation developing TB drugs, told IPS.

In recent years, disease experts and climatologists have sounded increasingly dire warnings about the potential impact of the climate crisis on the spread of lethal diseases.

The latest report from the Intergovernmental Panel on Climate Change (IPCC) warned of the health impacts of global heating, including an increase in the incidence of infectious diseases. Meanwhile, other research has shown how changes in climate have aggravated the risks of hundreds of infectious diseases worldwide.

But much of the discussion around that has focused on how higher temperatures and increased incidence of flooding and drought could drive more vector, food and water-borne diseases with diseases.

What has often been overlooked in these conversations, say Beumont and others, is how the effects of the climate crisis could worsen what is de facto a global TB pandemic.

Part of this is because of the nature of those effects in relation to TB.

“The potential impact of climate change is more indirect than with some other infectious diseases,” Dr Mohammed Yassin, Senior Disease Advisor, TB, at the Global Fund to Fight AIDS, Tuberculosis and Malaria, told IPS.

TB experts point to how more frequent and more devastating natural disasters linked to climate change, or simply places on the planet becoming too hot to be habitable, are leading to mass displacement, which can create ideal conditions for TB to spread.

“Mass displacement can lead to overcrowding and poor living conditions of those displaced. If some of those people already have symptoms of TB, there is a higher chance of it spreading. There would also be people living under stress, and facing malnutrition, which are factors adding to the potential for TB to spread,” said Yassin.

Displacement also raises issues with access to healthcare for the displaced, which can negatively affect the management of treatment for those with TB because patients need to take treatment daily. Interruption of treatment can leave them infectious for longer and at risk of developing drug-resistant TB, which in turn is much more difficult and expensive to treat.

But displacement would also impact the treatment of those with other conditions, such as HIV and AIDS and diabetes, which weaken immune systems and leave people more susceptible to TB.

Meanwhile, displaced people are likely to find themselves living in crowded areas where, in the absence of adequate screening and diagnostic procedures, TB could spread.

But displacement is far from the only problem. Both extreme droughts and flooding can impact food security, devastating crops and killing livestock and leading to malnutrition and undernutrition—known risk factors for TB.

The impact of extreme weather on health, particularly TB, is already being seen in some parts of the world.

Somalia is in the grip of severe drought following five consecutive failed rainy seasons—something which the UN has said has not been seen for four decades—with five million people facing acute food shortages and nearly two million children at risk of malnutrition, according to the UN.

TB is a major cause of death in Somalia, and late last year, with TB services largely non-existent in settlements for displaced persons, the Global Fund committed USD 1.9 million for food support for thousands of TB patients and outreach activities in settlements. Officials at the time emphasised the importance of such action to help reach the most vulnerable and stop TB from spreading.

Meanwhile, the devastating floods in Pakistan last year, which affected an estimated 33 million people, not only brought an immediate threat of diseases such as malaria and dengue but interrupted vital vaccination programmes, including TB.

“The impact of flooding on TB is usually seen sometime later, but it, of course, has an immediate impact in disrupting treatment which can lead to problems such as drug-resistant TB,” said Yassin.

TB experts are calling for governments and leaders within the TB community itself to begin paying more attention to the issue and start thinking about current TB programs and where changes need to be made to deal with these potential impacts.

Some groups, like TB Alliance, are looking to mitigate some of these impacts through treatment developments. The group recently developed a new TB treatment regimen, BPaL, with a much shorter treatment length and fewer of the sometimes very toxic side effects of previous regimens.

An oral-only regimen involving only a few pills a day, it has been widely praised by patients and experts for the relative ease with which it can be taken, notably in Ukraine, where it has recently been rolled out programmatically and used among the many millions displaced there because of the Russian invasion.

“What we are focusing on is trying to find solutions to make treatment safer and shorter, which would overcome some of the negative effects of climate change related to TB, for instance, displacement, as there would be less chance of treatment interruption with shorter treatment,” said Beumont.

A doctor studies x-rays of a TB survivor at a clinic in Kyiv, Ukraine. Credit: Getty Images for TB Alliance
A doctor studies x-rays of a TB survivor at a clinic in Kyiv, Ukraine. Credit: Getty Images for TB Alliance

Yassin said that investment in health systems, especially in low-income countries which have some of the world’s highest TB burdens and where healthcare is already under-resourced, is also crucial.

“We learnt from Covid that health systems can’t cope with a pandemic, and TB is actually a pandemic. It is very important for countries to think about strengthening their health systems and making them more resilient. There needs to be investment now to prepare the systems for a pandemic, including climate change-driven TB,” said Yassin.

“There was a collapse of some healthcare systems during Covid, and because of that, all resources in some countries went to dealing with that, and TB was forgotten, and the TB burden of those countries rose. We need to invest now, not wait for another pandemic. We need more resources,” he added.

Meanwhile, others say that alongside these measures, individual, non-climate-specific interventions could help.

Dr Krishnan Rajendran of the ICMR-National Institute for Research in Tuberculosis (NIRT) in India, which has the highest burden of TB in the world according to the World Health Organisation, told IPS that lessons learnt from the Covid pandemic could be used to reduce TB spread.

“National and local authorities could take preventive measures, such as at least encouraging people to wear masks in seasons where TB incidence is high,” he said.

Whatever efforts are made to deal with the impact of climate change on the disease, they need to be made soon, said Yassin.

“We shouldn’t wait for climate change impacts before we act—we should do something now and deal with TB to prevent more deaths and disabilities,” he said.

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Russias Press Freedom ‘Worst Since the Cold War’

  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Apr 12 (IPS) – The arrest of a US journalist in Russia has not only sent a chilling warning to foreign reporters in the country but is a sign of the Kremlin’s desire to ultimately stifle any dissent in the state, press freedom watchdogs have warned.

They say the detention at the end of March of Wall Street Journal reporter Evan Gershkovich signals the Russian regime may be tightening its already iron grip on control of information and expanding its repression of critics.

“The scale of this move is enormous. Not only is it the first time since the Cold War that an American journalist has been detained, but very serious charges have been brought against him. This is a big step,” Karol Luczka, Advocacy Officer at the International Press Institute (IPI), told IPS.

“ has been the Kremlin policy for some time now and it seems they are targeting more and more people,” he added.

Gershkovich, a US citizen, was arrested in Yekaterinburg on suspicion of spying. He is being held at Lefortovo prison in Moscow pending trial and faces up to 20 years in jail on espionage charges. Among his recent reporting were stories about problems Russian forces faced in their war effort, as well as how Western sanctions were damaging the Russian economy.

The Wall Street Journal has denied the accusations against their reporter and the arrest has been condemned by western leaders and rights campaigners.

