What I did on my summer vacation

The other day as I was trying to get every ounce out of what remained of summer, riding my bike up the Hudson River, I became really aware of the changing light and the presence of Columbia University just over the hill of Riverside Park. Summer was over. But it was also, compared to last year, a really good one. Last year I was still recovering from a really stressful job and trying to find my way in the new post-work identity. This summer, I took every opportunity that would get me closer to my goals and turned down others that would be less productive. The end result? Here's what I did with my summer vacation:

1. Hosted a birthday picnic for my 30th in Central Park with close friends
2. Ran lots of races with New York Road Runners
3. Hiked Bryce Canyon and Zion with my mom
4. Took a course in global public health in Geneva
5. Took another course in Amsterdam on post-conflict development
6. Traveled by myself for the first time in years
7. Took myself out to a lovely dinner on the river in Geneva
8. Ran a half-marathon through the street of New York City!
9. Went on a billion interviews and met some great people and organizations
10. Learned how to negotiate better for what I deserve
11. Swam in the ocean
12. Had many a lovely Thursday night out with my girlfriends
13. Started knitting again and made a dress for my friend's baby
14. Cleaned my closets and organized all my work and school stuff
15. Grew tomatoes, herbs, and flowers

I'm sure there's more, but with classes starting and some interviews just a few hours away they are escaping me. But it was a really good summer.

Letter to the Editor

Well, if the NYT won't publish my letter on the Afghanistan/Narco-State article then I'll do it myself! :)

Dear Sir:

Thomas Schweich's assertion that eradication must at all counts be pursued is flawed (Is Afghanistan a Narco-State?, July 27, 2008). There is a middle way to the poppy problem: pay farmers to grow the crop and turn the harvest into much-needed pain medication.

When more than 80% of the world's cancer patients and more than half of those with HIV/AIDS suffer severe pain but can not access drugs to ease their pain, to destroy crops with medicinal value is an enormous missed opportunity. By directing a portion of the funds now directed to eradication, the U.S. and its allies could help the Afghan government channel the crop into legitimate uses and be seen as a force for development instead of livelihood destruction.

This isn't a new idea. Turkey's government also refused eradication requests made by the U.S. in the 1970's and the two countries brokered an agreement that permitted the cultivation of poppy crops for medicine. The result? Millions of dollars each year to Turkish poppy farmers and 80% of the U.S. supply of poppy for medicine. Afghanistan's poppy problem requires creative solutions based in human rights and development, not military enforcement.

Alicia Meulensteen, New York, NY

Pain Relief for the Poor

Are we content to allow more than half of the world's cancer patients die in severe pain? Current global policy on opiate access says that we are. I was never aware of the global shortage of opiates for pain management for terminally and chronically ill patients until a very moving series published in the NYT last fall brought it to my attention. In this paper I explore the barriers to increased access and call for a review of existing restrictions on production and access to opiates, as well as an overhaul of regulations in developing countries that constrain the use of these powerful drugs for people in pain.

Pain Relief for the Poor:
Increasing opiate access in developing countries
Before death, agony. The World Health Organization estimates that 80 percent of the six million people who die from cancer each year suffer severe pain, as do 50 percent of those dying from AIDS.1 As development progresses and the world's population lives longer, people in developing countries now have the perverse “opportunity” to suffer and die from the diseases of the developed world—cancer, diabetes, and heart disease being the most common—while lacking the diagnostic and treatment tools that could help manage their illnesses and accompanying pain. Lack of diagnosis and unavailability of or inability to pay for treatment make palliative care and access to potent painkillers more than just an issue of proper medical pain management, but also an issue of inequality and social justice. This paper presents compelling health, political, and human rights arguments for making increased opiate access a priority in global health policy. It then proposes possible measures to greater access that have benefits for stakeholders in both the developed and developing world.

Palliative Care and Health Policy
Palliative care covers symptom management of acute and chronic illness as well as end-of-life care.2 When it is no longer possible to prevent a patient from dying, palliative care aims to alleviate suffering, make the final days as good as possible for both patient and family, and to help the patient die peacefully.3 Palliative care offers the dying patient and their family a support system to live as actively as possible until death occurs. Pain-relief medication such as morphine by no means constitutes the entirety of a comprehensive palliative care program, however, it does play a key role in advanced pain management. Other palliative care treatments include discussing anxieties, spiritual guidance, support of family and friends, physical comfort, and other measures.4 At its essence, palliative care is about enhancing quality of life. Palliative care is an essential part of public health, but one that is often overlooked. The World Health Organization writes:

