Who Failed Afghanistan? Who will help it to succeed?

 

The International Security Assistance Force (ISAF) was a multinational military mission in Afghanistan from 2001 to 2014. It was established by United Nations Security Council Resolution 1386 pursuant to the Bonn Agreement, which outlined the establishment of a permanent Afghan government following the U.S. invasion in October 2001. ISAF's primary goal was to train the Afghan National Security Forces (ANSF) and assist Afghanistan in rebuilding key government institutions, though it gradually took part in the broader war in Afghanistan against the Taliban insurgency.

ISAF's initial mandate was to secure the Afghan capital of Kabul and its surrounding area against opposition forces to facilitate the formation of the Afghan Transitional Administration headed by Hamid Karzai. In 2003, NATO took command of the mission at the request of the UN and Afghan government, marking its first deployment outside Europe and North America. Shortly thereafter the UN Security Council expanded ISAF's mission to provide and maintain security beyond the capital region. It gradually broadened its operations in four stages, and by 2006 took responsibility for the entire country; ISAF subsequently engaged in more intensive combat in southern and eastern Afghanistan.

From 2006 until 2014, NATO debate on ISAF centred around means instead of ends: how the burden of fighting should be equally distributed among the member states; what operational concepts like the “comprehensive approach” or “counterinsurgency”—often wrongly termed “strategies”—should be followed, or how to “transition” to Afghan responsibility. Pursuant to its ultimate aim of transitioning security responsibilities to Afghan forces, ISAF ceased combat operations and was disbanded in December 2014. A number of troops remained to serve a supporting and advisory role as part of its successor organization, the Resolute Support Mission.

The decision to launch a follow-on, NATO-led non-combat mission to continue supporting the development of the Afghan security forces after the end of ISAF’s mission in December 2014 was jointly agreed between Allies and partners with the Afghan government at the NATO Summit in Chicago in 2012. This commitment was reaffirmed at the Wales Summit in 2014.

Resolute Support was a NATO-led, non-combat mission. The mission was established at the invitation of the Afghan government and in accordance with United Nations (UN) Security Council Resolution 2189 of 2014. Its purpose was to help the Afghan security forces and institutions develop the capacity to defend Afghanistan and protect its citizens in the long term. 38 Countries (Albania, Armenia, Australia, Austria, Azerbaijan, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, Georgia, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Mongolia, Netherlands, New Zealand, North Macedonia, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Turkey, Ukraine, United Kingdom an United States) had posted their personnel to the mission in Afghanistan at different points in time.

In February 2020, the United States and the Taliban signed an agreement on the withdrawal of international forces from Afghanistan by May 2021.

On 14 April 2021, recognising that there is no military solution to the challenges Afghanistan faces, the Allies decided to start the withdrawal of RSM forces by 1 May 2021.

NATO’s assumption of ISAF command on the one hand, and ISAF expansion on the other did not go hand in hand with a total revision of the DOD’s (US Department of Defence) position. Not only the sentiments of the “unilateralist” major US but the emotions of the non-Muslim world post “9/11”, which pushed NATO to be engaged in Afghanistan as intensely as possible − even without clearly defined political goals. This was not a conscious project but an unintended result of the colluding interests of the political masters in NATO countries with those of their administrative cadres. UN was made the Accidental Front.

The Afghans now have suffered generation after generation of not just continuous warfare but humanitarian crises, one after the other, and the world has to remember that this is not a civil war that the Afghans started among themselves that the rest of the world got sucked into. This situation was triggered by an outside invasion, initially by the Soviet Union, during the Cold War, and since then the country has been a battleground for regional and global powers seeking their own security by trying to militarily intervene in Afghanistan, whether it be the United States after 2001, the C.I.A. in the nineteen-eighties, Pakistan through its support first for the Mujahedeen and later the Taliban, or Iran and its clients. To blame Afghans for not getting their act together in light of that history is just wrong.

In the nineteen-nineties, there were only three governments in the world that recognized the Taliban: Pakistan, Saudi Arabia, and the United Arab Emirates. And this time around, too, Pakistan will be one of them. It isn’t the nineties, but Pakistan is still in the same awkward place that it was last time around. The Saudis and the Emiratis have a new geopolitical outlook. But China is not the same country that it was in the nineties. How will China support Pakistan in trying to manage a second Taliban regime, especially one that may attract sanctions or other kinds of pressure from the United States and its allies is something to be watched? Flirting with Taliban will blow back on Pakistan in one way or another, be that in the form of international pressure or instability.