Some have seen the detention as a political ploy by the Kremlin and believe Gershkovich is being held to be used as part of a prisoner exchange with the US at some point in the future.

But press watchdogs say that, even if that is the case, the arrest also sends out a very clear message to any journalists not following the Kremlin line.

“I have no doubt that the arrest is a political thing. When I heard about the charges against Evan, the first thing that I thought was, ‘what high-profile Russian do the Americans have in one of their jails at the moment?’” Gulnoza Said, Europe and Central Asia Program Coordinator at the Committee to Protect Journalists (CPJ), told IPS.

“Foreign correspondents offer a rare glimpse of the real picture in Russia to a global audience. The arrest sends a message to all foreign journalists that they are not welcome in Russia, and they can be charged with a crime at any time. From now on, it’s clear that the situation for them unpredictable and unsafe,” she added.

Independent media in Russia had faced repression even before the full-scale invasion of Ukraine, but it has increased since then.

The regime has moved to block websites of critical newspapers, as well as social media platforms, to stop people from accessing information critical of the war, while military censorship has also been introduced with new draconian laws criminalising the “discrediting” of the military.

This has led to some outlets shutting pre-emptively rather than risk their employees being sent to prison, while others have been forced to drastically slash staff numbers, or move newsrooms out of the country, operating in de facto exile.

But until now, foreign media outlets had been relatively unaffected by this crackdown. At the start of the war, many pulled their correspondents out of the country amid safety concerns. But a number, like Gershkovich, returned and had been able to report on the war with comparatively far greater freedom than their Russian counterparts.

For this reason, Gershkovich’s arrest is so worrying for the future of independent journalism under the current Russian regime, Jeanne Cavelier, Head of Eastern Europe and Central Asia desk at Reporters Without Borders (RSF), said.

“To arrest a foreign journalist for such serious charges is a new critical step in Putin’s information warfare. The aim is to intimidate all the remaining Western journalists on Russian territory who dare to report on the ground and investigate on topics linked to the war on Ukraine,” she told IPS.

“It is a signal that they are no more relatively protected than their Russian colleagues. As usual, to spread fear and silence them. Dozens of foreign media outlets have already left Russia since March last year, as well as hundreds of local independent journalists. This blow may worsen the situation and further reduce the sources of trustworthy information from Russia.”

Others believe that the arrest could signal the Kremlin is moving towards a goal of almost total control over information in Russia.

“We are still some way off the kind of censorship that existed in the USSR, but Putin and the Russian ruling regime have said for a long time that the system of censorship in the USSR is a role model for them. This is the way it is going in Russia and the way the government wants it to go. It is deplorable but it is the reality of things,” said Luczka.

“Eventually, it could become like the Cold War when all information coming out of Russia was strictly controlled,” added CPJ’s Said.

Meanwhile, some believe that the arrest is also a signal to the wider population.

In recent years the Kremlin has moved to shut down the opposition, both political and in other areas of society. While vocal critics such as opposition leader Alexei Navalny have ended up in jail, many civil society organisations, including domestic and foreign rights organisations, have been closed down by authorities.

This repression has intensified since the start of the war, and Russians who spoke to IPS said that, particularly following the introduction of legislation criminalising criticism of the invasion, many people have grown increasingly wary of what they say in public.

“It’s crazy. There are shortages because of the war, there are supply problems, and we see it at work all the time. We can talk about the shortages as much as we want to at work, but we cannot say what is causing them – the war – because just using the word ‘war’ can land you in jail for years,” Ivan Petrov*, a public sector worker in Moscow, told IPS.

He added that he knew many people who were against the war but were afraid to express even the slightest opposition to it.

“They know it’s wrong but just can’t speak about it. There is so much censorship. You can get jailed for treason just for mentioning its negative effects on the economy,” he told IPS.

Against this backdrop, Gershkovich’s arrest is likely to reinforce fear among ordinary Russians who do not support the war or the government and stop them speaking out, rights campaigners say.

“It’s hard to separate the stifling of all media freedoms from the stifling of all independent voices – they go hand in hand. When  arrest such a high-profile reporter on patently bogus grounds, no matter what the true purpose of the arrest may be, they are no doubt fully aware of the chilling message it sends to the broader public,” Rachel Denber, Deputy Director of the Europe and Central Asia Division at Human Rights Watch, told IPS.

*Name has been changed

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Repression of Reproductive Rights and Out of Sync Activists — Global Issues

The Abortion Dream Team (from left to right Natalia Broniarczyk, Justyna Wydrzynska, Kinga Jelinska) outside the Warsaw court after Wydrzynska’s conviction. Credit: Abortion Dream Team
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Apr 05 (IPS) – “People want the abortion laws here liberalised. Society has changed; even the politicians can see it,” Kinga Jelinska, a Polish reproductive rights activist, says. “In four or five years, I believe, the abortion laws here will be liberalised, because it’s what the people support.”

Jelinska, a member of the Abortion Dream Team (ADT) collective, which provides assistance to women in Poland who need an abortion, spoke to IPS not long after her fellow activist and ADT co-founder Justyna Wydrzynska had been sentenced to eight months community service for giving abortion pills to another woman.

She is disappointed by the ruling but, like her colleague, remains defiant and determined to carry on her work.

“We’re just going to keep going. The court claimed Justyna was ‘guilty of helping’ someone have an abortion. Well, we have to help each other in cases where people are being systematically denied access to care. Without people like Justyna, women are left to take their own decisions , and they may take an unsafe option,” Kinga says.

Wydrzynska’s trial and conviction have, activists such as Jelinska say, highlighted problems connected with abortion access in Poland and the risks women needing the procedure – and those they turn to for advice – often face.

Poland has some of the world’s strictest abortion laws – terminations are only permitted where the pregnancy threatens the mother’s life or health, or if it results from a criminal act, such as rape or incest – and while not illegal to have an abortion, it is illegal to help someone do so.

Many women in Poland who want an abortion self-administer pills bought online from abroad or travel to neighbouring countries with less restrictive legislation, such as Germany and the Czech Republic, for terminations. Some contact groups like ADT for help. It is not illegal to give out information about abortions, including advice on how to buy pills online.

In February 2020, at the start of the Covid pandemic in Poland, ADT had been contacted by a woman, named Anya*, who was 12 weeks pregnant and desperate. She said she was a victim of domestic violence and was considering going abroad to terminate her pregnancy as the pills she had ordered online were taking too long to arrive.

Wydrzynska decided to give Anya her own pills, but the package she sent was intercepted by Anya’s partner, who reported what had happened to police. Anna later miscarried.

