international aid

There are no innocent victims.

North Americans and Europeans love to victimize people. We love to package the poor forsaken souls of the “third world” as “helpless”, in need of our savior, and of course as “innocent victims” who then essentially have no voice or control in their own lives. This is simply a fallacy that will lead to more destruction and violence in the long run.

One thing we often misunderstand is that there really are no “innocent victims”, except for maybe babies and small children (but then again, who’s to say of the evil they committed in womb or in their tiny minds??). There are people who have experienced misfortune in their lives. There are people who are poor. There are people who have had terrible things happen to them. To label a person as victim– in my opinion– only re-victimizes. It belittles their experience and makes the actor helpless. Takes away their control, their personal choice and agency in their own lives. Instead of being actors in their own life, they are merely pantomiming someone else’s script. That of their “saviour” who expects them to behave in a certain way to receive assistance.

Look to the very definition of the word “victim”:

  1. one that is acted on* and usually adversely affected by a force or agent
  2. “one that is injured, destroyed*, or sacrificed under any of various conditions”
  3. “one that is subjected to oppression*, hardship or mistreatment”

(*emphasis added)

My grandmother used to tell me that someone can not oppress you unless you let them. Sure, they can enslave you. They can beat you senseless. They can make you do degrading and horrible things– but they can never oppress your mind unless you give them that power. It’s easy enough to say, but much harder to live under extreme conditions. Still, there is truth there. There are many who rise up out of what some would call extreme oppression and do not feel “oppressed”– crushed by the abuse of power— but rather they feel empowered by it. Enraged into action by it enough to even oppress their oppressors.

“Innocent” is also a relative term. Does a person deserve to be raped or tortured or killed because of their own wrongdoing or guilt? Does it matter the level of guilt or wrongdoing? Do they become more deserving of rape or torture if they say injure someone as opposed to simply lie about something? What if they severely injure someone, or even kill them? Do they deserve it then? Do they become deserving of death if they merely spout hatred or have racist feelings in their hearts?  There is a scale of innocence that varies greatly depending on one’s background and belief system. If a person doesn’t injure, steal or hurt anyone directly, does that make the person completely uncorrupted? Completely without sin? Is one only a victim if they are completely “innocent”. Are they only worthy of assistance if they are uncorrupted?

Take for instance the Rwandan genocide in the mid-90s. Humanitarian aid poured in for the poor helpless refugees flooding into the neighbouring countries. Many of these “helpless refugees” were also mass murders who openly admitted their willing participation (page 25) in the slaughter of their countrymen. They were also dying by the thousands of dysentery, cholera, starvation and other such things and painted as “victims” to the outside world. Their innocence was played up with pictures of their young children beside them, their swollen bellies and sad stories of hardship. But were they all really “innocent”? Would they still have received our sympathy, our assistance and our money if we were told they were murderers? Did we really only “rescue” them so that they could continue to oppress and murder others in the future?

People can not be separated from their politics, but when it comes to those in disaster or war zones, we infantilize them and make them apolitical. We infantilize those in need to ease our own morality about helping them. In doing so, we further jeopardize the political situation that is happening on the ground. We take sides with the “victims”, even though they may be less “innocent” than their oppressors. We help them overcome their perhaps temporary “victimhood” allowing them to gain strength over their opponents. In doing so, we perhaps create more “victims” in the future.

Do we feel better about ourselves feeling that the “victims” we help are “innocent”? It certainly eases the mind. One wouldn’t want to think of giving a Hitler or a Pol Pot aid so that they can could continue their crimes, yet this type of thing does happen in humanitarianism.

So what’s the answer? How do we avoid making a further political or humanitarian nightmare while still assisting those who need help?

Lately, I’ve been reconsidering extreme non-intervention and wondering about the possibilities of such an action. It is intervention to militarily invade a country, but is it not also an intervention to take on the function of the government by providing services such as health care or education through the work of international NGOs? How much is humanitarian intervention really helping and how much is it really harming in the long run?  Many NGOs are extremely corrupt and wasting money, but evade responsibility due to their so-called “philanthropic” spirit. Others can be compared to colonial imperialism (on page 60 and 243, also Chomskey and Delany among others ), justifying their takeover of a country on humanitarian grounds much as the colonial powers justified taking over Africa to “save” the poor “savages”.

Now I know that if tomorrow all humanitarian assistance were to be removed from trouble zones, massive chaos would erupt; but we also can’t expect them to stay forever either. So many governments now feel they can neglect their own people, knowing that NGOs and international assistance will come in and fill the gaps and that the international aid will continue to flow as they line their own pockets with little chastisement.

Instead of a government capable and willing to actually take care of its people, the population are left with a patchwork of services that are reliant on continual funding streams that may or may not be there in the coming years. Now those receiving assistance are perpetual “victims” in need of help, who will be reliant on handouts instead of their own capabilities (and they ARE capable). Instead of working towards securing small patches of land for these people, where they could grow their own food and be sustainably self-sufficient, NGOs rush in with handouts of western food assistance that only helps to continue western domination in agricultural markets.

So quick is the western world to jump to judgment of conflict in fledgling nations that are struggling to fully etch out their boundaries and constitutions, little remembering that their own struggles for independence were fraught with wars, slavery and massive human rights abuses. Let’s not forget that slavery was still alive and well in the US for nearly a century after independence and that its Manifest Destiny resulted in brutally conquering Mexicans, British settlers and Native Americans. And can we also not forget that American Independence came on a wave of warring and human rights abuses such as the War of 1812, the Mexican-American War of 1846-8, the American Civil War, the American Indian Wars and the Trail of Tears, the women’s suffragette movement, and the civil rights movement to name a few. And in Europe, the current nations were only made through war and rights abuses; the Battle of Trafalgar, the Finnish War, the Spanish Peninsular War, the Napoleonic Wars, the Belgian Revolution, the November Uprising in Poland, the Carlist Wars in Spain, the Spanish Inquisition, the 1848 Revolutions in Europe, the Crimean War, the Austro-Prussian War, the Franco-Prussian War, and even WWI and WWII.