“Assessing cancer palliative care needs is in many ways equivalent to assessing an urgent humanitarian need to reduce unnecessary suffering of patients and their families. It is important to bear in mind that although – in the medium to long term – effective prevention, early detection and treatment will reduce palliative care needs, palliative care needs will never be eliminated, because some types of cancer will inevitably remain fatal for some patients.”5

The World Health Organization defines essential medicines as “those that satisfy the priority health care needs of the population.”6 Opiates are on the WHO list of essential medicines for all countries, but access to opiates is obstructed by lack of availability of drugs, regulatory and policy barriers, and lack of education about the drugs.7 Recognizing that misperceptions persist around pain management and treatment, the World Health Organization created a three-tier ladder for pain treatment for cancer patients. This logic has been replicated and applied to pain relief and palliative care in other treatment settings as well, such as HIV/AIDS. The first “rung” on the ladder of pain treatment is non-opioids, such as aspirin and paracetamol. Then, as pain intensifies to what the WHO classifies as “mild to moderate” levels, and the first rung of treatment options are no longer effective, mild opioids such as codeine are administered. When the patient is in what they would consider moderate to severe pain, opioids are added to treatment options.8

Misperceptions about addiction—by the patient, their family, and even the medical community—present barriers to medicinal pain relief. The American Cancer Society acknowledges that fear of addiction is a major reason people with access to opiates opt not to take them, even though there is a difference between continued medicinal use of opiates and addiction, and that “when opioids—the strongest pain relievers available—are taken for pain, they rarely cause addiction.”9 Developing countries have additional barriers to comprehensive pain management. Poor health care system infrastructure development, staffing shortages, and limited funds for public health all conspire to prevent palliative care from becoming a priority in national health policies. The WHO reports that “there is a close correlation between the proportion of the population needing palliative care and the proportion of adults living with HIV/AIDS. The highest proportions are found in Botswana and Zimbabwe.”10 Given the lack of access to anti-retroviral drugs for HIV/AIDS and the fact that the majority of cancer cases in Africa are incurable by the time they are diagnosed, palliative care needs to be incorporated into national health priorities.11 The emphasis on national plans that address HIV/AIDS by countries and funders have also directed efforts away from creating national public health plans that deal with the emerging challenges of chronic disease. The World Health Organization found that Ethiopia, for example, inadequately addressed cancer in its national health plan.12

Political Barriers to Opiate Access
Morphine and other opiates appear on the list of essential medicines published by the WHO for inclusion in all national health programs. There is no doubt that opiates are powerful drugs with potential for abuse and that their use must be carefully monitored in the course of treatment. All opiates derive from the same source, the opium poppy, and include heroin, morphine, oxycodone, methadone, codeine, fentanyl, buprenorphine, tradmadol, and others.13 All opiates create a sense of euphoria for the user, but they can also kill by suppressing breathing. Long term use can create dependence, and with use over time greater and greater doses are needed to achieve the same high relief. However, opiates can be used for shorter-term management of severe pain without addiction.

Opiates also have the distinction of being listed as both essential medicines and class 1 narcotics. Two of the best-known derivatives of the opium poppy, morphine and heroin, are both included on the list of Class 1 narcotics, as are several other products of the opium poppy.14 Opium production is tightly controlled by regulations in the 1961 Convention; five articles govern the cultivation and distribution of opium poppy, while only two dictate control and cultivation of coca leaves and cocaine. Yet because of the relatively low cost of production and high resale value of the crop, the end result of these numerous articles and qualifications is restrictions on poppy cultivation and export that limits legitimate medical use while at the same time fueling a lucrative market for illicit drug use.

Legalizing opium poppy production in developing nations is one possible answer to the medical shortage of opiates, and this is not the first paper to propose such measures. The International Narcotics Control Board's 2007 Annual Report acknowledges such advocacy in a recent annual report, though it falls back on its earlier stances and regulations instead of opening the door to further discussion of creative alternative policies.15 Yet the current restrictions on the cultivation and transformation of opium poppy ignore the realities on the ground of the trade in opiates. Article 23 of the 1961 Convention calls for the creation of a national oversight office to closely regulate the cultivation of poppy crops, determine which land and farmer can grow the crop, collect the harvest, and have the exclusive right of import, export, and trade of the crop.16 All of which, upon initial inspection, do not seem overly onerous until one thinks of the top opium poppy producer, Afghanistan, and its government whose rule of law extends not much farther than the city limits of Kabul. Afghanistan produces over 90% of the world's opiates, with 30% of its population engaged in poppy cultivation and production.17 With help from Western military and contractors, the Karzai government continues to routinely destroy poppy crops in an attempt to decrease the supply of raw poppy for the heroin market.