Wydrzynska was convicted of “aiding an abortion” – a crime under Polish law which carries a maximum sentence of three years in prison – by a Warsaw court in March 2023 in what is believed to be the first time in Europe that a women’s health advocate has gone on trial for aiding an abortion.

The conviction was immediately condemned by both local and international activists who said the case should never have been brought to court.

“We were disappointed that Justyna was convicted. We are happy that she is not going to jail, but her trial has dragged on for a year, in which time a lot of international organisations, including gynaecologists, said the case should be dropped. It should never have come to trial, and this would never have happened in another country,“ Mara Clarke, co-founder of Supporting Abortions for Everyone, told IPS.

Amnesty International described the court’s ruling as “a depressing low in the repression of reproductive rights in Poland”.

“This ruling is going to have a chilling effect and we are already seeing women who are worried about what they should do if they found themselves in the situation that they need an abortion,” Mikolaj Czerwinski, Senior Campaigner at Amnesty International, told IPS.

Others believe the trial was part of a wider campaign to crackdown on women’s rights and those of the minorities such as the LGBTQI community, by the right-wing government and its conservative religious allies.

“The case against Justyna was politically motivated,” said Clarke, pointing out that the judge in the case was promoted on the same as she handed down the verdict, and that the Christian fundamentalist group Ordo Iuris was allowed a role in the trial helping the prosecution.

“Who knows what will come up with next?” she added.

The ruling Law and Justice (PiS) party has long been accused by critics in Poland and abroad of systematically suppressing women’s rights, and it was instrumental in pushing through a tightening of abortion laws in 2021 which banned abortions even in cases where the foetus was diagnosed with a severe birth defect.

Meanwhile, the European Commission (EC) has raised serious concerns over judicial independence in the country under the PiS with some judicial bodies seen as being under the control of the ruling party.

Czerwinski said that following the trial there were now “questions over the independence of the judiciary in Poland and what impact that might have on women’s rights, and human rights in general, in Poland”.

But while anger remains at Wydrzynska’s conviction, activists such as Jelinska and Clarke believe that the trial has only highlighted how out of touch Poland’s government is with society on abortion laws.

Since the abortion laws was tightened even further in 2021 – a move which was met with massive street protests – surveys have shown strong support for liberalisation of abortion laws. In one poll last November, 70% of respondents backed allowing terminations on demand up to 12 weeks.

“People want access to abortions, public surveys have shown that. We see it too in the work we do every day,” she says, adding that during Wydrzynska’s trial “public opinion was overwhelmingly pro-Justyna.”

In a public opinion poll carried out in February for Amnesty International, 47% of respondents said they would have done the same as Wydrzynska. The survey also found that people were overwhelmingly against punishment for helping to access an abortion in Poland.

Meanwhile, some opposition politicians have suggested they would introduce legislation which would allow for abortion on demand if they get into power, pointing to public support for such a measure.

It is this public support which, Kinga believes, may have stopped the court handing down a jail sentence to the activist.

“This is an election year, and the government knows it would be political suicide to give her a harsher sentence with so many people in favour of liberalising access to abortion,” she explains.

It may also be behind Polish parliament’s rejection in early March of a bill, proposed by an anti-abortion group as a citizen’s legislative initiative under a special parliamentary procedure, which would have criminalised even providing information about abortions. Government MPs voted against it with some reportedly saying they did back it for fear of fuelling protests just months away from elections.

“Even they know that would have been going too far,” said Czerwisnki.

The trial, which was reported extensively in Poland and widely in international media, has also helped raise awareness of the work of groups like ADT and others with some organisations, including the Abortions Without Borders network which has a Polish helpline reporting a three-fold rise in calls since the trial began.

“Justyna’s case put even more focus on the issue and the ways women can access abortion services,” says Kinga.

If the conviction was designed to put activists off their work, it seems to have backfired, said Czerwinski.

“A lot of activists have been re-energised by this because they have seen Justyna and her response to the ruling,” he said. “They are aware of the risks, but at the same time will not stop helping women.”

Wydrzynska has appealed her conviction and insists that she has done nothing wrong. She has also vowed to continue her activism.

Speaking on public radio after her trial, she said: “Even if I should leave the country, I will never stop. In the same way, I know that there are thousands of people who’d do the same for me.”

*NOT REAL NAME

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Hate Attacks Against LGBTQI People Increase in Europe

People lay flowers and candles outside the Teplaren LGBTQI
bar in Bratislava, Slovakia, following an attack outside the popular
a meeting place for members of the city’s LGBTQI community in which two
people were killed, and a third seriously injured. Credit: Zuzana Thullnerova/IPS
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Mar 07 (IPS) – When D.A.* first heard about the fatal attack on a gay bar in the Slovak capital, Bratislava, last October, their first reaction was a mix of grief, shock and anger.

But then, soon after, the university student and member of the country’s LGBTQI community immediately began to worry.

“I was scared for my own safety,” D.A. told IPS.

Even now, months later, that fear remains in the community.

“I know people who have told me they are afraid to go out at night or who won’t go out on their own and stick together in a group instead. I’m the same,” they said.

The attack on the Teplaren bar, which was carried out by a teenage far-right sympathiser, left two dead and a third, who later recovered, seriously injured. It shocked many and sparked debate about attitudes towards LGBTQI people in the conservative, predominantly Catholic country.

But it also highlighted the threat of extreme violence faced by members of the LGBTQI community not just in Slovakia, but across Europe, coming just months after an attack on a gay bar in Oslo, Norway, which killed two and injured a further 21 people.

And groups working with LGBTQI communities across Europe say that violence is becoming increasingly planned and deadly, leaving many feeling unsafe in countries across Europe.

A report by the European branch of the International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA-Europe) released in February showed that 2022 was the most violent year for LGBTQI people across the region in the past decade, both through planned, ferocious attacks and through suicides.

It said this violence came in the wake of rising and widespread hate speech from politicians, religious leaders, right-wing organisations and media pundits.

“We have noticed a rise in hate speech for some time now and have been flagging it up for a number of years. But what we have been surprised by is the sheer ferocity and violence of the hate, and the physical attacks against LGBTQI people,” Katrin Hugendubel, Advocacy Director at ILGA, told IPS.

ILGA’s report shows that problems with hate speech – be it online, or publicly from politicians, state representatives, or religious leaders – against LGBTQI people run right across the continent from Armenia and Austria to Serbia, Sweden, Turkey, and Ukraine, with dire consequences for people and communities “not only in countries where hate speech is rife, but also in countries where it is widely believed that LGBTI people are progressively accepted”.

ILGA’s report highlighted hate speech used during debates on transgender laws in Finland’s parliament, while previously Finnish prosecutors have voiced concerns about hate speech fuelling anti-LGBTQI sentiment in society.