But yet, we feel it necessary to rush in and chastise those fledgling countries for doing exactly what was done during our nation-building processes because we have suddenly decided on a new sense of morality? Nations have been built on human rights abuses and war, as opposing interests struggle to etch out their own ideas of how to control their country and homogenize their ideas through slaughter and suppression of the opposition. Yet, we expect so many countries, barely 50 or 60 years old and left with brutal, segregationist colonial legacies to set aside their differences and now live in harmony according to OUR standards? Sounds an awful lot like continued imperialism to me. Do as we say, not as we did.

These nations do not need our continued meddling. They need time to develop their own governments free from external pressure to “democratize” and create “free” markets. Interventionism has so far not really proven to create more human rights respecting states. If anything, many governments have become more corrupt on the western aid dime. We continue to fund many proven brutal dictators with vast streams of cash flow and no accountability so they can increase their power, while those in need suffer at their hands. Will the dictator be the one to pay the debt he incurred? Hardly. We then swoop in to “save” those who suffer, spending even more money in humanitarian ventures that will again help line the dictator’s pocket. How is this “helping” anyone?

It’s time to stop meddling and trying to “save” the “innocent” victims and instead looking to our own problems that may be helping to contribute to wars and human rights abuses in other parts of the world. The inequitable and unfair privilege of certain states or communities within the international community. The inequitable policies of the international financial organizations and trade organizations, based in and primarily backing the “richer” nations at a disadvantage to the “poorer” nations. The “richer” nations’ increasing need to consume and pollute the planet that will result in war and death across the globe. The increasing state repression and rescinding of rights that is being found in Canada, the US, and Europe. The discrimination, racism and slavery that still occur across Europe and North America. The North American, European and international systems are still far from being peaceful and respectful of rights, and perhaps we should clean up our own act before we judge others for theirs.

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The DR Congo, MONUC and Joseph Kabila.

MONUC, the UN’s mission in the Democratic Republic of the Congo (DRC) will sadly soon be coming near an end, even though the country is arguably home to one of the most deadly and violent humanitarian crisis the world has ever seen. In December 2oo9, the UN extended their mission to run until May 2010 and have spent this time discussing plans for withdrawal. Recent talks suggest the troops will most likely stay past Congolese president Joseph Kabila’s hopeful June 30, 2010 deadline until the least devastating exit strategy can be fully devised. This will probably delay a full withdrawal until at least 2011.  The UN troop’s effectiveness and the necessity of their continuation in the country has been hotly debated. Congolese President Joseph Kabila calls for their immediate departure. Human Rights Watch has accused MONUC of complicity in massive abuses against the local population. Locals protest the UN headquarters, tell rumors of lizard-eating UN troops, and the abandonment of many bastard children parented by MONUC workers should they pull out of the country. Yet there is an obvious necessity for some stability as the local population is in desperate need of protection from wide-spread violence and an incredibly corrupt government system.

President Kabila has been asking the troops to leave now for years, claiming things are getting better and that the government can manage on their own, however the poor human rights record in the DRC would suggest otherwise. The atrocities happening in the DRC rival any crisis and brutality our planet has ever seen, yet seems hidden in the media behind violence in Afghanistan, Iraq or the Sudan. The DRC has been wracked with war for more than a decade, pushed to the brink after colonial independence, decades of poor despotic governance, enormous global theft of resources, and the violent militias fueled by ethnic hatreds spilling into the country following the Rwandan genocide. It is still enraged in severe violence with as many as 45,000 people dying each month from war or war related causes.  The violence has not diminished over these last few years. In fact, if anything, it seems to be increasing. According to OSCHA (the UN office for the coordination of Humanitarian affairs), violent incidents against aid workers increased 26% in the first six months of 2009 compared to 2008. They also report that security incidents in Goma were up 44% and up 63% in North Kivu over the past year. People are still dying at alarming rates, with mass violent atrocities regular, daily occurrences. One would be hard-pressed to find a person who hasn’t been personally affected by violence in the country. Yet, it seems to drop from our view here in North America so easily.

The UN mission in the Congo is the largest and most expensive in history with now more than 20,000 personnel on the ground. 150 UN personnel have lost their lives since the mission’s inception in 1999.   These troops have been accused of atrocities ranging from rape and murder, to assisting local militias and rebel groups in their massacres and have faced protests at the UN doorstep in extreme anger and frustration by local populations who feel they are not being fully protected. We cannot forget that despite all this negativity these troops have also been credited with protecting thousands of local Congolese on a daily basis who would surely die if not for their presence and assistance; they have also had their hands essentially tied by vague mandate and lack of funding. Millions and millions of locals have died (at least 5.6 million in the past decade and probably much more than that), millions more have been displaced, many tens of thousands have been raped (if not more) and these atrocities still continue daily in the most brutal fashion. More than half of the remaining 55 million people in the country are children who are vulnerable to recruitment into fighting factions, are subject to a lack of access to education, malnutrition, or other major human rights abuses, which makes long-term peace increasingly difficult. If these children grow up in constant violence and war, how can they ever know peace?

The peacekeepers’ are under a Chapter VII mandate which allows them to take “necessary action, in the areas of deployment of its infantry battalions and as it deems it within its capabilities, to protect United Nations and co-located JMC personnel, facilities, installations and equipment, ensure the security and freedom of movement of its personnel, and protect civilians under imminent threat of physical violence.” Their role on paper is essentially to provide stability, security and protection in the country while monitoring human rights abuses and assisting in disarmament, demobilization, resettlement and reintegration of rebel troops. The mission is clearly flawed as violence keeps increasing around them. By supporting the Congolese government, the UN peacekeepers are routinely found being complicit in operations that could be construed as war crimes. Peacekeeping is not enough for this mission. The corrupt government, police and army systems meant to protect are often accused of raid, rape, abuse and murder and the communities propagandized to continual vengeance by rumors that separate and demonize entire ethnic populations. Peacemaking, peacebuilding and regulation of government systems are a necessity on top of the peacekeeping force if any semblance of peace within the country is to be established.