This approach is problematic for a number of reasons, not the least of which is the destruction of a crop whose medicinal use is much needed for poor patients around the world. Destroying crops without compensating farmers creates hostility towards Western forces and countries, including those engaged in peacekeeping and relief efforts. Such actions also deprive farmers in Afghanistan, a country with a GDP per capita of $1,000,18 of the means to support their families, which may lead the men or boys to join rebel movements, become even further indebted to creditors, and ultimately face the decision to give up a daughter as payment or emigrate to Pakistan.19 None of these scenarios are beneficial to the development of Afghanistan.

Human Rights and Access to Opiates
The UN High Commissioner for Human Rights states that the right to health is a fundamental human right, upheld in the Universal Declaration of Human Rights, where it is included as part of an adequate standard of living, as well as in the International Covenant on Economic, Social, and Cultural Rights. According to the High Commissioner, “every State has ratified at least one international human rights treaty recognizing the right to health.”20 What is included in that right, however, is often truncated in the conversation on this human right.

By now, the medical and NGO community is well-acquainted with the rhetoric surrounding the debate on access to essential medicines. Arguments on access to essential medicines usually start and end with access to anti-retroviral medicines or malaria and TB treatments. This narrow focus on treatments for only contagious diseases overlooks the growing problem of treatment for chronic illnesses in developing countries. Disease prevention should of course be a priority in all nations, prevention being cross the board a more cost-effective approach than treatment. Yet the right to health seems to be increasingly construed to the right to a long life, without as much emphasis on a productive life.

Worldwide, most cancer patients are in advanced stages of illness when diagnosed. For them, the only realistic option is pain relief and palliative care. Treatment is no longer an option, if indeed it ever was due to availability of chemotherapy, radiation, and other treatments. In the absence of early and effective treatment, having all the resources available for proper pain management becomes even more necessary to a country's health policy. The vast majority of the world's legally produced opiates—more than 85%—are consumed by just 20 developed nations.21 Pain medication should not be the luxury of those who die in hospitals or hospice only in the developed world.

The economic benefits of pain management are also an important consideration in advancing access to opiates. Coping with chronic illness and disease can drive families living on limited resources even deeper into poverty. Proper pain management allows poor patients to remain active and productive members of their communities. It may even allow them to return to work, which in even a limited capacity can help earn income to feed their families and continue to send children to school.

Solutions: Pay the Farmer, Place Reasonable Restrictions
Patients in the developing world need access to pain medication. Nations developing and developed all want a decrease in illegal drug use and trade for their own security and the health of their citizens. Afghanistan's development must improve for state security and regional and global stability. To address these goals, a two-fold solution is needed: increased access to raw materials for medicinal opiates and rational restrictions on its trade and use.

Destroying poppy crops is not the answer to any of the objectives above. Achieving increased access to medicinal poppy requires that there be adequate crops. Farmers sell the product because there exists a demand. A World Bank study on market prices for Afghan opium poppy shows that prices have varied widely over the past few years, ranging from a low of $30 to a high of $600. Prices over the past few years have stabilized somewhat, to around $150/kg, likely due to bumper crops in the opinion of the Bank.22 According to the Bank, “Just as the de-facto legal status of the opium trade under the Taliban regime may have helped keep prices low, increasing criminalization and law enforcement efforts subsequently have tended to induce higher prices through higher risk premia, even if success in reducing opium production has been limited.”23 This creates a perverse incentive for farmers to gamble on producing poppy: if their field is the one not destroyed, their returns can be quite great. Legalizing poppy production for medicine would instead provide farmers with predictable, steady income. While some may still decide to gamble in the illicit market, the majority likely will not, preferring instead to be able to feed their families and earn a steady income. Further, making opium poppy a mainstream crop and legal would generate tax revenue to help build up weak government institutions in Afghanistan, while also freeing up hundreds of millions of dollars that could be used for development.

This is not uncharted territory. Since becoming independent, India has legalized poppy production, bringing $40 million in revenue for that nation and its farmers.24 In the 1970's, the United States and Turkey developed a legal poppy production agreement to divert that nation's crop to medicinal uses after total eradication of the crop was rejected by Turkey. Today, the United States gets 80% of its medicinal poppy from Turkey, which in turn earns that nation $60 million a year in export revenue.25 Given that Turkey and India's poppy production still do not meet the global demand for opiates in palliative care, adding Afghanistan to the list of legal providers would create competition, but not an insurmountable amount, for both these countries whose economies are increasingly dependent on other industries for economic growth. Afghanistan will need serious assistance in developing proper controls to regulate its poppy crops but these efforts, supporting farmers and their livelihoods, would likely be received with more enthusiasm by the Afghan people.