And in Slovakia, politicians, including former prime ministers, have publicly denigrated LGBTQI people, talked of homosexuality and transgender people as “perversions” and, in some cases, even called for legislation to limit LGBTQI people’s rights.

D.A., who said they had friends who had been attacked because of their identity, believes this kind of rhetoric, from politicians or anyone else, helps fuel violence against the LGBTQI community.

“People in Slovakia are often and easily influenced by the kind of information they receive on a daily basis. So yes, hateful rhetoric leads to violence,” they said.

In some other countries, politicians have taken things even further, enacting legislation which effectively prevents any positive public portrayal of the LGBTI community.

At the end of last year, a new law banning LGBTQI ‘propaganda’ was passed in Russia banning any promotion of what authorities see as “non-traditional sexual relations”.
Groups working with Russia’s LGBTQI community said the new law – an extension of 2013 legislation banning the positive portrayal of same-sex relationships to minors – was the latest part of a state system designed to further stigmatise the minority and was brought in amid intensifying anti-LGBTQI political rhetoric.

Violence against the community has been on the rise in Russia over the last decade, and they worry the new law will only fuel it further.

In Hungary, a similar law was passed in 2021, and experts there say it has emboldened people to express their hatred of the LGBTQI community physically.

“According to statements made by the perpetrators of hate incidents (and from looking at social media) it seems that the law reaffirmed already existing homophobic and transphobic prejudices and made it ‘okay’ to act upon them – people are citing that the law is on their side,” Aron Demeter, Programme Director at Amnesty International in Hungary , told IPS.

“Since the law is purposely confusing (and absurd) it is enough that they have an understanding of that it ‘protects children from LGBTI people’ and that serves as a ‘lawful authorisation’ to be hostile,” added.

While such overtly repressive legislation is not common in other countries in Europe, rights activists point out there are gaps in laws in many states protecting the community.

“In quite a lot of countries, there is still a lack of legislation dealing with hate speech specifically against the LGBTQI community,” Hugendubel pointed out.

She added that this should be addressed, but that it was crucial that people at the highest political levels must speak out against anti-LGBTQI hate.

“We feel that we need to see much more from EU institutions and national leaders in a real effort to stop the hate. There need to be clear statements from them saying that hate is not acceptable,” she said.

Immediately after the attacks in Norway and Slovakia, many politicians, both domestic and in other states, were quick to condemn it and the hatred behind it.

But worries remain that LGBTQI people will continue to be used as a welcome source of polarisation by politicians.

“It is important to see how politicians are using LGBTQI as a polarising tool. It’s something they can use to motivate a specific conservative voter base, and it is a tool with works to a certain extent. It is also being used to distract from other issues, such as corruption – it is polarisation at the expense of the LGBTQI community,” said Hugendubel.

However, while hate speech, and the violence it drives – prior to the killings in Norway, there was a massive rise in anti-LGBTQI hate crimes, jumping from 97 in 2020 to 240 in 2021, according to ILGA – is on the rise in Europe, action is being taken against it with growing numbers of prosecutions for hate speech and crimes in many countries.

Progress is also being made on legislative protections for LGBTQI people.

Meanwhile, despite an intensifying instrumentalization of LGBTQI issues by politicians and others against the community, there is a growing acceptance and support for the community in societies, notably in countries where governments are pursuing strongly anti-LGBTQI policies, such as Poland and Hungary, according to the group.

More needs to be done though, said Hugendubel.

“We are calling on all political leaders to step-up, speak out, and be proactive in fighting hate speech, rather than being reactive when faced with its consequences,” she said.

Note: *D.A.’s name has been withheld for reasons of personal safety.

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New Approach to Atrocities Needed, Say Ukraine War Crimes Investigators — Global Issues

War damage at a children’s facility in Ivanivka, Kherson. Investigators want changes in the way war crimes are investigated and prosecuted. Credit: Nychka Lishchynska
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Feb 10 (IPS) – As plans are announced to set up an international centre in The Hague to prosecute war crimes committed in Ukraine, groups involved in documenting them say there must be a fundamental change in how the world reacts to war atrocities.

Since Russia’s full-scale invasion of Ukraine almost one year ago, there have been allegations of tens of thousands of war crimes committed by invading forces.

But while there has been unprecedented support internationally for efforts to bring those behind these alleged crimes to justice, the scores of civil society organisations working to document them say this war, more than any other, has underlined the need to overhaul global bodies and individual states’ approach to war crimes.

“The entire world and all its nations realise that there needs to be a rapid global response to atrocities, that all nations have to establish ways of documenting war crimes and bringing them and those who committed them to light,” said Roman Avramenko, CEO of Ukrainian NGO Truth Hounds which is documenting war crimes in Ukraine.

“What we are now seeing is the result of inactivity. We have been talking about war crimes here for eight years, this started long ago. When there is no investigation of crimes, and no accountability for them, this leads to even greater atrocities and violence,” he told IPS.

Since the start of the full-scale invasion of Ukraine there has been a relentless stream of allegations of war crimes committed by Russian troops – earlier this month Ukrainian officials said more than 65,000 Russian war crimes had been registered since the beginning of the invasion.

Among the alleged crimes are rape, mass murder, torture, abduction, forced deportations, as well as indiscriminate attacks on civilians and civilian infrastructure, among others.

Ukrainian officials say 65,000 war crimes have been registered since the war began nearly a year ago on February 24, 2022. This picture shows some of the damage in the Novopetrivka, Kherson region. Credit: Nychka Lishchynska

Condemnation of these crimes has been widespread, as has the support for their investigation.

In March and April last year, more than 40 states referred Russia to the International Criminal Court (ICC), while a few months later, many of these declared their support for Ukraine in its proceedings against Russia at the International Court of Justice.

“There has been an absolutely unprecedented mobilisation among countries demanding justice for Ukraine,” Rachel Denber, Deputy Director of the Europe and Central Asia Division at Human Rights Watch, told IPS.

However, while this support has been welcomed in Ukraine, groups like Truth Hounds and others want to see it turned into effective prosecutions which will act as a deterrent to future aggression from Russia, or any other state.

“Russia was not punished for previous human rights violations and war crimes, and this has driven them to continue an aggressive foreign policy all over the world,” said Roman Nekoliak, International Relations Coordinator at the Nobel Peace Prize-winning Ukrainian NGO Centre for Civil Liberties (CCL).

“The UN and participating states must solve the problem of a ‘responsibility gap’ and provide a chance for justice for hundreds of thousands of victims of war crimes. Without this, sustainable peace in our region is impossible. An international tribunal must be set up and Putin, Lukashenko, and other war criminals brought to justice,” he told IPS.

