Introduction:

In the ebb and flow of Middle East diplomacy, the two interrelated issues of an Israeli-Syrian peace settlement and Washington’s bilateral relationship with Damascus have gone up and down on Washington’s scale of importance. The election of Barack Obama raised expectations that the United States would give the two issues the priority they had not received during the eight years of the George W. Bush administration. Candidate Obama promised to assign a high priority to the resuscitation of the Arab-Israeli peace process, and separately to “engage” with Iran and Syria (as recommended by the Iraq Study Group in 2006).

In May 2009, shortly after assuming office, President Obama sent the assistant secretary of state for Near Eastern affairs, Jeffrey Feltman, and the senior director for the Middle East in the National Security Council, Daniel Shapiro, to Damascus to open a dialogue with Bashar al-Asad’s regime. Several members of Congress also travelled to Syria early in Obama’s first year, including the chairman of the Senate Committee on Foreign Relations, John Kerry, and the chairman of the House Committee on Foreign Affairs, Howard Berman. In addition, when the president appointed George Mitchell as special envoy to the Middle East, Mitchell named as his deputy Fred Hof, a respected expert on Syria and the Israeli-Syrian dispute. Last summer, both Mitchell and Hof visited Damascus and began their give and take with Syria.

And yet, after this apparent auspicious beginning, neither the bilateral relationship between the United States and Syria, nor the effort to revive the Israeli-Syrian negotiation has gained much traction. Damascus must be chagrined by the fact that when the Arab-Israeli peace process is discussed now, it is practically equated with the Israeli-Palestinian track. This paper analyzes the difficulties confronting Washington’s and Jerusalem’s respective Syria policies and offers an approach for dealing with Syria. Many of the recommendations stem from lessons resulting from the past rounds of negotiations, so it is important to understand what occurred.

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Syria is trapped on a crumbling precipice, and however it might fall will entail significant risks for the United States and for the Syrian people.

The brutal regime of Bashar al-Asad is employing its loyal military forces and sectarian thugs to crush the opposition and reassert its tyranny. Even if Bashar fails, Syria may not be out of the woods: an increasingly likely alternative to the current regime is a bloody civil war similar to what we saw in Lebanon, Bosnia, Congo, and most recently in Iraq. The horrors of such a war might even exceed the brutal reassertion of Asad’s control, and would cause spillover into Syria’s neighbors—Turkey, Iraq, Jordan, Lebanon, and Israel—that could be disastrous for them and for American interests in the Middle East.

But the unrest in Syria, which is now entering its second year, also offers some important opportunities, ones that would come from the fall of the regime of Bashar al-Asad, whose family has ruled the country with an iron grip for over forty years. Syria is Iran’s oldest and most important ally in the Arab world, and the Iranian regime has doubled down on Asad, providing him with financial aid and military support to shore up his regime. Asad’s departure would deal a significant blow to Tehran, further isolating it at a time when it has few friends in the region or the world. In addition, Damascus is steadfast in its hostility toward Israel, and Asad’s regime is also a longtime supporter of terrorist groups like Hizballah and Hamas, and has at times aided al-Qa’ida terrorists and former regime elements in Iraq. The regime’s collapse, therefore, could have significant benefits for the United States and its allies in the region.

Actually ousting Asad, however, will not be easy. Although the Obama administration has for months called for Asad to go, every policy option to remove him is flawed, and some could even make the situation worse—seemingly a recipe for inaction. Doing nothing, however, means standing by while Asad murders his own people, and Syria plunges into civil war and risks becoming a failed state. Already the violence is staggering: as of March 2012, at least 8,000 Syrians have died and thousands more have been arrested and tortured in trying to topple the regime. At the same time, Syria is fragmenting. The Syrian opposition remains divided, and the Free Syrian Army is more a brand than a meaningful, unified force. Al- Qa’ida is urging fighters to join the fray in Syria, and sectarian killings and atrocities are growing. Should the violence continue to intensify, Syria’s neighbors may increase their meddling, and instability could spread, further weakening already-fragile neighbors like Iraq and Lebanon.

So to protect U.S. interests, Asad cannot triumph. But a failed Syria, one wracked by civil war, would be just as bad. Thus, U.S. policy must walk this tightrope, trying to remove Asad, but doing so in a way that keeps Syria an intact state capable of policing its borders and ensuring order at home. At the end of the day, however, removing Asad may not be doable at a price the United States is willing to pay. If so, the U.S. government may be forced to choose between living with a brutal but weakened Asad or getting rid of Asad regardless of the consequences.

This memo lays out six options for the United States to consider to achieve Asad’s overthrow, should it choose to do so:

1. Removing the regime via diplomacy;
2. Coercing the regime via sanctions and diplomatic isolation;
3. Arming the Syrian opposition to overthrow the regime;
4. Engaging in a Libya-like air campaign to help an opposition army gain victory;
5. Invading Syria with U.S.-led forces and toppling the regime directly; and
6. Participating in a multilateral, NATO-led effort to oust Asad and rebuild Syria.