Availability due to limited crops is one obstacle, but national and state laws restricting the administration, prescription, and handling of the finished products of opium poppy are perhaps easier to alleviate in the short term. In some cases, countries may have legitimate concerns about expanding access to such powerful drugs, particularly if they are operating in a post-conflict environment where drugs may have fueled wars, either by providing funds for different groups or by manipulating child soldiers, such as in Sierra Leone or Liberia. It is here that the World Health Organization needs to provide more guidance and assistance on implementing reasonable restrictions on these powerful drugs. In a recent survey of sub-Saharan countries and their palliative care policies, the WHO found significant deficiencies in pain management policies, including misperceptions of opiates, lack of workers trained in palliative care, non-existent policies on opiates, and overly-strict regulations on prescription of opiate drugs.26 In India, states issue their own policies on opiate access and regulation, creating a complex web of bureaucracy to navigate when looking to transport opiates across state borders.27 Simplified, national guidelines and licensing schemes would significantly ease the burden facing pharmacies and hospitals seeking opiates and other strong painkillers for their patients.

Increasing access to opiates for those in severe pain will require the participation of several stakeholders. Developed countries and donor institutions have a role to play by easing restrictions on the funds they provide for national health in developing nations and looking beyond infectious diseases when deciding on funding priorities. Global health and regulatory institutions need to help developing countries create reasonable restrictions on opiates that take into account each country's particular development challenges, especially those in post-conflict environments. States need to take assessments of their own internal policies on opiate production and use. Finally, the global community needs to reassess the benefits of opium poppy eradication when considering the effects of such a policy on global access to painkillers, the development of poppy-producing countries and their economies, and the use of funds which could otherwise be spent on regulation and development. Patients suffering around the world deserve better than the status quo currently on offer.

1 McNeil, Donald (September 10, 2007) “Drugs banned, many of the world's poor suffer in pain.” The New York Times. Retrieved on June 3, 2008 from http://www.nytimes.com/2007/09/10/health/10pain.html
2 World Health Organization (2004) Palliative Care: Symptom Management and End-of-Life Care. pp.2 Retrieved on June 20, 2008 from http://ftp.who.int/htm/IMAI/Modules/IMAI_palliative.pdf
3World Health Organization (year unavailable) Care for the Dying Patient and the Family. pp.205 Retrieved on June 7, 2008 from www.wpro.who.int/internet/files/pub/85/205-210.pdf
4Ibid, pp.208-209
5World Health Organization (2007) Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes, Palliative Care. pp.15 Retrieved on June 15, 2008 from www.who.int/cancer/modules/en/index.html
6World Heath Organization. (2008) “Selection and Rational Use of Medicines.” Retrieved on July 8, 2008 from http://www.who.int/medicines/areas/rational_use/en/index.html
7World Health Organization (2000) Narcotic and Psychotropic Drugs: Achieving Balance in National Opioids Control Policy, Guidelines for Assessment. pp.7 Retrieved on June 9, 2008 from http://whqlibdoc.who.int/hq/2000/WHO_EDM_QSM_2000.4.pdf
8World Health Organization (2008) WHO's pain ladder. Retrieved on July 17, 2008 from http://www.who.int/cancer/palliative/painladder/en/
9American Cancer Society (2007) Pain Control: A guide for patients with cancer and their families. Retrieved on July 11, 2008 from http://www.cancer.org/docroot/MIT/content/MIT_7_2x_Pain_Control_A_Guide_for_People_with_Cancer_and_Their_Families.asp
10World Health Organization (2007) A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Sub-Saharan Africa. pp.5 Retrieved on June 8, 2008 from http://www.who.int/cancer/media/FINAL-Palliative%20Care%20Module.pdf
11Ibid, pp.6
12 Ibid, pp.21
13International Narcotics Control Board (1997) INCB Report 1997: Drugs of Abuse. pp.1 Retrieved on June 22, 2008 from http://www.incb.org/pdf/e/press/1997/e_bn_09.pdf
14United Nations. (1961) “List of Drugs Included in Schedule 1.” Single Convention on Narcotic Drugs, 1961. pp.41 Retrieved on June 5, 2008 from http://www.incb.org/pdf/e/conv/convention_1961_en.pdf
15Ibid, pp.49
16Ibid, pp.26
17World Bank (2006). South Asia-Afghanistan: Drug Industry and Counter-Narcotics Policy. Retrieved on July 15, 2008 from http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:21133060~pagePK:146736~piPK:146830~theSitePK:223547,00.html
18CIA World Factbook. (2008) Afghanistan. Retrieved on July 11, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/af.html#Econ
19Vanda Felbab-Brown (March 23, 2006) Hasty Poppy Eradication in Afghanistan Can Sow More Problems. Christian Science Monitor. Retrieved on July 11, 2008 from http://www.csmonitor.com/2006/0323/p09s01-coop.html
20United Nations Commissioner for Human Rights, World Health Organization (2008) The Right to Health: Fact Sheet No.31, pp.5. Retrieved on July 19, 2008 from http://www.ohchr.org/Documents/Publications/Factsheet31.pdf
21 David E. Joranson, MSSW (1994) Global Opioid consumption: trends, barriers, and diversion. IASP Newsletter. 4-5. Retrieved on June 21, 2008 from http://www.painpolicy.wisc.edu/publicat/94iaspg.htm
22World Bank (2006). South Asia-Afghanistan: Drug Industry and Counter-Narcotics Policy. Chapter 5: Prices and Market Interactions in the Opium Economy. Retrieved on July 15, 2008 from http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/Publications/448813-1164651372704/UNDC_Ch5.pdf, pp.3
23Ibid, pp.5
24Romesh Bhattacharji (2007) India's experience in licensing poppy cultivation for the production of essential medicines: Lessons for Afghanistan. Retrieved on July 11, 2008 from http://www.selinascouncil.net/documents/india_case_study
25Jorrit Jamminga (2006) The Political History of Turkey's Opium Licensing System for the Production of Medicines: Lessons for Afghanistan, pp.6. Retrieved on July 15, 2008 from http://www.senliscouncil.net/documents/Political_History_Poppy_Licensing_Turkey_May_2006.
26World Health Organization (2008) A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Sub-Saharan Africa. pp.21 Retrieved on June 13, 2008 from http://www.who.int/hiv/pub/prev_care/palliativecare/en/
27M.R. Rajagopal, David Joranson, Aaron Gilson (2001) Medical use, misuse, and diversion of opioids in India. The Lancet. Vol. 358, pp.140.