International leaders and war crimes experts have highlighted the specific need to prosecute senior Russian officials for the crime of aggression. This crime is often referred to as the “mother of all crimes” because all other war crimes follow from it.

But it is difficult to bring the people behind such a crime to justice – the Rome Statute on which the ICC is established defines the crime as the “planning, preparation, initiation or execution” by a military or political leader of an act of aggression, such as an invasion of another country.

Ukrainian and European prosecutors are working together to investigate war crimes, but they cannot move against senior foreign figures, such as heads of government and state, because of international laws giving them immunity.

Meanwhile, the ICC cannot prosecute Russian leaders because neither Russia nor Ukraine has ratified the Rome Statute, and although a case could be brought if referred by the UN Security Council, as a permanent member of the UN Security Council with a veto over any such resolutions, Russia would simply block such a referral.

Indeed, in 2014, Russia and China vetoed a UN Security Council resolution that would have referred the situation in Syria – where Russian troops were later alleged to have committed war crimes – to the ICC.

“It would be wrong to say that the West did not react to , but what they are seeing now is that what happened there is happening again in Ukraine, and that it will continue elsewhere if Russian aggression is not stopped now, said Olga Ajvazovska of the Ukrainian civil society network Opora which is documenting war crimes.

“International societies also now understand that we need to develop stable international bodies which will have a way of stopping systematic Russian aggression,” she added.

Various solutions to the problem of bringing senior Russian figures to justice have been mooted.

Ukraine wants a special tribunal similar to courts established for war crimes in Rwanda and the former Yugoslavia set up, and in early February, Ukrainian prosecutors said they believed they were close to winning US support to establish a special tribunal to prosecute Russia’s crimes of aggression.

Separately, the European Commission announced this month that an international centre for the prosecution of the crime of aggression in Ukraine would be set up in The Hague.

But ICC officials are against the creation of a special tribunal, fearing it could fragment efforts to investigate war crimes in Ukraine, and have urged governments to support their continuing efforts.

In the meantime, the documenting and investigation of war crimes is continuing, and those involved are convinced that their work will help see justice served eventually.

They point out that they are working very closely with local and international prosecutors, as well as the ICC, and that experience gained in documenting war crimes in Ukraine prior to last year’s invasion – Truth Hounds was created just after Russia’s illegal annexation of Crimea in 2014 and the start of the conflict in the country’s Donbas region – and learning from investigations into war crimes in other countries, has proved invaluable in ensuring the effectiveness of their work.

“In the 2008 Georgia war, both sides reported violations of humanitarian law and war crimes. Nevertheless, research into them was conducted with limited support from international partners, and it was only in 2016 that the ICC got involved. Over eight years, significant information can get lost, and this is exactly why war crimes in Ukraine need to be documented constantly, as we, and several other organisations and international partners, are doing,” said Nekoliak.

So far, the ICC has issued only three arrest warrants charging men with war crimes related to the Georgia conflict.

The nature of the war itself is also helping them gather compelling evidence in a way that has perhaps not been possible in any conflict before.

“We are in a digital age and cyberspace is much more developed than 20 years ago. You can see in real-time, every day, the crimes being committed, the bombings, the people dying under the destroyed buildings, you can hear their screams.

“Today, it is much easier to find someone through technology, for instance, satellite pictures or other data can help identify which soldiers were at a certain location at a certain time when a war crime allegedly took place,” said Ajvazovska.

They believe these, along with a continued international focus on the conflict, and a strong desire among Ukrainians themselves to see accountability for the crimes committed against them, will help bring even those at the highest levels of Russian leadership to court at some point.

“The trials the former Yugoslavia wars, the 2012 war crime conviction of former Liberian President Charles Taylor, Félicien Kabuga last year being put on trial over the 1994 Rwandan genocide, show that no matter how much time has passed the inevitability of punishment remains,” said Nekoliak.

“And Russian war criminals will face the same fate.”

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Destruction of Ukraine’s Healthcare Facilities Violates International Humanitarian Law — Global Issues

On March 6, 2022, Izyum Central City Hospital (Kharkiv oblast) was attacked as a part of what appears to have been a large-scale carpet-bombing campaign. Reportedly, the hospital team had also marked the hospital with a big red cross that could be seen from the air. Credit: UHC
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Jan 27 (IPS) – While recent reports highlight the growing list of human rights abuses and war crimes committed by Russian troops in Ukraine, new research has laid bare the massive scale of arguably Russia’s most systematic and deadly campaign of rights violations in the country – the targeting and almost complete destruction of healthcare facilities.

According to a report released by the Ukrainian Healthcare Centre (UHC), 80% of healthcare infrastructure in one of Ukraine’s largest cities, Mariupol, was destroyed as Russian forces occupied the city.

It was left with practically no primary care, general hospitals, children’s hospitals, maternity hospitals, or psychiatric facilities, and large areas of the city were thought to have no medical care available at all.

On March 3, 2022, a Russian aircraft dropped unguided heavy bombs on the residential apartment buildings in the city center of Chernihiv; Chernihiv Regional Cardiac Center (Chernihiv oblast) was affected during the attack. At 12:16 pm, an aircraft dropped at least eight unguided bombs on Viacheslava Chornovola Street, according to verified dashcam footage. The bombing killed 47 civilians (38 men and nine women); another 18 people were injured. According to witnesses, the FAB-500 “dumb” bombs were used. No military targets in the area were confirmed by witnesses and international investigative organizations. Credit: UHC

Reports have been circulating for some time that a humanitarian catastrophe has already unfolded in the occupied city, and with the almost complete lack of healthcare provision, the threat of disease and sickness looms large among those still living there.

UHC says the destruction of Mariupol can only be compared with what happened to Grozny in Chechnya or Aleppo in Syria where Russia did its utmost to destroy each of these cities. And it claims that with its massive, indiscriminate shelling of civilian infrastructure, Russia “did not only violate certain regulations of international humanitarian law — waged the war as if this law did not exist”.

“This destruction of healthcare facilities is a very, very serious war crime. Russia did the same in Syria, but in Ukraine, what it has also done is that it has not distinguished between military and civilian infrastructure – the goal has been to just destroy everything, and in Mariupol, we saw this philosophy at its most concentrated,” Pavlo Kovtoniuk, UHC co-founder and former Deputy Minister of Health of Ukraine, told IPS.

The Russian siege and eventual occupation of Mariupol was one of the earliest and clearest examples of the destruction and brutality which have come to define the war in Ukraine.