President Joseph Kabila has been a controversial leader of the DRC since 2001. Taking control after his father’s assassination, he was elected as president three years later. His history (including even his age) is highly debated and the subject of great rumor. His lineage and parentage are also debated. Many local rumors claim he is the son of a Rwandan who was adopted by Laurent Kabila after his marriage to Joseph’s mother (Laurent was said to have as many as 13 wives and more than 25 children). There are also many claims of Joseph’s relation to and alliance to Rwandan forces, as he is feared as a puppet of Rwandan President Paul Kagame with an eventual plan to occupy and annex the eastern Kivu provinces from the Congo. Joseph spent many years of his life in neighbouring Tanzania and Uganda, making his life even more of a mystery to many Congolese citizens. He was commonly known as the commander of the famous army of kadogos (child soldiers) in his father’s campaign to oust the Mobutu regime. Kabila is also said to have studied at the Makerere University in Uganda and the PLA National Defense University in China. He had to change the Congolese constitution in 2006, lowering the eligibility age for elections from 35 to 30 so that he could himself run for office legally. His government troops have been accused of mass atrocities and continuing violence that seem to go unpunished. Despite this violence and lack of accountability, his government continues to receive extensive funding and assistance from many foreign sources.

The IMF has loaned over $502 million to the government of the Congo, requiring with it a roll-back of government services that have had some devastating effects. The World Bank and many other agencies continually supply the Congolese government with financial assistance, despite claims of massive human rights abuses by governmental parties. The DRC currently owes billions in debt from Mobutu’s dictatorial period with interest payments consuming more than 10% of the government budget each year, although talks are currently underway to try to reduce this debt. CIDA, Canada’s international development agency funnels over $30 million per year to “political and economic governance” programs with little accountability and transparency of where this funding actually goes. Natural resource wealth is the prime fuel for much of the violence including that earned from uranium, cobalt, coltan, gold, copper, tin, zinc, diamonds, and tantalite often found in many electronics products or packaging for products such as cans. Rebel and government groups battle it out for control of resources; a single mine able to provide them with upwards of $20 million per month in profit, enough to fund more weapons, power and control. The Chinese, Belgians, French, Canadians and Americans (among others) all have a vested monetary interest in the country and often take the opportunity to politically maneuver the government for their own interests.

Refugees returning to the Kivus are adding to the tensions as local politicians and rumor say the returnees are not Congolese Tutsi but rather Rwandans who have never even lived in the Congo. They are accused of throwing locals off their land, fueling further ethnic tensions and hatred in the region. Armed militias for several different ethnic groups who claim to “provide protection” for local and refugees populations are themselves accused of mass rape, murder, forced recruitment of soldiers (including child soldiers), and using slaves to illegally exploit minerals. There is little place to really turn for protection. The intense violence has caused dwindling humanitarian services (see also here, here, here, and here) that will surely diminish even further if the UN does withdrawal.

Something must be done to stop this violence. Proper oversight of natural resources is an absolute necessity combined with awareness in consuming nations to pressure the change within North American, Chinese and European consumption and lending habits. UN withdrawal will only bring more devastation, murder and abuse to the civilian population and must be avoided at all costs.

Please speak out against these crimes to anyone who will listen and be aware of what you purchase as you may be much more connected to this war than you might think. If you would like to read more about conflict resources in the Congo, please read about my quest for a conflict free laptop.

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Some hope for the future.

In Canada:

Act respecting Corporate Accountability for the Activities of Mining, Oil or Gas in Developing Countries

In the US:

Conflict Minerals Trade Act of 2009

Congo Conflict Minerals Act of 2009

In the EU:

Global Witness pushes for legislation

Some of the corporations:

Congo tracking project aims to end IT industry’s use of “blood tin”

Supply chains unite to start iTSCi mineral traceability project in DRC

Global e-Sustainability Initiative


The “kindness” of the International Financial Institutions.

“Working for a World Free of Poverty”- The World Bank

“The International Monetary Fund (IMF) is an organization of 185 countries, working to foster global monetary cooperation, secure financial stability, facilitate international trade, promote high employment and sustainable economic growth, and reduce poverty around the world.”- The International Monetary Fund

The world is so lucky to have such caring institutions as the World Bank and International Monetary Fund. If you can’t tell, that last statement was said in sarcasm. If one were to read these institution’s own boasting they would believe that world poverty has been reduced because of their influence, rather than partially created and continued by them. These institutions, commonly referred to in international development circles as the Bretton Woods institutions or International Financial Institutions (IFIs), have helped to ensure that many countries will remain in poverty through their loans and structural adjustment programs (SAPs) for years to come.

The World Bank and the IMF are responsible for supporting the economic and financial order between governments. They were developed in the 1940s as a way of financing economic development for war-torn Western Europe. Over time, they have extended outside of Europe to any poor or war-torn nations, lending over $330 billion since their inception.

The OPEC oil crisis of the 1970s caused major worldwide inflation, significantly raising the price of gas and increasing the cost of goods produced in the richer nations. Many economies of the poorer nations of the world could no longer afford to pay for their imports and began to run on major deficits, resulting in a significant balance of payment deficit. Due to deteriorating terms of trade, these economies needed to look for more resources to pay for their imports; because essentially they were receiving much less for their products, and paying much higher costs for any manufacturing.