Books not Bombs

Great Op-Ed in today's NYT on the efficacy of putting money spent on military actions into education and human development instead. Click here to read the full piece.

It reminds me a bit of my current research on increasing access to medicinal opiates in developing countries. What if we took the money currently being used to try to destroy Afghan poppy crops and instead bought the harvest from farmers, turning the materials around into subsidized pain medication for people dying in developing countries who currently do not have access? I'll be posting that paper next week, once it is finished.

I have many interviews this week and lots to catch up on, in addition to still trying to shake off my epic jet lag. More posts later when I have a moment to spare!

WHO, WIPO, and Wagner

So here I am in Geneva, taking a class through NYU on Global Public Health. And we're acting like such UN groupies. We spent Monday at the ICRC, Tuesday at the WHO, and this morning at WIPO (world intellectual property organization--who knew?).

Geneva is, of course, lovely. It is a cozy, relatively multi-cultural city, and one that seems to blend both the lovely old Europe style with a very diverse population of ex-pats from the UN and migrant workers from everywhere else. It's rare that an European city does it well--I'm jaded on the subject from so much time over here--and from what I've seen on the admitted surface of Geneva it seems to get along better than other cities.

The ICRC was, unfortunately, a big disappointment, mostly due to our speaker. I really wanted to press someone on the issue of neutrality. What was the ICRC's position on Rwandan refugee camps, when other groups pulled out because they realized they were aiding people who had committed genocide? How far can one take the topic of neutrality--and is there such a thing in so many of today's modern conflicts? Sadly, topics I will have to explore on my own, so it seems.

WHO was much better. We spent a lot of time on malaria and also on non-communicable diseases. We don't think about them too much in the context of developing countries, but cancer, diabetes, hypertension, and other things you can't catch are a growing problem in the developing world, largely because the treatment we get in the developed world just aren't afforable to people elsewhere.

Which actually ties into the topic of my research here: the lack of opiods for palliative care in the developing world. Between late-stage AIDS, rising cancer rates, and an utter lack of diagnostic or surgical care in many developing countries, palliative care is needed yet terribly lacking. Something like 3 countries in the developed world consume 85% of the world's opioids, even though they are grown in India and--hello--Afghanistan. Morphine is listed by the WHO as an esstential medicine, but burdensome regulations and misinformation in the medical community prevent their use in many places where people suffer from stages of cancer and AIDS that the developed world doesn't see too much of anymore. People die in agony. More of this happy topic later once I post my paper, but here is a link to the article that woke me up to this issue.