Pictures and drone footage of the city at the time showed the consequences of massive, indiscriminate bombardment by Russian forces, and in the months since Mariupol fell, Ukrainian officials have reported on what they claim are the appalling conditions facing those still living – its population has dropped from 425,000 pre-invasion to an estimated around 100,000 today as people have fled or been killed – in the city.

It is difficult to verify any such reports as access to the city and information about life there is strictly controlled by occupying authorities.

The Adonis Medical Center in Makariv was totally destroyed. The facility was situated close to the city center, surrounded by residential buildings, shops, and the City Council of Makariv. The hospital was not far from the bridge over the Zdvyzh River (around 200 m north). The bridge had an essential role in supply and reinforcements connecting Makariv to the E40 highway leading directly to the western part of Kyiv. Source: Kyiv Regional Health Department for UHC

But there were confirmed reports as early as last summer of mass protests in the city over a lack of water, electricity and heat, and sources with some access to locals in Mariupol have told IPS that the reports of severe hardship are largely accurate and that war crimes and human rights abuses are regularly being committed against the population.

Kovtoniuk said even without any direct access to Mariupol, it was certain that the situation there was “dire” for many and would almost certainly be the same in other occupied areas.

“It is difficult to know too much about exactly what is happening in occupied areas, but we can see from the experience in areas which were once occupied and then retaken by Ukraine,” he explained.

Indeed, reports from liberated cities and testimony from people who managed to escape from occupied areas paint a picture not just of widespread war crimes and atrocities such as mass executions, rapes, torture, abductions, forced disappearances, imprisonment, and unlawful confiscation of property, but also of humanitarian catastrophes. People are without money, and jobs, unable to access any services, and are completely reliant on humanitarian aid.

Kovtoniuk highlighted that in Mariupol alone, the destruction has been so great – since the start of the invasion, four out of five general hospitals have been destroyed, but also five out of six maternity facilities, and there is no mental health care available – that there is no way comprehensive medical care can be continuing in the city.

“There may be some facilities still going, but there is no system, which is just as bad if not worse. What we also don’t know is the situation with drugs and their supply. What about people with chronic conditions who need them? Are there drugs for them, and if so, where are they coming from? Are some people simply not taking them anymore? This is course can be fatal for some people with certain conditions,” he said.

“Russian strategies have been to completely destroy healthcare, healthcare staff have been deported, civilians are being denied access to healthcare as facilities are being used solely to treat Russian soldiers, healthcare facilities are looted for equipment,” Kovtoniuk added.

Ukrainian Minister of Health Viktor Liashko said earlier this month that about one thousand Ukrainian medical facilities had been damaged or destroyed, while as of January 23, the World Health Organisation (WHO) has documented 747 attacks on healthcare facilities in Ukraine since the start of the invasion. Its officials have said these attacks are a breach of international humanitarian law and the rules of war.

Other groups, like UHC, are documenting and collecting evidence of alleged car crimes during the invasion and have said the attacks on healthcare are part of a wider, even more, destructive Russian military strategy in Ukraine.

“Attacks on medical facilities are considered particularly condemnable under international law. They have serious negative consequences for the safety and health of Ukrainians. Since Russia is using war crimes as a method of warfare, we can talk deliberate actions to create a humanitarian catastrophe in Ukraine and a desire to make it uninhabitable,” Svyatoslav Ruban of the Centre for Civil Liberties human rights organisation in Kyiv told IPS.

Regional Children’s Hospital On March 17, 2022, Russian forces shelled the area in the city center of Chernihiv, where the hospital is located. Cluster munitions were used, launched presumably from the Uragan MLRS. Fourteen civilians were killed and another 21 injured as a result of the attack. Credit: UHC

Other rights groups have also condemned the targeting of healthcare facilities and workers. In its latest global report, Human Rights Watch (HRW) castigated Russian forces for a “litany of violations of international humanitarian law” in Ukraine, and Rachel Denber, Deputy Director of the Europe and Central Asia Division at HRW, told IPS: “Attacks on critical infrastructure which are carried out with the seeming intent to instil terror in the population and deliberately deprive people of essential services could be potential war crimes and illegal. These attacks in Ukraine are unlawful.”

“It is obvious that the authors of these attacks are fully aware of the harm they will cause, and the aim is to make living cumulatively untenable. These attacks on infrastructure impact millions of people, having an effect on hospital operation, water supplies, heating etc,” she added.

She also warned that the apparent Russian strategy of deliberately targeting Ukrainian civilian infrastructure was chillingly reminiscent of what its forces had done in Idlib in Syria in 2019-2020 – hospitals, schools and markets were repeatedly targeted during an 11-month Syrian-Russian offensive which ultimately left 1,600 people dead and another 1.4 million displaced.

HRW’s own report on the Idlib offensive documented scores of unlawful attacks in violation of international humanitarian law, or the laws of war. Meanwhile, UN investigators claimed Russian forces had been responsible for multiple war crimes.

“It would not surprise me if it turned out that the Russians are doing the same in Ukraine as they did in Idlib,” said Denber.

While Russian attacks on civilian infrastructure, including medical facilities, continue, the situation will not improve, said Kovtoniuk.

He pointed to Russian forces’ ongoing deliberate destruction of power, heating, and water plants, and potential subsequent health risks – damage to water and sewage systems led to a serious risk of a cholera epidemic in Mariupol last summer – as well as the effects of such attacks on the ability of medical facilities to continue functioning.

He said people outside Ukraine, including leaders in countries already supporting Ukraine, must not allow the current situation to be accepted as a new normal, nor let the conflict drag on.

“We have learnt to survive and adapt, but it is important that this situation is not normalised – that is the Russian aim, to normalise it like what happened in Syria. People have to understand that the pattern of Russian strategy is to not make a distinction between waging war on civilians and on the military. It is also critical to end this war as soon as possible. Its protraction is bad for Ukraine and bad for Europe,” he said.

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European Energy Crisis Hits Roma Populations Hard — Global Issues

Roma community protest in the Serbian city of Nis after dozens of families in a settlement in the city had their electricity cut off. Credit: Opre Roma Srbija
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Jan 05 (IPS) – As European households brace for energy shortages this winter and leaders draw up support packages to help people heat homes in the coming months, experts fear that the largest minority on the continent, the Roma, will be left behind.

Many of the 12 million Roma in Europe have a low standard of living, and even before the energy crisis, energy poverty was rife among their communities.

Roma leaders and rights organisations say the current crisis has only deepened the problem and are calling for governments to ensure that one of the continent’s most vulnerable groups gets the help they need this winter and beyond.