Biden Administration is unlikely to change its policy. US cannot reverse the Taliban’s momentum without bombing Afghanistan to shards. US can certainly take responsibility for the lion’s share of the response to this unfolding humanitarian crisis to arrest the setting in of another massive refugee flow, which could certainly have political consequences.

US does what it likes – be it in Korea, Vietnam, Persian Gulf, Iraq or Afghanistan – the rest of the countries either support or keep quiet, few feeble voices of dissent are barely audible noises. This is called - जिसकी लाठी उसकी भैंस (Literally it means, he who has the stick gets to own the buffalo or One who owns power owns everything). But what would one say to the situation when the stick-owner decides to leave the diseased buffalo in wilderness and simply run away? लाठी वाला तो इस बीमार भैंस को लाचार हालात में छोड़़कर भाग छूटा है, अब यह बेचारी बीमार भैंस किसकी जिम्मेदारी है, कौन करेगा इसकी देखभाल और तीमारदारी?

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First posted on 28 Aug 2021

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Politics of Commotion: Superficial Dialogue through Digital and Social Media

 

Over the last several years, we are witnessing, may be not perceiving it seriously, that political discourse in India is now getting confined to TV and Social Media and is commandeered by the scheduling consideration of these media options.

To enable the TV editors to gather participants for the debates and encapsulate content for prime time viewing, the messages are created no later than 5:00 pm. Likewise, to ensure proper rest for the media persons and the message sources, political activities, agitations, rallies, sloganeering, press-conferences, are all usually held after 10:00 am but before 2:00 pm.

The use and proliferation of digital and social media has radically changed both the way we are using language and the way we are ‘doing politics’ these days. Virtual space has now become the ‘natural habitat’ of an increasing number of individuals around the world; a space where they engage in discussions, work, shop, bank, hangout, relax, vote, find love partners, conduct their day-to-day activities, and so forth. A large proportion of day-to-day verbal and visual communication has migrated to various participatory web platforms. Social media have been hailed as either emancipatory tools contributing to a more participatory democracy, creating instant awareness about different social issues, a new public space of sorts (‘Arab Spring’ and the ‘Occupy’ movement are two widely cited examples).

A public sphere is a space of political communication and access to resources that allow citizens to participate in it. In this sense, given the exclusionary and commodified character of digital and social media, they cannot be considered as public spheres nor should they raise our hopes that revolution will be tweeted. Social and digital Media is dominated by corporations that make money by exploiting and commodifying users and this is why they can never be truly participatory. On a serious consideration, digital and social media are just another tool of control and containment, a profoundly depoliticising arena that fetishizes technology leading to a denial of a more fundamental political disempowerment.

One can realize the magnitude and impact of the medium if they consider that in the famous ‘Russia meddling,’ posts from a Russian company had reached the newsfeeds of 126 million users on Facebook during the 2016 US election and hundreds of thousands of bots posted political messages during the election on Twitter alone.

Digital and Social media is a new kind of an effective political instrument that, in the context of advanced capitalism, both dehumanizes politics and struggles and absolves people from the guilt of inertia in the face of major social and economic crises. It serves as an escape from the stress of intelligence, the pain and tension which accompany autonomous mental activity. Social Media is actually an effective anaesthesia against the mind in its socially disturbing, critical functions – leading to the knocking out of the mental agitation. Social media, as tools for producing and consuming different kinds of texts promotes a one-dimensional discourse. Consider the characteristics of Twitter’s one-dimensional discourse:

Language used in Twitter is short, fragmented and decontextualized: it is a language that tends to express and promote the immediate identification of reason and fact, truth and established truth, essence and existence, the thing and its function leaving no room for a dialogue and counter-reason. Twitter demands simplicity, promotes impulsivity, and fosters incivility.

Digital media takes the pedestal of instrumental and technological rationality and reduce audiences to the status of commodities and consumers of advertisements.  Such audience commodities that the media consumers become themselves are than sold as an audience to the advertising clients of the media.

Face-book, Twitter and other sites serve as an escape from the mechanised work process, and a breather to muster strength in order to be able to cope with the next round of work again. This allows social media to be marketed as entertainment – an entertainment that is accessible, on demand, any time and every time. For this entertainment to remain as a pleasure, it must not demand any effort of independent thinking from the audience. This constructs an involvement through inertia that creates a false sense of participation, security, homogeneity and consensus. Everyone is presumed to be a producer as well as a consumer of content, and the meaning of the messages get lost.