At WIPO today we heard from someone working on the issue of patents and IP issues of folklore, local medicine, culture, and biological material. That was a highlight. One of the big issues in health care equity and ethics is what to do when developing countries provide the raw material for influenza vaccines but developed countries develop the actual "flu shots." Shouldn't the countries that provided the virus receive a supply of the vaccine that otherwise they couldn't afford? How can developed countries and their pharma companies place patents on medicines from plants in the developing world that have been used by communities for generations? We often only think of patent issues when it comes to AIDS medications but it goes far deeper than that.

Tomorrow we go to UNHCR, which I am ridicuously exicted about, having spent several years working for a refugee organization. More on that later. Right now it's back to the EuroCup, which everyone around here is utterly transfixed by, and rooting for underdog Turkey.

Off to summer courses

This is just a quick post to say that it's been really busy since the end of classes and tomorrow I leave for Geneva and Amsterdam for yet more school fun so no chance of getting a post of any depth until I come back! I'll be taking a course on global public health policy in Geneva (and researching palliative care and opioids policy in the developing world) and post-conflict development (researching the role of women and youth in reconstruction) in Amsterdam.

I've been really preoccupied with my job search and the interviews and finally starting to roll in. Here's hoping there are some more meeting requests when I get home.

Until July...

Xenophobia in South Africa

For my Politics of International Development course this semester, I had to follow one country through various themes and research them for two papers. The first paper was posted in March, on South African state-building and reincorporation of the "homelands" post-apartheid. My last topic, the sorry state of South Africa's refugee processing, dealt a lot with rising xenophobia in the country and the shameful scape-goating of immigrants from the rest of the African continent. Sadly, more and more articles on this issue cropped up every day that I wrote the massive paper. Over the weekend it seems the kettle boiled over.

The NYT reports that over 200 people were arrested in and around Johannesburg over the weekend in one of the country's largest waves of anti-immigrant violence. Twelve people were killed, beaten by sticks, shots, or burned alive.

It would be easy to dismiss this as repressed anger unleased in the face of high unemployment, HIV/AIDS edipemics, massive poverty unresolved after apartheid's fall, etc. But it's not just ordinary people who scapegoat immigrants and refugees from Zimbabwe and other nations--government officals have done their share of blaming, as have government ministries and the police force, which has at times encouraged citizens to assist them in outing illegal immigrants. As a result, people are targeted if they appear "foreign" and a lot of apartheid's racial classifications are rearing their heads again as people judge whether someone looks "too black" to be South African.

I wasn't planning on posting my paper because it was, after all, 20 pages long, but I'm going to post a few excerpts below today for some background:

The Rainbow Nation ends at the fence
The end of apartheid was a literal and figurative end to South Africa's “fortified boundaries.”1 Under apartheid, the electric fence along South Africa's border was set to “lethal” and claimed close to 100 lives of those seeking clandestine entrance into or out of the country.2 Under the new government, the electric fence has been in non-lethal mode, but South Africa's borders are not considered any less threatened by many in its government, media, security forces, and indeed even by some in the South African population.

South Africa has long wrestled with its identity. For a nation where race had determined citizenship, redefining what it meant to be South African was an enormous undertaking. To forge a new national identity, South Africa's leadership referred to its peoples past, invoking their common, if divisive, history.3 Experience of this “divided but shared history is used to identify true 'South Africans'...those who are deemed to stand outside this shared history are excluded from its unifying implications.”4 South Africa also tied its new identity to its national borders. Peberdy writes that “the reinvented nationalism and national identity of the 'new South Africa' is 'derivative' in that it continues to identify with the territorial boundaries and national models of the apartheid state.”5 While simplistic, using recognized borders to define the nation allowed the new government to side-step demands for independent territories by both black and white groups within the country during the handover from the old regime to the ANC.

South Africa has created an image of itself as separate from the rest of Africa. The nation historically felt a certain superiority when compared to its neighbors, not uncommon amongst immigrant-receiving countries, who tend to view the desire of other people to move to their country as stronger than it may be in reality, while viewing their own borders as vulnerable to this onslaught of people fleeing poverty and conflict.6 Some South African websites describe migration to South Africa in almost religious terms: “For many, post-apartheid South Africa has become both an imagined Mecca of economic opportunity, or a haven from war-torn or troubled homelands.”7 Under apartheid black South Africans were denied educational and economic opportunities; nonetheless, the apartheid government played up statistics of black migration to South Africa as proof of apartheid's success and the country's position in comparison to other African nations, promoting a view internally that without tight restrictions on black immigration South Africa would be flooded by the rest of the continent.8 This idea supported the racist views of many of South Africa's white citizens. In also created a xenophobia amongst South Africans at large. The nation is struggling with its promises to deliver greater opportunity and equality for its citizens, and this xenophobia is now proving problematic in the country's dealings with refugees and migrants who are viewed as competing for scarce resources and causing violent crime, economic downturns, and rising HIV infection rates.9