The options are complex, and policymakers will probably try to combine several in an attempt to accentuate the positives and minimize the negatives, which will inevitably be difficult and bring out new complications. But by focusing on discrete approaches, this memo helps expose their relative strengths and weaknesses. For each course of action, this memo describes the strategy inherent to the option and what it would entail in practice. It also assesses the option’s advantages and disadvantages.

This memo does not endorse any particular policy option. Rather, it seeks to explain the risks and benefits of possible courses of action at this moment in time. As conditions change, some options may become more practical or desirable and others less so. The authors mostly agree on the advantages and disadvantages of each approach but weigh the relative rewards and costs differently.

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The Saban Center for Middle East Policy joined with the American Enterprise Institute and the Institute for the Study of War in June 2012 to host a one-day crisis simulation that explored the implications of spillover from the ongoing violence in Syria. The simulation examined how the United States and its allies might address worsening instability in Lebanon, Iraq, Jordan, Turkey, and elsewhere in the Middle East as a result of the internecine conflict in Syria.

The Saban Center’s Middle East Memo, “Unraveling the Syria Mess: A Crisis Simulation of Spillover from the Syrian Civil War,” authored by simulation conveners Kenneth M. Pollack, Frederick W. Kagan, Kimberly Kagan, and Marisa C. Sullivan, presents key lessons and observations from the exercise.

Among the key findings:

• A humanitarian crisis alone is unlikely to spur the international community to take action in Syria.
   
• Turkey is a linchpin in any effort to end the fighting in Syria, but Washington and Ankara may not see eye-to-eye on what the end game should be.
   
• U.S. history in Iraq and Lebanon make intervention there unlikely, even if spillover causes a renewal of large-scale violence.

The simulation suggested a tension between U.S. political antipathy toward greater involvement in Syria and the potential strategic desirability of early action.

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The crisis in Syria continues with no end in sight, and in the Saban Center's latest Middle East Memo, Breaking the Stalemate: The Military Dynamics of the Syrian Civil War and Options for Limited U.S. Intervention, Saban Center Senior Fellow Kenneth Pollack argues that until there is a breakthrough on the battlefield, there will be no breakthroughs at the negotiating table.

In his paper, Pollack lays out the military advantages and disadvantages of both the opposition and the regime's forces, and looks at how different opportunities for U.S. intervention can affect those critical dynamics. This analysis provides a much-needed counterpoint to the debate over the possible cost of U.S. options in Syria with an analysis of their likely impact on the conflict.

Highlights include:

• The strengths and weaknesses of the opposition, including: greater numbers, a history of deprivation of political power, the aid of Islamist militias affiliated with the Muslim Brotherhood and Salafist groups, and support from Arab and Western countries.
   
• The strengths and weaknesses of the regime, including: motivation to defend against a determined majority, a geographic advantage, the remnants of the Syrian armed forces, help of foreign contingents like Hizballah, and the support of foreign countries like Iran and reportedly Russia and China.
   
• Options for U.S. interventions to break the stalemate, including:

  • Training and equipping the opposition.
  • Stopping the resupply of the regime in order to diminish its ability to generate firepower.
  • Attacking regime infrastructure targets, such as military bases, power-generation plants and transportation choke points like bridges.
  • Establishing and maintaining a no-fly zone.
  • Engaging in a tactical air campaign against regime ground forces.

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Last September, as part of its annual conference with the United States Central Command, the Saban Center for Middle East Policy at the Brookings Institution conducted a day-long simulation of a confrontation between the United States and Iran arising from a hypothetical scenario in which the Syrian opposition had made significant gains in its civil war and was on the verge of crushing the Assad regime.  

The simulation suggested that, even in the wake of President Rouhani’s ascension to power and the changed atmosphere between Tehran and Washington, there is still a risk of misunderstanding and miscalculation between the two sides.

This new Middle East Memo examines the possible U.S. foreign policy lessons that emerged from this crisis simulation, and stresses the importance of communication, understanding the Saudi-Iran conflict and the difficulty in limited interventions. 

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• Hard Road to Damascus: A Crisis Simulation of U.S.-Iranian Confrontation over Syria

       

       

       

INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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The Roma people, the largest minority group in Europe and in many European countries, trail other ethnic groups in almost every characteristic that defines well-being. Perhaps of greatest importance, the Roma are less educated than other ethnic groups. But they also suffer from excess health problems, high unemployment, poverty, and political weakness. The Roma population of Bulgaria is certainly no less disadvantaged than the Roma in other countries. An especially poignant example of Bulgarian Roma disadvantage is that the death rate among children under age 1, a prime indicator of children’s health in any nation, is 25 per 1,000 for Roma children as compared with 9.9 for children of Bulgarian ethnic origin. The mathematics of death almost before life gets started is a symbolic indicator of the Roma burden in Bulgaria. Similarly, research conducted for UNICEF by the University of York shows that the poverty rate among Roma children in Bulgaria is 92 percent, perhaps the highest poverty rate for any ethnic group in Europe. By contrast, the poverty rate among children of Bulgarian heritage is less than half as high at 43 percent.