Prior to the oil crisis, the IFIs had “assisted” many of the poorer nation’s economies by offering loans to their governments originally borrowed at minimal interest rates of about 1-2%. By the 1980s these loan’s interest rates had climbed to about 16%, and many of the countries were taking on increasing loans to help pass them through the crisis. The rise in the use of synthetics and new agricultural techniques during this time reduced the need for many of the raw materials and agricultural products; an economic staple of many of the world’s poorer nations. During the early 1970s, more than 80% of these nation’s external revenues were created by the exportation of raw materials, dropping to only 34% by 1993.

Many of the richer nation’s banks were required by the IFIs to open lines of credit for the poorer nations that were in distress, and these commercial banks began giving out more money in loans than they actually had. Many of the poorer countries were now left with extreme debt that was growing larger and larger each day as the interest compounded. Many countries owed millions of dollars per month in interest; money that they could sorely afford and in some cases amounts that surpassed the nation’s earnings. These payments were only touching the interest on the loans and barely cracking the surface of the actual debt, ensuring these countries would owe for the long-term.

By 1985, many Latin American countries were suggesting that they were going to default on their loans and just disown their debts. Scrambling to not bankrupt the richer countries’ commercial banks and cause a massive economic meltdown, the “generous” IFIs decided on a plan to help reduce the poorer nations’ debt; on the condition of structural adjustment. The debtor nations would be required to implement stabilization packages supervised by the IMF, that would dictate their government’s spending.

Several plans were implemented to help reduce debts, and failed miserably; leaving many nations with still massive and overwhelming debt. Interestingly, with all the debt reduction projects during this period, the debt of the poorer nation’s between 1984 and 1994 had not been reduced at all, and was in fact only steadily increasing. It was soon decided by those at the IFIs that state-run services in the debtor countries were the reason for the economic crises and that the solution was to be found in removing all state intervention and socialist/communist approaches to government in these nations. The IFIs began demanding packages of fiscal disipline, trade liberalization, exchange rate adjustments and privatization of state services in the debtor nations as a way to stop the crises.

The removal of trade restrictions, including import licenses, quotas, and tariffs in the debtor nations, allowed the lending nations’ governments to fix their prices and dominate the global markets. The IFIs insisted on the devaluation of the local currency in the debtor nations as an incentive for local producers to produce more export commodities. Massive public sector layoffs ensued, as the governments were required to reduce their spending. All public enterprises were to be sold off and export was to be promoted through incentives such as easier access to foreign exchange.

Many of these loans were (and are still to this day) granted to nations ruled by authoritarian depots who use much of the monies to secure their own position of power or build their armies. Overall inflation in many of the nations was reduced by the SAPs and the nation’s earning increased; reducing their debt to earning ratio. The social costs of these economic changes however, had a devastating effect on the populations. All public services were now gone, or were pay-for-use services. The number of people living in poverty in these debtor nations dramatically increased, as did unemployment.

After much world-wide protest, the IFIs decided they must try to reduce the debts to more sustainable levels and focus more on the poverty and social costs that their decisions were having. Several countries qualified for loan reduction initiatives to help reduce these social costs. A number of initiatives were tried and failed, and all now included a poverty reduction strategy paper (PRSP), a plan that would detail what the nations would do with the money they were now “saving” from loan payments. This allowed the richer nations to have a large say in the running of debtor nation’s governments. Many nations, including many of the world’s poorest, found they could not qualify for the loan forgiveness programs and so remained completely devastated with debt payments and running further and further into absolute poverty.

The debt initiatives had the effect of reducing some of the total stock of debt from the qualifying nations, however, it also resulted in successful litigation by commercial and bilateral creditors who sued some of these governments for their debt, despite their promised forgiveness by the IFIs. So the IFIs came up with new and even “better” plans, that would involve mandated country-driven and specific programs that were implemented with the purpose of benefiting the poor. In reality, the nations were often given little say into what programs would actually be implemented and were forced to democratize in a western way and create capitalist economies that would serve the richer nations. It had the desired effect. “Democracy” spread from 27.5% of the globe in 1974 to cover 61.3% of the world’s nations in 1995. By the late 1980s, the IFIs had decided that “good governance” was now to become a condition of any loan and much aid, institutionalizing the rule of law and democracy in debtor nations. Elections became staged affairs in order to meet conditions, often held in the face of intense structural and direct violence that suppressed any and all opposition.

Loans continue to be made, and debt forgiveness of only a handful of nations has had little effect on reducing the overall poverty experienced in these nations. The originally mandate and purpose of these financial organizations has been completely lost, as they are creating more devastation than they are repairing. The poorest populations are those who suffer the most. Many who once had governmentally funded education, water and extensive health services are now reliant on international aid and NGOs for even basic necessities. They are left with nothing and no hope for the future.

The colonial grips have changed. Instead of being held in servitude by imperial powers, regions are now being controlled by the IFIs and are forced to go along with the lender nation’s political agenda. The richer, more powerful nations continue to extract the resources of the poorer nations at a tremendous discount for themselves because of their financial situation, ensuring the poorer nations will always be their cheap supplier and be willing to bend to their demands for many years to come.

For further details on the effects of structural adjustment in some of the more “successful” nations see here and here.


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International Intervention without Cultural Specificity: The Problems of Aid and Intervention to Russian Health Care

Distributing international aid can prove to be a problematic process if background situations and local considerations are not thoroughly regarded. International intervention within the post-socialist Russian health care system was fraught with difficulties stemming from misconceptions, flawed perceptions and a lack of coordination between locals, international NGO workers and the state. The legacy of the socialist period cast itself on the future of development assistance, as public prejudices regarding expectations were transferred from communism’s failure to the failure of capitalism. How has international intervention and aid to the Russian health care system shaped the relationships between citizens, civil society, and the state; and how has this changing shape been affected by the socialist legacy? How have the concepts of public and private spheres in the socialist context affected the way aid is being received? What are the problems facing international health care aid to this region and what is the best way to overcome these problems?