Creating “illegal people”
Regardless of how they enter the nation, South Africa's laws for refugees and migrants, and the practices of their security forces and government institutions charged with processing asylum claims, create a system where attainment of the rights on paper is incredibly difficult. It has been argued that the cause of South Africa's hostility to refugees and migrants is not the sheer number of asylum seekers but is instead that South Africa's ministries tasked with handling asylum applications are simply overwhelmed due to chronic under-staffing and poor training.1 Departments lacking translators and other key staff are overwhelmed with any increase in volume of asylum applications, and may be more apt to deny asylum in order to clear cases off the docket. Indeed, part of UNHCR's recent campaign in South Africa was to train more officials to facilitate the processing of additional asylum claims, but many of those trained soon found work in other, more lucrative, areas.2

South Africa's strict refugee laws have been likened to that of Spain, a European nation on the receiving end of migration from developing countries. Other researchers have argued that Spain's laws “are written in a way to marginalize third world immigrants, to regularize the notion of the 'irregulars.'” Barriers to normal status are constructed through long waits for permits and other restrictions.3 South Africa creates similar hurdles. Its government states that asylum claims can be filed at any of its refugee reception offices.4 However, these offices are all located in the country's major cities, not at its border crossing, and are notorious for long lines that are sometimes patrolled by security forces picking up undocumented migrants.5 These centers also make migrant and refugee populations highly visible and vulnerable to abuse from the community.

Several different departments have interactions with refugees and migrants; the majority of them involve security issues. The South African National Defense Force, the Department of Home Affairs, the South African Police Service (SAPS), and the SAPS Border Policing component all have a role in enforcing South Africa's Alien Control Act.6 South Africa's laws similarly not only construct the migrant and refugee as “illegal” by their very nature of being in the country without authorization, but South Africa goes one step further by creating a category of “prohibited persons” who, by their nature, are “without legal standing as persons.”7 This language dehumanizes migrants and effectively categories them as criminals, making abused by police, security, and local populations seemingly more justifiable.

Apart from Africa
South Africa's neighbors are some of the world's poorest countries, and with large income disparities between neighbors often comes a flow of documented and undocumented migrants. The cases of the countries on South Africa's borders also test the largely artificial distinction between “refugee” and “economic refugee.” Zimbabwe is one such case. In the past decade, the inflation rate in Zimbabwe has escalated from 32 percent to over 100,000.8 Today, Zimbabweans face not only hyperinflation but unemployment rates of 80%, food shortages, and an increasingly oppressive government.9 Human rights groups within South Africa have warned that Zimbabwe is near collapse.10 Initial asylum claims from people crossing over the South African border were dismissed by the South African authorities, who stated that “Zimbabwe is not at war” and so any claims were invalid.11 At the time of writing, results from Zimbabwe's March 29 election had just been released, with results pointing to a run-off, and reports of violence and persecution against opposition-party members and sympathizers on the rise. A shipment of arms destined for Zimbabwe came under international pressure to return to China, but violence against the political opponents and suspects opponents of President Mugabe has been increasing. According to the BBC: “The defense minister in neighboring Botswana said Zimbabweans were fleeing the violence, with almost 100 people arriving in the past three days. He said in the past, Zimbabweans had been economic migrants but now they were seeking political asylum. There have been similar reports from Mozambique.”12 If one looks to Kunz's theory that refugee migrations are signaled by the early migrations of a few, and then examines the situation in Zimbabwe, it makes little sense to categorize those fleeing Zimbabwe now as legitimate refugees but not those who left earlier in the unraveling of the state.