It is not surprising, then, that over at least the past decade, the European Union (EU) and most European governments, joined by the Open Society Foundation, the World Bank, and other organizations, have created important initiatives to address all these problems. It is possible to think that now is an historic moment in which European governments and dominant ethnic groups, after eight or nine centuries of the most pernicious types of discrimination against the Roma, are finally, albeit often reluctantly, admitting the problems facing their Roma populations and their own role in creating and sustaining these problems. Equally important, most of the Central and Eastern European (CEE) governments, where discrimination against the Roma has been and continues to be particularly intense, are gradually adopting policies to address the problems.

To the extent that the moment of Roma opportunity has arrived, perhaps the most important force moving Bulgaria and other CEE nations in the direction of integration and inclusion is the EU. In the period leading up to the ascension of Bulgaria and other CEE nations to membership in the EU, all the new member states were required to meet a host of conditions required by the EU as the price of admission. Among these conditions were laws outlawing discrimination and requiring equality of educational opportunity. The CEE nations complied with the EU directive to pass such laws, but implementation of the laws in Bulgaria and other nations has been something less than aggressive.

Nor is EU ascension the only force driving the CEE nations to reduce discrimination against the Roma and other minorities. The Open Society, the World Bank, and a number of other private organizations, including several Roma nongovernmental organizations (NGOs), have initiated a sweeping program to promote inclusion of the Roma in the civil society of the CEE nations. Called the “Decade of Roma Inclusion” (2005-2015) the initiative is notable for getting all the CEE nations (plus Spain) to participate, to commit themselves to activities designed to promote inclusion and nondiscrimination, and to make a financial commitment to a fund administered by the World Bank to promote the initiative. As a part of the initiative, Bulgaria and the other participating nations originated ten-year action plans. The Bulgarian action plan, the purpose of which is to create a set of goals and activities that will promote Roma integration, includes proposals for education, health care, housing, employment, discrimination and equal opportunity, and culture.

An important part of the Decade program was the establishment of the Roma Education Fund in 2005. Eight nations (Canada, Greece, Ireland, Netherlands, Slovenia, Sweden, Switzerland, and the UK), as well as several international agencies including the Open Society, pledged a total of 34 million Euros to support Fund activities during the Roma decade. The major goal of the fund is to “support policies and programs which ensure quality education for Roma, including the desegregation of education systems.”

By joining the EU, Bulgaria and the other CEE nations brought themselves into a well-developed culture of inclusion and a complex system of interlocking laws and agencies that not only outlaw exclusion and discrimination, but provide funds to implement inclusion policies and to monitor the extent to which EU nations are aggressively implementing these laws. The laws and directives include the EU Charter of Fundamental Rights, the European Commission against Racism and Intolerance, the Racial Equality Directive, and several others. It would be a mistake to conclude that every EU member, even the original 15 EU nations with relatively more advanced economies and longer histories as democracies than the CEE nations, faithfully implement every component of the various legal requirements of being an EU member. Even so, EU requirements and funds have initiated both profound legal changes and a host of programs to increase the social, economic, political, and cultural inclusion of the Roma as well as studies and evaluations that bring some light to the actual situation of the Roma and other minorities in member nations. Given the all but inevitable distance between the laws on inclusion and discrimination the CEE nations passed in order to join the EU and the actual implementation of those laws, studies commissioned by various EU agencies and NGOs illuminate the gaps between policies and implementation.

An excellent example of such illumination is a 2006 study commissioned by the Economic and Scientific Policy program of the European Parliament. The report is a hard-hitting assessment of the status of Roma throughout Europe with regard to their legal status and socio-economic conditions. The latter category includes assessments of Roma exclusion from employment, education, social services, health care, and community integration. The upshot of the report is that although there may be some progress in these important areas of integration, the Roma are still a second-class group throughout the CEE nations. Seemingly, good laws have not yet produced good results. Laws may be changed, but changing human behavior and culture takes longer.

CEE governments and their defenders are reluctant to admit the lamentable lack of progress in Roma integration. In part for this reason, the European Commission, based on extensive evidence from evaluations, surveys, and news reports of often ferocious discrimination against the Roma, felt the need to publish “An EU Framework for National Roma Integration Strategies up to 2020” in April 2011. The need for a new framework is a clear signal that the EU Commission believes the CEE governments in general and Bulgaria in particular are not achieving the results the EU hoped for when it approved these nations for EU membership and is therefore trying to push the governments of these nations into further action.

Following publication of the Framework, the Open Society released one of the most thorough and provocative reports on the situation faced by the Roma in Europe and strategies that should be adopted to attack the wide range of Roma disadvantages. Appropriately entitled “Beyond Rhetoric,” the Open Society report includes entire chapters on two issues that I will examine in more detail below.