This paper will explore the transformation of health care services in Russia from the Soviet period to the post-socialist era, detailing the realities of the health care situation on the ground. It will attempt to describe the changing perceptions of public and private space and the expectations that coincide with these spaces, recounting the growing dominance of one space over the other under socialism, and later its repackaged continuance under capitalism. It will then turn to the emergence of international intervention (in the form of NGOs and development assistance) that were focused on transforming the socialist state into a market democracy, and how this assistance was misinterpreted and perceived by many as insulting, damaging the possibilities for overall success. The difficulties facing the depoliticizing of aid are explored, as well as the misconceptions precipitated by the Cold War ideologies. Pro-natalist agendas are discussed as shifting the perceptions and institutionalizing moral responsibilities, a practice that was continued in the delivery of international assistance. The devaluation of Russian skills and knowledge (by Westerners) as a mechanism for change is explored, as well as the disregard and disrespect for Russian input which resulted in the marginalization of the local. The paper will then describe Western attempts at ‘democratizing’ the health care system from the ground up, and how this was limited because of vertical hierarchies in existence. It then details how the perceptions of the socialist state cast themselves on the perception of international aid and intervention, and prevented it from succeeding. The example of Uryupinsk is then described as a type of home-grown “civil society” that is able to meet the needs of its population, followed by recommendations for strengthening the health care system and ensuring aid is better received in the future.

Health Care in Russia

During the socialist period in Russia, there were two phases of health care, the first taking place during the 1920s. This first period was dominated by the Marxist perception that illness within society was primarily the product of sickness (inequality and capitalism) in society and that the “cure” to problems such as alcoholism, drug abuse and prostitution would be socialism. This phase deemphasized the value of scientific and clinical approaches to health care and instead narrowed in on socio-economic factors. Beginning in the next decade, the second phase saw more scientific approaches to care exhibiting a belief that work force capacity was dependent on the health of its workers (Bar and Field, 1996). Poorly managed and poorly funded programs that left physicians without pay, resulted in fees-for-service, extending hospital stays and providing unnecessary treatments as money-making ventures (Rivkin-Fish, 2005:86). After the fall of socialism, a third phase occurred and involved reigning in already minimal payments by the government to the healthcare system and reducing the hospitalization rates and lengths of stay of patients as a means of limiting spending and becoming more “cost-effective” and “efficient” (Rivkin-Fish, 2005: 89).

During the Soviet period, education, healthcare and child care were to be provided by the state at no cost to the citizenry. The health services in particular however, were often under-resourced and segregated based on the person’s position within the Communist Party, their access to extensive personal networks and their ability to pay the increasingly expected fees and tips for supposedly free services. The government publicly prioritized the training and recruitment of doctors and provided large numbers of hospital beds, but often neglected the quality of the personnel or facilities being offered as the percentage of GDP spent on healthcare services plummeted (Bar and Field, 1996).

Professional associations for physicians were outlawed during the Soviet period. This resulted in the removal of an important system for monitoring the quality of care and the chance for physicians to lobby for better working conditions and rights. Claims of bribery, corruption and network favoritism cast shadows on the admission and graduation processes of many physicians, causing their skills to be considered extremely sub-par or non-existent by Western standards. Doctor’s wages came last among state spending, many receiving lower salaries than factory workers, leaving them with little choice but to charge their patients fees in order to survive. Pharmaceuticals and supply shortages lead to a reliance on gray and black markets for the provision of basic materials. Many hospitals lacked even adequate plumbing or sanitation systems, and electricity or the equipment necessary to run basic tests (Bar and Field, 1996). Patients were asked in some cases to provide their own bed sheets, nourishment and even blood for transfusions brought from home if having an operation while in the hospital (Rivkin-Fish, 2005:87) The dissolution of the state after the fall of communism led to a further erosion of these already abysmal services (Hemment, 2004, Spring). The World Bank and International Monetary Fund (IMF) restructured loan payments with the government, and advocated for the state to eliminate promises of universally free healthcare and to reign in their health spending, exacerbating the underlying problems and compromising patient care (Rivkin-Fish, 2005: 87-9).

The Changing Relationships between the State, Civil Society and the Individual

Radical economic and social reforms enacted by the new governments, who were under World Bank and IMF pressure, failed to install more equitable socio-economic structures. Rising unemployment, withheld wages, and hyperinflation forced the already poor and desperate to rely on personal networks in order to obtain the social security that the government was failing to provide (Hemment, 2004, Spring). Janine Wedel (1998:3) comments that many Westerners were and still are “naïve to the realities of the Eastern world and the political skills it took just to survive” on a daily basis. The changing relationships between the individual and the state and the growing institutionalization of the private sphere exacerbated the citizen’s distrust for the state. This distrust was later projected from the state onto Western aid and interventions (which will be discussed in a later section).

The public sphere is traditionally regarded as an inclusive space where private individuals could come together as a public to debate issues of public authority such as governance. The private sphere complemented this sphere as an area traditionally outside of the reach of the government or public institutions (Habermas, 1989:27). Civil society was seen to occupy the space between the state, the market and the private; and conventionally consisted of NGOs, associations, community groups, trade unions and social movements (Centre for Civil Society, 2004). The public, private and civil society spheres have been referred to as the legs on a “three-legged stool”, with a separate but equal balance existing between all three legs. In reality, the situation is slightly more complicated as balance is not necessarily equitable, and the legs are not entirely separate. A common neoliberal assumption asserts that there should be a distinct separation between the private, civil society and the state. This assumption neglects to realize that the boundaries between these entities are not always clear (Drue, 2002: 187-200).

Modern housing made available after the fall of communism allowed many citizens their first access to a truly “private” sphere, a location reserved specifically for families that could be closed to neighbours and other uninvited visitors previously forced onto the private sphere by institutionalized situations such as communal apartments during the Soviet era. The “official” or “public” sphere (that being controlled by the Communist party) became increasingly dominant in daily life under socialism, as housing was communalized, and a wide array of topics became too dangerous to be discussed in “public” spaces, which were now extended to sometimes include areas within people’s own homes such as shared kitchens, hallways and bathrooms (Oswald and Voronkov, 2004).