“EU leaders and policymakers must ensure that energy policies already agreed, or any agreed in future, must be tailored and implemented in such a way that the most vulnerable, including the Roma, can access and benefit from them,” Zeljko Jovanovic, director of the Open Society Roma Initiatives Office at the Open Society Foundations (OSF), told IPS.

Roma living in Europe are among the most discriminated and disadvantaged groups on the continent. In many countries, significant numbers live in segregated settlements where living conditions are often poor, and extreme poverty is widespread.

Energy poverty is also common. It is estimated that at least 10% of the roughly 6 million Roma living in EU countries have no access to electricity at all.

Roma protest after electricity supplies to 24 families in the ‘12 February’ Roma settlement in the southern Serbian city of Nis was cut off over unpaid bills. There are calls for European countries to take into consideration the plight of the Roma during the energy crisis. Credit: Opre Roma Srbija

Meanwhile, where utilities are available, many struggle to afford them.

Rising energy prices this year have exacerbated the problem. But while governments have rolled out help in the form of one-off payments and other support for families and businesses to pay energy bills, this aid is often not filtering through to Roma despite the minority being among those most in need, say rights activists.

Unemployment in Roma communities is often high, with only one in four Roma aged 16 years or older reporting being employed, and many earn money working in the grey or black economies. But because of this, they often struggle with accessing state support schemes. This is especially true for measures approved to provide financial aid during the energy crisis.

“Even before the energy crisis, there was a problem with energy poverty in Europe, and for the Roma, this was even more so because so many were not in the formal system.

“Measures for the energy crisis are made for those in the formal system. Many Roma are not in that system – they are unemployed, or not formally registered, or earning money and paying into the social welfare system – so they cannot access those measures,” explained Jovanovic.

Roma NGOs working in some countries say they have already seen these problems.

In Romania, which has a Roma population of 1.85 million according to the Council of Europe, a programme to help the vulnerable with energy payments has been launched.

But Alin Banu, Community Organiser at the Aresel civic initiative, told IPS some Roma are unable to access it precisely because “they work in the grey or black economy and don’t have the right documentation of social insurance payments, wages etc.”.

Meanwhile, even those who are eligible for help are often being denied it, he claimed. He said that some municipalities had put conditions on receiving help to pay energy bills – for example, evidence of historical tax debt, or car ownership, makes an individual ineligible for the help.

The group says this is illegal.

“We have solved this problem in some cases, but most Roma will not complain about this because often they simply will not know it is illegal,” Balu said.

There are also concerns that other measures already adopted will actually make things worse for Roma.

Last year European leaders agreed on a non-binding goal for EU countries to reduce overall electricity demand by at least 10% by 31 March 2023, and a mandatory reduction of electricity consumption by 5% for at least 10% of high-demand hours each week.

Jovanovic fears that politicians’ first steps to save on energy consumption could involve simply cutting off power supplies to those not formally connected to the energy grid.

“Countries’ reductions in energy demand might come from cutting energy to those who do not have formal access to it, like the Roma,” said Jovanovic.

Nicu Dumitru, a Community Organiser at Arsesel, agreed – “the Roma would be the first to be cut off in that case,” he told IPS – but said that even if that does not happen, many Roma are already struggling with soaring energy costs.

Information collected by his group suggests that a fifth of all Roma households have had their electricity cut off since the start of the crisis because they cannot afford to pay. They are then connecting informally to the grid – usually through one person in their community who has a connection and who then charges high prices for others for use of that power – often borrowing money to do so, and worsening their already precarious financial situation.

There are an estimated over 400,000 people informally connected to the power grid in Romania, many of them Roma.

“The situation is getting critical for Roma,” Dumitru said.

Meanwhile, Roma activists in other countries are worried that politicians will use the energy crisis as an excuse to ignore long-term problems with energy poverty among the Roma or even as a justification to allow Roma settlements to be cut off from supplies.

In May this year, electricity supplies to 24 families in the ’12 February’ Roma settlement in the southern Serbian city of Nis were cut off over unpaid bills. The families claim this debt pre-dates their time living there, but the local power distributor demanded proof of house ownership from the families before reconnection.

People in many Roma settlements often lack such documents as the process for obtaining them is costly and difficult for many to navigate without expert legal help, and none of these families was able to provide the required proof.

It was only after both local and nationwide protests by members of the community themselves and negotiations between the families, who were represented by the Opre Roma Serbia rights group, local authorities, and the local distributor Elektrodistribucija Nis, that in December, limited supplies of electricity were restored to the families involved.

Jelena Reljic of Opre Roma Serbia said she was pleased those affected could now access electricity again but warned “the situation in this settlement is an example of a much wider systemic problem” which politicians are not doing enough to solve.

“The last cut off in this settlement was because of historic debt, but the problems with electricity have been going on for a decade. Politicians are relying on being able to cut Roma settlements off from electricity during the energy crisis without too much public outrage or resistance. Around 99% of the reaction we have seen to the problem in this settlement has been of the type ‘oh, no one should be getting energy free during this crisis, we pay, so why shouldn’t they?’” she told IPS.

“Politicians are using the energy crisis to cover up the fact that they have never dealt with the problem of energy poverty for years and years,” she added.

The OSF’s Jovanovic wants European policymakers to review their proposed help during the crisis, including not just the approved reductions in energy demand but plans for energy price caps and a solidarity levy on the profits of businesses active in the oil, natural gas, coal, and refinery sectors.

He said the 5% reduction must not lead to electricity cuts for those already in energy poverty and that public revenues from the energy cap and solidarity levy – estimated at €140bn within the EU – should be redistributed along principles that are both morally and macroeconomically justified.

He has been involved in high-level EU committee meetings on energy crisis support policies, but, he told IPS, at those meetings, there seemed to be “little idea of the perspective of Roma and other vulnerable groups and how they would cope in the crisis”.

Now he and other activists are trying to arrange further talks with EU and national policymakers to urge them to address shortcomings in current policies affecting vulnerable groups, including Roma.

“We want to raise these issues,” he said.

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Russia’s LGBTQI ‘Propaganda’ Law Imperils HIV Prevention — Global Issues

Russia’s new law banning any promotion of what is seen as “non-traditional sexual relations” could stigmatise the LGBTQI community and put HIV/AIDS prevention at risk.
  • by Ed Holt (bratislava)
  • Inter Press Service

BRATISLAVA, Dec 16 (IPS) – A new law banning LGBTQI ‘propaganda’ in Russia will further stigmatise LGBTQI people in the country and could worsen what is already one of the world’s worst HIV/AIDS epidemics, critics have warned.

The legislation, approved by President Vladimir Putin at the start of this month, bans any promotion of what authorities see as “non-traditional sexual relations”.