First, the Open Society strongly recommends that nations collect ethnically disaggregated data. Logically enough, the report holds that it is impossible to document the effects of policy initiatives on the Roma and other groups unless outcome data, including measures of health, education, housing, employment, income, and death rates by age, are collected for individual ethnic groups. So important are ethnically disaggregated data that the report goes so far as to recommend that, if necessary, governments should change their statistical systems to “incorporate ethnic data components into regular statistical surveys.” A second recommendation that deserves special attention is the report’s emphasis on early childhood education and care. Virtually every report about the Roma emphasizes the vital importance of education in fighting Roma exclusion, but the Open Society report strongly recommends that nations implementing the EU Framework should “give urgent consideration” to establishing an early child development fund to “support innovative early development programs and allow for scale up of what works.”

Beyond these specific recommendations, the Open Society report emphasizes that the EU Commission stated explicitly in its Framework document that “member states do not properly use EU money for the purpose of effective social and economic integration of Roma. As if this judgment, which seems to represent the views of many EU agencies, the World Bank, the Open Society, and many Roma groups themselves, needed additional reinforcement, a United Nations expert on minority issues visited Bulgaria this summer and called upon the government to “turn its policies on Roma integration into concrete action.” She went on to give what seems to represent the views of all these groups on the flaws in the Bulgarian government’s approach to fighting Roma exclusion: “Many policies seem to remain largely only rhetorical undertakings aimed at external audiences – official commitments that are not fulfilled in practice.” The result, according to the UN expert, is that “all the evidence demonstrates that Roma remain in desperate circumstances at the very bottom of the socio-economic ladder.” In particular, she mentioned that the access of Roma children to quality education “remains overwhelmingly unfulfilled.”

If CEE nations are now entering a period in which governments will be working, often ineffectively or at a very modest pace, to improve the conditions of the Roma, judging by the efforts of other nations to reduce discrimination against minority groups and by the stately rate of progress so far in the CEE nations, it can be assumed that the fight for Roma equality in Bulgaria will be measured in decades. In the U.S., for example, the Civil Rights movement of the 1950s and 1960s was largely successful. By the mid-1960s, vital court decisions had dismantled major parts of the system of legal discrimination against blacks and the federal government had enacted programs to ensure voting rights and other fundamental rights to blacks. To enhance the legal war on poverty and discrimination, the federal government also initiated an army of social programs designed to boost the education, health, employment, housing, and political participation of the poor in general and blacks in particular. Yet today, nearly half a century after achieving legal rights and the initiation of large-scale government inclusion programs, blacks (and Hispanics) still trail whites by large margins in education, income, housing, poverty levels, and health. Although achieving significant progress against discrimination may require decades or generations, discrimination will not diminish until strong legal, economic, and social forces are mobilized against it. Expecting a long struggle cannot be a reason not to begin.

If the history of making substantial progress in overcoming ethnic discrimination in the U.S. can serve as a rough comparison to the situation of the Roma in CEE nations, several factors are going to be vital in the fight of the Roma to overcome discrimination and exclusion in Bulgaria and throughout Europe. These factors include an antidiscrimination plan, aggressive implementation of the plan by all levels of government, leadership by the Roma themselves, educational progress by Roma children and young adults, political activism by the Roma people, a media committed to accurate reporting and fairness, and a civil society that reflects underlying public opinion favoring integration and opposed to discrimination. Most of these factors appear to be present in Bulgaria, often in rudimentary and brittle form, but present and in many cases moving in the right direction nonetheless. The progress that is just now beginning can be greatly enhanced by the efforts of groups that have the resources, the will, and the vision to roll up their sleeves and help promote Roma inclusion.

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With over 16 million people and nearly 8.6 million jobs, America's older industrial cities remain a vital-if undervalued-part of the economy, particularly in states where they are heavily concentrated, such as Ohio and Pennsylvania. They also have a range of other physical, economic, and cultural assets that, if fully leveraged, can serve as a platform for their renewal.

Read the Executive Summary  »

Across the country, cities today are becoming more attractive to certain segments of society. Meanwhile, economic trends-globalization, the demand for educated workers, the increasing role of universities-are providing cities with an unprecedented chance to capitalize upon their economic advantages and regain their competitive edge.

Many cities have exploited these assets to their advantage; the moment is ripe for older industrial cities to follow suit. But to do so, these cities need thoughtful and broad-based approaches to foster prosperity.

"Restoring Prosperity" aims to mobilize governors and legislative leaders, as well as local constituencies, behind an asset-oriented agenda for reinvigorating the market in the nation's older industrial cities. The report begins with identifications and descriptions of these cities-and the economic, demographic, and policy "drivers" behind their current condition-then makes a case for why the moment is ripe for advancing urban reform, and offers a five-part agenda and organizing plan to achieve it.

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Michigan State Profile
Michigan State Presentation 

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Ohio State Profile
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In this interview, Vanda Felbab-Brown addresses issues of terrorism, organized crime, and state responses within the context of Boko Haram’s terrorism, insurgency, and militancy in the Niger Delta. She was interviewed by Jide Akintunde, Managing Editor of Financial Nigeria magazine.