The state privileged the public over the private sphere. Increasing productive and reproductive duties were nationalized and incorporated as individual moral responsibilities making once private issues public concern (Einhorn, 1993:31-3). This private and public tension was further exacerbated by the secularization process undertaken by the state during socialism that strove to limit private influence in the public sphere (Richardson, unpublished, 2008). Destined for disaster, the state increasingly took on more responsibility by broadening its political reach into the private realms, overburdening and overstretching its already thin capacity. The state lacked equitable distribution capabilities, dooming it to be resented by the people whose needs were increasingly being ignored. The increasing control of the private sphere where individual responsibilities became public responsibilities only intensified the already deep resentment towards the state for its distributional failures. The fact that the state lacked the structural capabilities to fulfill its existing promises without taking on increasing responsibilities, made these private intrusions all the more hated (Oswald and Voronkov, 2004).

Gal and Kligman (2000: 39) suggest that the private and public spheres are not mutually exclusive and are more like a nested set of ideologies that are overlapping and malleable, sometimes permitting the private within the public and vice versa. The exact distinction between public and private is completely relative to the interactional situation to which it is applied. Civil society often appears as a sort of public within the private sphere, or as a private interaction between individuals and the state existing usually in public space. During the Soviet era, “civil society” in the western sense was almost non-existent, as its functions were being primarily met or excluded by the state. Thus civil society came to be known as anything not being determined or offered by the Communist Party (Hemment, 2004 Spring). International foundations in the post-socialist context presented civil society as the antidote to the state, which was characterized as corrupt and obsolete in Russia even though the state was needed for these NGOs to gain recognition, practice legally and distribute resources (Drue, 2002: 183).

The growing distrust for all things public, stemming mostly from a lack of adequate resource distribution, favoritism and corruption amongst unequal hierarchies, increased estrangement from the state or public sphere and induced a withdrawal of many citizens from the routinization, institutionalization and standardization that socialism was providing. The boundary between public and private was blurred and permeated by the resource-attaining practice of blat, a collection of personal networks that transcended the private sphere while attempting to obtain public goods (Oswald and Voronkov, 2004). Public space became increasingly masculinized after the fall of communism, as competition for jobs forced many women from public roles and back into the home, leaving little space for female involvement outside the private sphere. These women, barred from the traditional public sphere, often became increasingly active within civil society, organizing associations and NGOs and leading to a feminization of the civil society sector (Hemment, 2004, Spring).

International NGOs Combating Communism

International aid and nongovernmental organizations (NGOs) entered the former USSR upon its collapse, with the original intention of combating communism and transforming the state from communism to capitalism (Wedel, 1998). Expanding civil society was seen as instrumental to the development of free markets and democratic ideals (Hemment, 2004, Spring). The main categories of aid and NGO work being supplied internationally to Russia were interested in privatizing former state services, developing the private sector (including private property reform), democratization and basic humanitarian assistance such as health care. A disconnect between the West and the East facilitated by the Cold War ideologies however, prevented this work from being fully effective (Wedel, 1998: 4). NGOs were painted in opposition to the state, as inherently “good” and representing everything the state could not provide in a less bureaucratized, and more efficient manner that was able to reach local populations more effectively than centralized resource distribution (Fisher, 1997).

The West was originally regarded with suspicion, but also lauded as a potential savior whose eventual assistance was never really in question since it was perceived as fully capable of distributing resources. The East considered the West as a kind of rich Soviet Union able to furnish the vast array of products and services not being supplied under communist rule (Wedel, 1998: 22). The West lumped most of the former states of the USSR into the category of “undeveloped”, akin to the Third World, as they began providing aid, NGOs and development schemes to ease the transition from communism to capitalism in the region. This was interpreted by Russians as insulting since many saw themselves as being more or equally “civilized” and “cultured” as the West, needing institutional and social changes instead of economic growth and handouts (Wedel, 1998: 20). The problems in the post-socialist era were difficult to address as Hemment (2004) explains in her example of a highly educated woman with graduate degrees, who lives in a tiny two-bedroom apartment with no hot water, her family of five and her in-laws. The socialist situation was comprised of a highly educated population living in extreme poverty, with few rights and unable to make a living, and differed greatly from the Third World situations.

International anti-communist, pro-natalists intent on transitioning Russia towards capitalism after 1989, were accused by Russians of working to strategically depopulate the country due to their push for abstinence and individual moral changes in the face of existing East-West tensions, perceptions and suspicions (Rivkin-Fish, 2005: 215). Applying pre-existing and inappropriate models of aid in the Russian context had the reverse effect of transference to capitalism by solidifying support for the socialist parties and strengthening “mafia-style” networks that were clinging to resource possibilities and the power vacuum created upon the state’s retreat. The lack of transparency along the aid-distribution channels intensified the connection between the realities of the former socialist state and the realities of capitalism, as Western aid, untracked, was assumed to be in the pockets of the elites, much as under socialism. Many Western aid officials were assumed to be spies sent by the West to evaluate the potential competition of the Eastern producers, with as much as two-thirds of the Russian population believing that the US had a calculated anti-Russian foreign policy (Wedel and Creed, 1997).

Depoliticizing the Political

Perceptions can shape the success or failure of any aid mission, and to be most successful aid must be apolitical, not operating within the standard political debate (Creed and Wedel, 1997). The depoliticization of aid became nearly impossible in Eastern Europe as the socialist legacy ensured the economy was completely controlled by the political apparatus. Personalistic connections were required for the NGOs and associations to distribute, arrange and acquire resources, lending legitimacy to the existing inequalities and undermining attempts at institutional and social reform. Many sectors, such as health care and agriculture were highly politicized. Collectivized farms, for example, were seen as the biggest threat to capitalism, with Communist support being saturated mostly in rural areas. Attempts to decollectivize were promoted as the best way to defeat the remaining Communist influence that was primarily in control of the collective farms, essentially restricting the possibility of production to non-collective means, eliminating a way of life for many and hailing capitalist production as the only possible way (Creed and Wedel, 1997).