Groups working with Russia’s LGBTQI community say the new law – an extension of 2013 legislation banning the positive portrayal of same-sex relationships to minors – will effectively make outreach work illegal, potentially severely impacting HIV prevention and treatment among what is a key population for the disease.

It also comes amid intensifying anti-LGBTQI political rhetoric and a Kremlin crackdown on the minority and civic organisations helping it.

“Since 2014, Russia has been purposefully driving HIV service organizations underground. The new law is another nail in the coffin of effective HIV prevention among vulnerable populations,” Evgeny Pisemsky, an LGBTQI activist from Orel in Russia, who runs the Russian LGBTQI information and news website parniplus.com, told IPS.

Russia has one of the worst HIV epidemics in the world. For much of the last decade the country has seen some of the highest rates of new infection recorded anywhere – between 80,000 and 100,000 per year between 2013 and 2019, although this has fallen to 60,000 in the last two years.

Officials figures for the total number of people infected range from between 850,000 cited by the Health Ministry and 1.3 million according to data from the Russian Federal AIDS Centre. The real figure though is believed to be much higher as the Russian Federal AIDS Centre estimates half of people with HIV are unaware of their infection.

Experts on the disease have repeatedly criticised Russian authorities’ approach to HIV prevention and treatment, especially the criminalisation and stigmatisation of key populations, including LGBTQI people.

Indeed, the new legislation is an extension of a controversial 2013 law banning the promotion of LGBTQI relationships to minors. This was denounced by human rights groups as discriminatory, but also criticised by infectious disease experts who suggested it further stigmatised gay men and men who have sex with men (MSM), affecting their access to HIV prevention and treatment.

Organisations working with the LGBTQI community in Russia worry the new legislation could make the situation even worse.

Gennady Roshchupkin, Community Systems Advisor at the Eurasian Coalition on Health, Rights, Gender and Sexual Diversity NGO, told IPS: “Practice in many countries has proved that increased stigma of marginalized populations leads to increased discrimination towards these groups, and, subsequently, these people increasingly frequently refuse to come forward for testing and help.

“Formally, the new anti-LGBTQI law puts no limits on providing LGBTQI people with medical help and examinations. But, of course, the ban on sharing information with anyone about the specific characteristics of their sexual life may significantly decrease the quality and timeliness of testing and care.”

Meanwhile, Pisemsky said outreach work was likely to stop in its current form as provision of some services will now be too risky.

“All outreach work will go deep underground. Even online counselling will be dangerous,” he said.

The law could also impact LGBTQI mental health – research showed LGBTQI youth mental health was negatively affected after implementation of the 2013 legislation – which could, in turn, promote risky sexual behaviours.

“We cannot know what exactly will happen. Use of alcohol and practice of chemsex may increase, and there could be a rise in cases of long-term depression and suicides. But what we can say with certainty is that there will be a dramatic decrease in the use of condoms and pre-exposure prophylaxis (PrEP) – unprotected sex with an unknown partner is also an indicator of mental and cognitive conditions in the age of HIV – sexual health literacy, and self-esteem among LGBTQI people,” said Roshchupkin.

Meanwhile, international organisations heading the fight against HIV/AIDS have attacked the law, warning of its potentially serious impact on public health.

“Punitive and restrictive laws increase the risk of acquiring HIV and decrease access to services… Such laws make it harder for people to protect their health and that of their communities,” UNAIDS Executive Director Winnie Byanyima said in a statement.

But such warnings are almost certain to fall on deaf ears, at least among Russian lawmakers.

Although homosexuality was decriminalised in the early 1990s after the fall of communism, LGBTQI people face widespread prejudice and discrimination in Russia. The country placed 46 out of 49 European countries in the latest rankings of LGBTQI inclusion by the rights group ILGA-Europe.

These attitudes are fuelled by what many LGBTQI activists say is a systematic state policy to stigmatise and persecute the minority.

Since the 2013 law was implemented, authorities have cracked down on NGOs campaigning for LGBTQI rights, using various legislation to force them to close. At the same time, politicians have intensified anti-LGBTQI rhetoric, and regularly attack the community.

Indeed, the new legislation was overwhelmingly supported in parliament, with senior political figures rushing to defend it as a necessary measure against Western threats to traditional Russian values.

Chairman of Russia’s federal parliament, Vyacheslav Volodin, said about the law: “We must do everything to protect our children and those who want to live a normal life. Everything else is sin, sodomy, darkness, and our country is fighting this.”

International rights groups say it is clear the law has been brought in for a specific discriminatory purpose.

“There is no other way of seeing it than as an extreme and systematic effort to stigmatise, isolate, and marginalise the entire Russian LGBTQI community. It is an abhorrent example of homophobia and should be repealed,” Rachel Denber, Deputy Director of the Europe and Central Asia Division at Human Rights Watch, told IPS.

“This law has a characteristic similarity to other repressive laws adopted in Russia in recent years – the opportunity for its arbitrary interpretation. In an environment that is as repressive as Russia’s is right now, rather than deciding to take the risk of falling foul of the law and speaking openly about relationships or sexuality, people will just remain silent.

“This law emerged in a climate of cumulative repression of human rights and repressive laws across the board, which seek to silence dissent, and, through the force of law, enforce conformism,” she added.

Pisemsky agreed: “Laws like this one are designed to scare people. Fear needs to be constantly fed with something, otherwise it stops working. This law is not the last step in the escalation of homophobia in Russia.”

The effects of the ban, which essentially makes any positive depictions of the LGBTQI community in literature, film, television, online, and other media illegal with stiff fines (up to 80,000 US Dollars for organisations) for breaches, have been immediately visible.

Pisemsky described how HIV service organizations had altered their websites and social media pages to comply with the law, while Roshchupkin said LGBTQI community health centres were removing from their premises homoerotic posters and brochures with explicit depictions of same-sex sexual acts.

Meanwhile, Russia’s first queer museum, in St Petersburg, had to close its doors just weeks after opening to comply with the law, bookshops have cleared their shelves of works dealing with LGBTQI themes and libraries have taken to displaying similar works with blank covers.

It is unclear what other effects the law will have, but some LGBTQI organisations which spoke to IPS said people had been in touch with them asking for advice on emigrating.

Nikita Iarkov, a volunteer with the Andrey Rylkov Foundation, an NGO which helps people with HIV in Russia, said that though he did not think there was yet widespread fear among LGBTQI people in Russia, he is realistic about what the future holds for many of them.

“Unfortunately, this is not the first law discriminating . This kind of ban is sort of a regular practice now,” he told IPS.

“I hope that clubs in Moscow and St Petersburg will remain safe spaces for queer people, but I think that it will be impossible to have openly queer parties and clubs.”

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