Q: The Boko Haram menace has been with Nigeria for seven years. Why is it that the group does not appear to have run out of resources?

A: Boko Haram has been able to sufficiently plunder resources in the north to keep going. It has accumulated weapons and ammunition from seized stocks. It also taxes smuggling in the north. But its resources are not unlimited. And unlike other militant and terrorist groups, such as ISIS or the Taliban, Boko Haram faces far more acute resource constraints.

Q: Boko Haram is both an insurgent and a terrorist group. Does this explain why it is arguably the deadliest non-state actor in the world and the group that has used women for suicide bombings the most in history?

A: Boko Haram’s record in 2015 of being the deadliest group is a coincidence. Very many other militant groups have combined characteristics of an insurgency and a terrorist group. Its violence belies its weaknesses as much as its capacities.

Boko Haram’s resort to terrorism, often unrestrained terrorism and unrestrained plunder, reflect its loss of territory and most limited strategy calibration and governance skills. Its terrorist attacks, including by female suicide bombers, also reflect the limitation of the military COIN (counter-insurgency) strategy. For instance, after the international clearing, little effective control and “holding” is still exercised by the Nigerian military or its international partners.

Q: Although many views have rejected economic deprivation or poverty as the root cause of the insurgency, almost everyone agrees that military victory over the group would not help much if economic improvement is not brought to bear in the Northeastern Nigeria – the theatre of the insurgent activities. Is this necessarily contradictory?

A: Economic deprivation is hardly ever the sole factor stimulating militancy. There are many poor places, even those in relative decline compared to other parts of the country, where an insurgency does not emerge. But relative economic deprivation often becomes an important rallying cause. And indeed, there are many reasons for focusing on the economic development of the north, including effectively suppressing militancy but it also goes beyond that. Improving agriculture, including by investing in infrastructure and eliminating problematic and distortive subsidies in other sectors, would help combat insurgency and prevent its reemergence.

Q: While Nigerians remain befuddled about the grievances of Boko Haram, we are clear about the gripes of the militants in the oil-rich Niger Delta: they want resource control, since the Nigerian state has been unable to develop the area that produces 70 per cent of the federal government’s revenue. So, is the state always just and right in suppressing militant groups?

A: Indeed not; the state is hardly always just in suppressing militancy, even as suppressing militancy is its key imperative. Economic grievances, discriminations, and lack of equity and access are serious problems that any society should want to tackle. Even if there are “no legitimate grievances,” the state does not have a license to combat militancy in any way it chooses. Its own brutality will be discrediting and can be deeply counterproductive.

The Nigerian state’s approach to MEND (Movement for the Emancipation of Niger Delta) is fascinating: essentially the cooptation of MEND leaders through payoffs, but without addressing the underlying root causes. The insurgency quieted down, but the state’s approach is hardly normatively satisfactory nor necessarily sustainable unless new buyoffs to MEND leaders are again handed over. But that compounds problems of corruption, accountability, transparency, and inclusion.

Q: We can raise the same issue about economic justice in the way criminal and terrorist organizations operate their underground economies. How flawed have you found the alternative social orders that the leaders of criminal and terrorist organizations claim to foster?

A: The governance – the normative, political, and economic orders -- that militant groups provide are often highly flawed. They often underdeliver economically and they lack accountability mechanisms, even when they outperform the state in being less corrupt and providing swifter justice.

However, the choice that populations face is not whether the order that militants provide is optimal or satisfactory. The choice that matters to people is whether that order is stable and better than that provided by the state. So the vast majority of people in Afghanistan, for example, say they don’t like the Taliban. But they don’t like corrupt warlords or corrupt government officials even. It’s not the absolute ideal but the relative realities that determine allegiances or at least the (lack of) willingness to support one or the other.

Moreover, the worst outcome is constant contestation and military instability. A stable brutality is easier to adjust to and develop coping mechanisms for than capriciousness and unstable military contestation.

Q: The Nigerian amnesty programme seemed to be a model in resolving issues between the state and the non-state actors in the Niger Delta, given the quiet in that region in the past few years of the programme. But since the political power changed at the federal level, we are seeing signs of the return of sabotage of oil installations. What models, say in Latin America or elsewhere, can help foster more sustainable peace between governments and non-state actor militant groups?

A: I don’t think that the MEND programme is a model, precisely because of the narrow cooptation I alluded to. Many of the middle-level MEND commanders as well as foot soldiers are dissatisfied with the deal. And much of the population in the Delta still suffers the same level of deprivation and exclusion as before. The deal was a bandage without healing the wounds underneath. It’s a question how long it will continue sticking. Despite its many urgent and burning tasks and a real need to focus on the north, the Nigerian government should use the relative peace in the Delta to move beyond the plaster and start addressing the root causes of militancy and dissatisfaction there. 

This interview was originally published by Financial Nigeria.