In health care during the socialist period, the state largely ignored its purported responsibilities to its citizenry by blaming “low levels of culture” (Rivkin-Fish, 2005:91) and an “underdeveloped sense of individual character” for ill health. It began targeting the individual for moral transformations instead of examining the possibility of structural or policy reforms. This essentially privatized perceptions and shifted the blame from state to individual. The widespread use of abortion during the socialist period offers a prime example of this politicization. The Soviet pro-natalist and state-production agenda originally passed restrictions on abortion, focusing on the size and quality of the population as being most important to national production and essentially making the issue one of national security (Rivkin-Fish, 2005:4-5).

Abortion was later institutionalized as the most accessible means of fertility control with all other choices being almost non-existent. As a result, abortion rates more than doubled the live-birth rate and the population began to decline. Official policies institutionalized the focus onto the individual as potentially antisocial and degenerate, changing health education to conform to standards of ‘proper’ hygiene and sexual restraint and making the problems individual moral problems as opposed to state structural ones such as growing inequality, poverty and the decline in universal services (Rivkin-Fish, 2005: 93-4).

Reinforcing Social Inequalities and Hierarchies

International aid officials decided they had seen the problems of the Russian health care system before and applied inappropriate and existing models from the Third World to ‘fix’ them. They were critiqued as not listening to Russian input or promoting cooperation and sharing of ideas between the East and the West; instead lecturing and devaluing the professionals in existence even though they claimed to be working in a democratic fashion in collaboration with the locals. They assumed total Russian ignorance and ignored the scientific and research opportunities in the socialist context that gave many Russians knowledge and abilities equal to or surpassing Western knowledge and abilities. Aid officials attempted to make appeals to change more receptive to the Russian audience by entirely disregarding their knowledge and former modes of care (Creed and Wedel, 1997). Westerners also completely ignored Russian priorities while claiming to be promoting them. Russian officials in the early nineties placed low priority on the health care system instead focusing on socio-economic and ecological causes of disease, while the WHO (professing to be following the priorities of the Russians) prioritized sanitation and maternal and infant health as the most pressing issue (Bar and Field, 1996).

An anthropologist noted the disrespect offered by many international organizations to local organizations at local-run events. This disrespect was evidenced in their sending low level workers with little decision-making capability that “dressed in blue jeans”, “appeared bored” and were unable to comprehend the language or situation at hand (Drue, 2002: 192). Drue (2002: 205) also illustrated the marginalization of local groups who had to account for their lives and convince sponsors of their social worth in order to receive funding or acknowledgement. This was compounded further by a complete lack of attention from the government and media even after receiving extensive NGO training in media and governmental relations by international parties and attempting to implement this generic training in the Russian context.

Convinced that the Russian health care system was akin to medical practices in the West in the 1960s and 70s, the international community emphasized the Russian’s problems as being “familiar” or “behavioural” and not technological or induced by systemic poverty. They moved away from the original focus of maternal mortality to narrow in on issues such as changing the practice of separating mother and child at birth, promoting breastfeeding over scheduled feedings; allowing companionship during birth, removing the “dehumanized” nature of practices and changing the emphasis from institutional demands to consumer wants and needs. This characterization of “dehumanized care” led the World Health Organization (WHO) to promote the reorganization of post-natal care from concentrating on biomedical expertise to the individual needs and demands of the patients. This essentially recontextualized the original issue of maternal health into a women’s social issue that ignored the local cultural norms and standards. It blamed the physicians while ignoring the role of the state attempting to be apolitical. What the aid officials didn’t realize is that the political was already thoroughly intertwined in the health care system through the unequal hierarchies (where physicians received low status against the powerful state), and the blurred boundaries that existed between public and private spaces that allowed for state control on almost all levels (Rivkin-Fish, 2000: 79-80).

‘Democratizing’ Clinical Practices

The Russian physicians blamed their problems on a lack of proper supplies, equipment, communication and financing from national sources, and placed little value on the institutionalized and medicalized nature of their health system. The WHO’s focus on eliminating embarrassing (by Western standards) procedures such as the forced provision of enemas and pubic shaving, routine in Russian birthing practices, reflected a lack of local cultural understanding of the body and its care in this region as Russians saw this to be an unimportant issue. Westerners assumed the medicalization of health care practices during childbirth equated to the subordination of women as a need for physicians to assert their power, much as doctors had in the West in the 1960s and 70s (Rivkin-Fish, 2005: 60-90).

International bodies assumed that the Russian physicians’ resistance to change was induced by a self-interested quest for power, much as in the West, due to their prestige and position as a physician and the lack of knowledge of their patients. They neglected to realize however, that physicians in Russia were not afforded the same status as in the West. In fact, the deep investment in the ideology of biomedicine, which stressed technology, knowledge and research in medical practices, was rooted in the need for physicians to achieve professional efficacy in a hopeless socio-political environment. Little chance for advancement of material or symbolic power due to low wages and poor status as a physician resulted in many clinging to their knowledge over their patients as a way to express their social dominance and experience social power that was otherwise missing from their lives. In fact, the feminization of the position was seen as caused by declining wages and low political socio-economic status, resulting in more than seventy percent of doctors in Russia being female. The West’s assumption that the Russian present was the same as their past neglected to address the low status to which doctors were afforded in Russia, and prevented the Russians from heeding the advice to individualize and humanize care (Rivkin-Fish, 2005: 60-72).