Numerous human rights abuses have been documented in the arrest and detention of undocumented migrants, refugees, and those suspected of being non-citizens by security forces in South Africa.13 Several human rights NGOs have also highlighted growing abuse of asylum seekers.14 These abuses include frightening parallels to apartheid's police state. Police have used “irrational standards to determine whether individuals are 'illegal immigrants,' including skin color and location of vaccination marks.”15 People report being stopped and interrogated based on perceptions of their race or nationality due to “texture of hair and breadth of nose.”16 This has led to persecutions of naturalized South Africans by police forces who have determined them to fit one of their arbitrary conditions, a troubling allusion to apartheid's pass laws when black South Africans could be stopped and forced to produce their papers.17 Such actions now violate South Africa's Bill of Rights and the right to privacy of all its citizens.18

Host governments of refugee populations often argue that refugees “present serious economic, environmental, and security threats, and that they can no longer keep their borders open.”19 Over 50% of South Africans still live in poverty,20 and despite an end to formal segregation and discrimination, the majority of the country's wealth still resides with its non-black population. These economic disparities contribute to the scape-goating of migrants and refugees. Maharaj writes that “xenophobia is rife in the townships, where migrants are referred to as kwerekwere (disparaging word for African immigrant). It has been argued that xenophobia thrives where economic deprivation and hardships are acute.”21 Regarding its treatment of Mozambican refugees, even UNHCR criticized South African xenophobia.22 In recognition of the problem in South Africa, national ministries, working with UNHCR, launched a campaign against xenophobia in the country in 2000.23 Even as of last month, South Africa's government offices were still taking steps to address the issue.24 It is a sign of progress that the government seems acutely, and uncomfortably, aware of negative perceptions of its treatment of asylum seekers.25 How the government chooses to continue to address the problem will be illustrative.

1Jeff Handmaker. (2001) No Easy Walk: Advancing Refugee Protection in South Africa . Africa Today, Vol. 48, No.3, pp.98
2UNHCR. (2005) UNHCR Global Reports: South Africa. Retrieved on May 3, 2008 from http://www.unhcr.org/publ/PUBL/4492678e0.pdf
3Jonathan Klaaren; Jaya Ramji. (2001) Inside Illegality: Migration Policing in South Africa after Apartheid. Africa Today, Vol. 48, No.3, pp.39
4South Africa Department of Home Affairs. Directorate: Home Affairs. Retrieved on May 5, 2008 from http://www.home-affairs.gov.za/refugee_affairs.asp#3
5Refugees International. (2004) Zimbabweans in South Africa: denied access to political asylum. Retrieved on May 6, 2008 from http://www.refugeesinternational.org/content/article/detail/3012
6Jonathan Klaaren; Jaya Ramji, pp.40
7Ibid.
8CIA World Factbook. (2007) Zimbabwe. Retrieved on May 1, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/zi.html
9J. Anthony Holmes; Sasha Polakow-Suransky. (April 17, 2008) The Silence of Mbeki. The International Herald Tribune. Retrieved on April 21, 2008 from www.cfr.org/publication/16059/silence_of_mbeki.html
10Zimbabwe Standard (November 26, 2007) Zimbabwe: AU Probes Abuses of Refugees. Retrieved on February 6, 2008 from http://allafrica.com/stories/200711261669.html
11Human Rights Watch (2006) Uprooted Migrants: Zimbabweans in South Africa's Limpopo Province. Retrieved on February 7, 2008 from http://www.hrw.org/reports/2006/southafrica0806/
12BBC News. (May 2, 2008) Zimbabwe announces poll results. Retrived on May 2, 2008 from http://news.bbc.co.uk/2/hi/africa/7382319.stm
13Klaaren; Ramij, pp.35
14U.S. Committee for Refugees and Migrants (2007) World Refugee Survey. Retrieved on May 6, 2008 from http://refugees.org/countryreports.aspx?subm=&ssm=&cid=2020
15Klaaren; Ramij, pp.43
16Maharaj, pp.52 See also Peberdy, pp.21
17Peberdy, pp. 21
18Southern Africa Migration Project. (2001) The South African White Paper on International Migration: an analysis and critique. Migration & Policy Brief No.1, pp.10. Retrieved on April 14, 2001 from http://www.queensu.ca/samp/sampresources/samppublications.
19Karen Jacobsen (2002). Can Refugees Benefit the State? Refugee resources and African statebuilding. The Journal of Modern African Studies, Vol. 40, No.4, pp.579
20CIA World Factbook (2007) South Africa. Retrieved on May 1, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html#Econ
21Maharaj, pp.51
22Klotz, pp.833
23Humanitarian Practice Network (2008) “We are not treated like people: the roll-back xenophobia campaign in South Africa.” Retrieved on May 5, 2008 from http://www.odihpn.org/report.asp?id=2208
24South Africa Department of Home Affairs (2008) Deputy Minister to hold a discussion with youth immigrants/Refugees and stakeholders in Pretoria. Retrieved on May 6, 2008 from http://www.home-affairs.gov.za/media_releases.asp?id=467
25South Africa Department of Home Affairs (2008) Press release, Refugee Day remarks by President Mbeki. Retrieved on May 6, 2008 from http://www.home-affairs.gov.za/documents/refugee_article.pdf