       

       

       

       

       

INTRODUCTION

Over the past decade, the focused attention of African nations, the United States, U.N. agencies and other multilateral partners has brought significant progress toward achievement of the Millennium Development Goals (MDGs) in health and malaria control and elimination. The potential contribution of these strategies to long-term peace-building objectives and overall regional prosperity is of paramount significance in sub-regions such as the Horn of Africa and Western Africa that are facing the challenges of malaria and other health crises compounded by identity-based conflicts.

National campaigns to address health Millennium Development Goals through cross-ethnic campaigns tackling basic hygiene and malaria have proven effective in reducing child infant mortality while also contributing to comprehensive efforts to overcome health disparities and achieve higher levels of societal well-being.

There is also growing if nascent research to suggest that health and other humanitarian interventions can result in additional benefits to both recipients and donors alike.

The social, economic and political fault lines of conflicts, according to a new study, are most pronounced in Africa within nations (as opposed to international conflicts). Addressing issues of disparate resource allocations in areas such as health could be a primary factor in mitigating such intra-national conflicts. However, to date there has been insufficient research on and policy attention to the potential for wedding proven life-saving health solutions such as malaria intervention to conflict mitigation or other non-health benefits.

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Before the City Club in Cleveland, Bruce Katz emphasized the importance of Ohio's older industrial cities for the state's overall prosperity and outlined, despite seemingly grim statistics, why now is the time for a rebirth of those places and how it can be achieved.

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The flight of humans from Syria has been rapid, massive and dynamic. The number of refugees has grown from 26,000 in the first year of the war to almost 4.2 million now, four years later. It is time for bold action from the world to support Turkey and the other countries of the region hosting the vast majority of refugees.

None of Syria’s neighbors – the primary hosts of refugees – expected the displacement to reach such a scale, nor for the crisis to last this long. Many believed in the early days of the Arab Spring that the oppressive regime of Bashar al-Assad would be replaced by a reformist-minded, popularly-elected government - mirroring the transition that had just taken place in Tunisia and Egypt. Instead, Syria became mired in a civil war between an ever-growing number of opposition groups and the regime, whose repression of civilians, regardless of any involvement in the crisis, has forced millions to flee in terror on either side of the country’s borders.

Until recently, the overwhelming majority of the refugees were fleeing the indiscriminate attacks of the Syrian government. More recently, ISIS has been a significant source of terror, while even more recently Russia’s entry into the conflict has triggered another wave of flight.

Today, the refugee populations registered in Lebanon, Jordan and Turkey total more than 4 million souls. Managing the presence of such large numbers of refugees has been costly on host countries economically, socially and politically. What was expected to be a temporary refugee influx has become a protracted crisis. With no signs of a resolution of the conflict in the foreseeable future, the refugees’ hope to return is diminishing.

The massive influx of refugees into Europe, often via extremely costly and life-threatening channels, reflects the despair and harsh living conditions that many refugees feel. Syrians constitute the majority of the 800,000 migrants that have crossed into Europe this year. As the crisis spills beyond Syria’s immediate neighbors, the EU is experiencing major challenges in managing a response. It is clear that attending to refugees is not only a concern of the immediate neighborhood – but that of a much wider region.

In looking at the challenges to Europe, it is important to underscore that neighboring countries have shouldered most of the burden of caring for the refugees, with inadequate assistance from the international community. Resettlement has been extremely limited, and roughly only a third of the pledges to U.N. response plans have been met.

Now is the time to adopt a comprehensive approach that will offer a better future for refugees and their hosts. Attention must be paid to two areas in particular: Education and access to employment. In this regard, it will be critical to move beyond a strategy focused on humanitarian relief to one explicitly structured around sustainable development and empowerment of refugees.

We need a globally-funded Recovery Program for the Middle East that brings about immediate action to mitigate the impact of the crisis on the economies and services of Syria’s neighbors. As part of that, we need to recognize the skills and income that refugees could contribute to the Turkish economy, if they were only allowed to do so. This program could not be carried out by the Turks alone, but would need the engagement of a range of actors – from the U.N. to the World Bank to the private sector and other donors.

Turkey and its neighbors have generously cared for more than 4 million refugees: But as the displacement crisis enters its fifth year, this burden needs to be shared out much more fairly and effectively.

Sadly, despite the desperate need for peace in Syria, we need to respond to the reality that Syrian refugees will not be able to return home for a while yet. As simultaneously the host of the world’s largest Syrian refugee population as well as host to the G-20 Summit, Turkey is in an ideal position to bring this reality to the attention of G-20 member-states – and leverage more resources to assist it and its neighbors to cope with the crisis.

G-20 leaders must commit to sharing Turkey’s burden and place increased emphasis on empowering refugees to shape their own destinies and become productive members of their host societies.

And it must be remembered: The majority of Syrians want to go home. Eventually they want to be able to contribute to rebuilding a stable and democratic nation for themselves and their families. But peace cannot be served while al-Assad drops barrel bombs on his people and ISIS beheads journalists on the steps of Palmyra. Our leaders must focus on a sustainable political solution to this conflict as the end goal of any plan for the region.