The international aid community failed to acknowledge the undemocratic position that physicians were accorded due to their limited access to state communication, policy direction and financing. Instead, they plowed along promoting a ‘democratic’ clinic setting hoping it would vertically transcend the hierarchies in existence, but not realizing the physicians didn’t have the technical, political or financial means to make it happen. By “throwing out ideas” at the individual level and hoping that they “plant seeds” into larger structures, the international community essentially commoditized these ideas, making them “seemingly available for any individual to choose according to their desire and whim” and un-attaching them from the structural positions in which they are embedded (Rivkin-Fish, 2005: 61).

Transferring Perceptions

The perception of international aid as being able to actually distribute resources and make changes quickly faded, casting it in much the same light as the former Communist state that was also unable to equitably distribute. The promises of change and lack of actual structural transformations brought about by the promises, only further isolated the population from the hierarchal structures of aid, and made them continue to be reliant on their own networks for survival. Individual blame and expectations of personal change as a way of achieving democracy, with no demands on institutional or structural changes, angered the population into resistance and reminded them of the public intrusions by the state into their personal affairs. The lacking levels of transparency and use of blat networks to distribute resources also painted international assistance in much the same light as the state. These perceptions and associations determined the fate of international intervention and prevented it from being a true success.

Hope for the Future

Is it possible for international aid and intervention into this region to be successful? Is international intervention even necessary and what can be done to ensure that this intervention is not reinforcing current hierarchies? The example of Uryupinsk, a city in the Volgograd region, demonstrates the ability of the community to strengthen itself without international intervention.

Uryupinsk has an incredibly active population with a strong sense of community and incredibly proud citizenry whose needs are being primarily met through local initiatives. The local cell of the Communist Party of the Russian Federation (KPRF) has taken on the role of civil society within the community and has been able to provide quality services for its citizenry. Since the KPRF is no longer the party in charge, it is able to play the role of intermediary between the population and the state. Zhensovets (women’s councils), trade unions and street committees are extremely active and powerful and are being fully promoted and funded by the KPRF.

The street committees are the most power organization at the grassroots level, and are able to deal with about half of the problems, conflicts, sanitary and welfare conditions of its population without using any state judicial or structural authority, literally reaching everyone in the community. They have also been described however, as the political machine of the mayor, as they use his access to networks and resources to negotiate supplying the population with their needs and desires in return for votes in the elections. The people who lead the street committees are actually neither directly imposed on from the state or criminal groups, and are able to use negotiation with these groups to provide for the welfare of their community. Their primary responsibility remains to the population (Kurilla, 2002).

If this is the case, it would seem a local form of ‘democratic’ structure has taken root here, sprung from the communist remains. The politicians are providing the citizens with their needs in return for votes. If the politicians failed to meet their promises, the citizenry could choose to change their votes in the next election, and find other ways to meet their needs. This example shows that the Russians are able to meet the needs of their population by themselves and use the existing networks to negotiate change. It is not without difficulties and problems, but shows that collaborative efforts created specifically for the Russian context by Russians have the ability to work and need to be encouraged.

International intervention would best be served as a two-way, collaborative effort between East and West as opposed to an imposition directly led by the West. Russians should direct their own priorities and be given the voice to strengthen their own structures. The international community would be best to address the issues of socio-economic inequality in the light of structural hierarchies that exist instead of focusing on individual changes to achieve democracy. The Russians have the ability, knowledge and passion to change their own future, but are being denied this possibility because of structural and institutional problems. Changing the role of the state sphere so that it doesn’t interfere into personal freedoms would be the first step for the Russians to attain balance and respect within their own system. International financial institutions like the World Bank and the IMF should promote the strengthening of certain state structures, such as the health care and education systems, so that they are functional on at least a basic level instead of trying to privatize all enterprises, to ensure the population is able to be productive and thus pay back their loans.

The governments need to prioritize their spending so that the basic needs of their citizens are being met, and restructure their system to allow for public input and opposition. The individuals need to be empowered by the state to take on this role, so that they are directing the services and in charge of their own future. The state must be supported by the international community in its efforts to be more transparent and accountable to its population. Specific sanctioning and provision of aid given on the conditionality of being as transparent as possible could help push the state towards this goal and help to ensure that aid is being received where it is needed. Investment into proper facilities, wages and equipment within the health care system is necessary for adequate levels of care. The encouragement of physician’s associations who can lobby for better conditions, education and services by the state and international officials, could help to strengthen the health care services and provide the physicians back their sense of pride and status. Most importantly, the Russians should decide how their systems should run, and all initiatives should be on a thoroughly collaborative, Russian-directed and specific basis.

Conclusions

This paper has demonstrated the state’s intrusion into the private sphere under socialism and how this intrusion led to resentment and withdrawal by the citizenry. It has shown that Western intervention and aid was received in this context, using these structures and reinforcing them in the way it structured and provided its assistance. It described the attempts of international officials to remain apolitical in a highly politicized environment and how this reinforced the structural hierarchies and prevented success. It detailed the crumbling health care system in Russia and how the undemocratic structure within the system left physicians with little power to make change. International intervention placed their emphasis for change upon these individual physicians while ignoring the larger structural problems that were preventing actual change. The need for a balancing of public, private and civil society was addressed as well as the importance of cultural specificity in the design, implementation and delivery of aid.

The Russians are fully capable of directing their own systems, and are in the most appropriate position to design programs that will exact positive change within their region. Aid supplied in non-specific, and unaccountable ways will only further exacerbate the underlying problems and provide temporary solutions to short-term needs. The international community would be best to provide assistance in the form of knowledge sharing, technological transfers, promoting localized solutions to problems and the restructuring of the state so that it is able to meet the needs of its population. It cannot do this without transparency in the face of clouded cultural perceptions. The international community needs to learn to work in collaboration with populations, governments and local organizations, in a more secondary or assistive and not authoritative and superior manner.

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