This piece was originally published by Hurriyet Daily News.

       

The tragic and deadly attacks in Paris, the day before leaders were set to arrive in Antalya, Turkey, for the G-20 summit, underlined the divisions that Syria, its fleeing population, and the terrorists of ISIS have created, as fear and short-term political calculations seem to shove aside policies aimed at sustainable solutions to the unprecedented refugee challenge.

It had started on a more hopeful note. Turkey, which chairs the G-20 this year, had placed the refugee issue on the agenda, hoping for a substantive global dialogue while looking for broad-based solutions to the crisis in Syria and the terrorism challenge. No doubt the 2 million refugees in Turkey played a big role, as President Erdogan and other officials tried to rally support for this unusual situation in a variety of G-20 and other venues.

Turkey was supported by another full member of the G-20, the EU, the only non-nation state member of the group, which shrugged off its complacency when hundreds of thousands turned up on its shores in 2015. European Council President Donald Tusk and Jean-Claude Juncker, European Commission president, echoed the Turkish President in calling for a global response: “Meeting in Turkey in the midst of a refugee crisis in Syria and elsewhere, the G-20 must rise to the challenge and lead a coordinated and innovative response… recognizing its global nature and economic consequences and promote greater international solidarity in protecting refugees.”

The G-20 is an imposing group, consisting of the world’s 20 largest economies, accounting for 85 percent of its GDP, 76 percent of its trade, and two-thirds of its population. Established in 1999 and growing in reach since the 2008 financial crisis, it should be a body that carries weight beyond the economic, with effective mechanisms to have impact on the global agenda. Yet, while Syria and the refugee crisis was the first time the G-20 stepped outside its usual narrower economic mandate, the agenda was quickly overtaken.     

The tragedy in Paris highlighted deep divisions over the refugees. Poland’s new government was the first to announce that it would stop participating in the EU resettlement plan whereby it would have accepted 5,000 refugees. Politicians from Hungary, the Czech Republic, Slovakia as well as those with a nativist message from the Nordic countries, France, Germany, and others saw an opening for tighter border controls and a much less welcoming approach to the more than 800,000 refugees that have already made their way into Europe, not to mention the many more on the way. Such views linking refugees to terrorism are not restricted to Europe but can be seen on the other side of the Atlantic, as U.S. presidential candidates and some 27 State Governors declared that Syrian refugees were not welcome.

At this early date, except for a single Syria passport “holder”—a document easily acquired these days, and found near one of the suicide bombing sites in Paris—all those who died or are being sought as suspects are citizens of either France or Belgium. Clearly, there could be some who get into Europe by using the refugees as a cover but with literally thousands of Europeans fighting in Syria, the real threat emanates from the small number of home-grown extremists in Europe who have easy access to the West and a cultural and linguistic familiarity that will elude newcomers for years. This was the same scenario one saw in the Madrid, London, Copenhagen, and the Charlie Hebdo attacks in Paris earlier this year. 

Fear is winning out over policy

The EU also appears in disarray on aiding the 4 million refugees in Jordan, Lebanon, and Turkey. This is significant since it is reduced funding and aid that is leading to the worsening of conditions in Jordan, Lebanon, and Syria, and driving many to Europe. Turkey too is reaching its limits and may potentially face a million or more new refugees if Aleppo falls. Yet funds pledged to these countries remain largely unfulfilled—of the 2.3 billion euros pledged by EU governments, only 486 million are firm government offers. The discussions between the EU and Turkey for additional aid to refugees of 3 billion euros also remain less-than-certain since such aid requires that EU countries agree to receiving and distributing asylum-seekers from Turkey. It also underlines the lack of funding for Jordan and Lebanon.    

In the end, the G-20 yielded little by way of concrete actions on refugees, though additional border controls, enhanced airport security, and intelligence sharing were promised. There was a call for broader burden sharing and greater funding of humanitarian efforts, as well as a search for political solutions. The G-20 also added little to the broad outlines of a potential settlement on Syria discussed in Vienna, Austria, on November 14, 2015, a day before the start of the G-20 summit.

Unfortunately, these are the very things that separate G-20 members among and within themselves. The growing danger is that fear and political opportunism rather than well-thought-out polices will guide the global response to the greatest human displacement tragedy since World War II. It is precisely this fearful and exclusive reaction that ISIS seeks. Indeed, that legacy may live long after ISIS is gone.                           

       

       

       

       

During the height of the Ebola crisis in September 2014 there were 21 confirmed cases of the virus and 8 deaths in Nigeria. The African nation has the continent’s largest population, a high poverty rate, and the government spends relatively little on health care. At the time many were worried about a scenario where the virus spread throughout Nigeria. But, the Nigerian Minister of Health Onyebuchi Chukwu disagreed with that assessment. He commented to Forbes, “Nigeria will be as clean as any other country as far as Ebola virus disease is concerned.” His comments were proven to be accurate in the coming months. There were a variety of factors that contributed to Nigeria’s success at combating the disease. One important factor was the use of mobile electronic health records programs.

How mobile fights disease

1. Training Healthcare Workers

Training health care providers was a priority at the beginning of the Ebola outbreak. A survey found that 85 percent of health care workers in the country believed you could avoid Ebola by abstaining from handshakes or touching. Correcting these myths about the disease was a critical part of the response effort, especially for health care workers.

2. Rapid Deployment

One of the virtues of mHealth is its speed and flexibility. Mobile allows officials to quickly disseminate the latest information to front line health care workers. Increasing the speed of communication is a general boon to any large public health response.

3. Virtual Records

Ebola Treatment Units (ETU) greatly benefitted from using digital rather than paper records. Paper records cannot be removed from an ETU. Deborah Theobald co-founder of Vecna Technologies that created the mHealth platform in Nigeria has pointed out that, “If the patient is isolated, so is their paperwork”. Electronic records are easy to share and also lower the risk of infection for health care workers.

Mobile health policy challenges

Despite the potential benefits of mHealth, barriers in some countries prevent the full positive impact of these technologies from coming into effect. Many developing nations lack the electrical infrastructure that is necessary to power mobile devices. Health care regulations are often too overly bureaucratic and burdensome. This makes it difficult for innovators to develop and equip workers with mobile tools and applications. It often takes an emergency situation like the Ebola crisis to make substantive changes. Success in the long term is only possible if leaders create an environment that is more hospitable to mHealth.

Mobile interventions have also demonstrated potential to address important public health issues. Recently experts gathered at the Brookings Institution to discuss how mHealth can improve health outcomes. Apps like Mobile Midwife and Text4Baby can encourage healthy pregnancies by providing valuable tips to expecting mothers. Mobile health platforms are successful because they directly inform caregivers. The proliferation of mobile phones through the developing world presents a health opportunity to communicate with the people who need help.

      

       

       

       

Event Information

As the prevalence of drug-resistant bacteria continues to rise, there is a pressing need for new drugs to combat infections by these organisms. However, research and development in this area has slowed, creating a public health concern that we lack the drugs necessary to treat multi-drug resistant infections. Challenges to promoting antibacterial drug development may be scientific, methodological, regulatory, or economic in nature.

On Wednesday, May 9, 2012, the Engelberg Center for Health Care Reform convened an expert workshop, "Facilitating Antibacterial Drug Development,” that explored solutions to methodological and regulatory challenges that could make the development process more efficient. This meeting brought together diverse multi-stakeholder experts—including medical product developers, health care professionals, researchers, patient advocates, representatives of the U.S. Food and Drug Administration, and other groups—to explore the following issues:

• Existing paradigms for antibacterial drug development;
• Novel approaches to further antibacterial drug development, including use of pharmacokinetics and pharmacodynamics, Bayesian methods, innovative clinical trial designs, new data sources, alternate clinical endpoints, and new regulatory tools; and
• Short- and long-term opportunities to advance the antibacterial drug development enterprise through collaboration among stakeholders, improved regulatory science, and other means.

For more information on FDA’s Antibacterial Drug Development Task Force, click here.

Event Materials

• May 9 Event Summary
• Antibacterial Drug Development Participant List
• Facilitating Antibacterial Drug Development Agenda
• Facilitating Antibacterial Drug Development Discussion Guide
• Panel 1 Brad Spellberg Presentation
• Panel 1 George Talbot Presentation
• Panel 1 John Powers Presentation
• Panel 1 Thomas Fleming Presentation
• Panel 2 George Drusano Presentation
• Panel 2 Scott Emerson Presentation
• Panel 3 Daniel Benjamin Presentation
• Panel 3 Edward Cox Presentation
• Panel 3 John Rex examples
• Panel 3 John Rex Presentation
• Panel 4 Helen Boucher Presentation

       

Event Information

As part of ongoing cooperative work with the U.S. Food and Drug Administration, the Engelberg Center for Health Care Reform has formed a council to bring together expert perspectives on the challenges facing antibacterial drug development. Designed to include representatives from academia, patient advocacy groups, industry, providers, and government agencies, the Brookings Council on Antibacterial Drug Development (BCADD), will convene twice a year to discuss pressing issues in the treatment of infectious diseases and potential steps to address them.  

The first BCADD meeting, held on August 30, 2012, brought stakeholders together to discuss the following:

• Ongoing antibacterial initiatives at FDA and the Clinical Trials Transformation Initiative
• Statistical and methodological approaches that could be harnessed to improve the efficiency of antibacterial drug development
• Balancing benefit-risk and uncertainty considerations with public health needs
• Next steps for council action

For more information on FDA’s Antibacterial Drug Development Task Force, click here.

Event Materials

• 30 antibacterial drug development summary
• Presentation Slides
• FINAL BCADD Discussion Guide 20120828
• FINAL May 9 Summary 20120828
• Participant List_Final