While there is around-the-clock exposure, constant access, and immediacy (all content is immediately available for reading and commenting), the message in the digital and social media is often decontextualized. The context is always that of-the-moment, limiting broader interpretations, connections and exploration of ramifications. Such content have a planned obsolescence, as the next programme or tweet will draw even more attention, commentary, visibility, and currency. The contents history is the here and now, as an ongoing critique of reality. Meaning loses history.

It comes, then, as no surprise that digital and social media have been serving as the ideal medium for populist parties and their leaders promoting the Politics of Commotion.  Digital and social media constitute an alternative to the mainstream media. Political campaigns started using social media as early as 2009, but it was with the 2019 General Elections that their use was taken to the next level.

Today, most political figures and parties use digital and social media platforms to disseminate their agendas and this has largely changed the way politics is conducted. This is a time when politics is ‘branded’ through social media. While democracies need liberation of the individuals from politics over which they have no effective control,  it seems that digital and social media have a firm grip on a large percentage of the our population, while people, in turn, have no control over digital and social media.

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First published 05 Aug 21

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Surely you are joking Dr. Lele?

 

Evidence-Based Medicine is a hot topic ever since the unpleasant and acrimonious spat between Swami Ramdev, also known as Baba Ramdev, of Patanjali and Dr. Jayesh Lele, MBBS, general secretary of the country’s largest lobby of allopathic doctors, the Indian Medical Association, or IMA was aired on 25 May 2021.

Lele seem to claim that COVID-19 treatment being undertaken in India by the allopathic doctors is Evidence-Based Medicine, which Ramdev was unwilling to accept due to very frequent and recurring changes in the allopathic treatment-protocols being practised, the preceding ones being abandoned citing lack of evidence while the succeeding ones being merely new conjectures.  Following the dictum that ‘absence of evidence’ is not the ‘evidence of presence’ let us dispassionately and objectively examine Lele’s claim.

The updated (revised and improved) definition of Evidence-Based Medicine is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values. (David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes. Evidence-Based Medicine: How To Practice And Teach EBM. 2^nd edition, London: Churchill-Livingstone, 2000)

Speaking at the MLA 2010 Annual Conference, held in Washington DC, Mark Ebell, MD, MS, Associate Professor at the University of Georgia, and Editor-in-Chief, Essential Evidence Plus  defined Evidence-Based Practice as, "Making a conscientious effort to base clinical decisions on research that is most likely to be free from bias, and using interventions most likely to improve how long or well patients live." (https://youtu.be/XWi7vNv2nos )

Evidence-based medicine includes three key components (see Figure): research-based evidence, clinical expertise (i.e., the clinician’s accumulated experience, knowledge, and clinical skills), and the patient’s values and preferences.

Practicing evidence-based medicine is advocated on the promise of improved quality, improved patient satisfaction, and reduced costs.

The EBM Pyramid (see figure) explains the knowledge types and the reliability of such evidence. Evidence in Level I is considered the gold standard of medical knowledge. Evidence in Level II comes from Controlled trials without randomization or Cohort or case-control analytic studies or multiple time series studies. It is often true that the best evidence available to clinicians is their own observed aggregate data. Evidence in Level III is based on expert opinion from experts who have narrowed their focus as much as possible about a complex area. Evidence in Level IV is based on personal experience. This is the least desirable source of evidence and lacks any statistical validity.

There is good evidence (e.g., from RCTs) and there is bad evidence (e.g., from personal experience). Then there’s evidence that falls in the grey area—neither clearly defined as good nor bad. It can be difficult for clinicians to know whether to use evidence in the grey area. To determine the validity of evidence, a team of clinicians with several years of experience in evidence-appraisal should review the knowledge in question. The team can then determine if the evidence is valid (i.e., accurate) and applicable (i.e., useful for the situation or population being considered).

COVID-19 is a fast moving epidemic with many uncertain parameters. In view of the lack of prior knowledge and urgency of the situation to have some understanding, clinicians and researchers worldwide are reporting rapid results in the form of Level III and Level IV evidence. There is no evidence at Level II or Level I about any treatment protocols at this time. These rapidly reported results are continuously changing as new insights on the SARS-CoV-2 virus and COVID-19 emerge.

The treatment protocols adopted by allopathy for treatment of COVID-19 have therefore been non- standardized, non-evidence-based protocols. They have been based on near real-time data, mostly of level IV and level III, to make care decisions with the sole objective of improving outcomes of treatment. Given the urgency for action, transparency, accountability, quality of care and value of care have expectedly taken a back seat.

Numerous preventative strategies and non-pharmaceutical interventions have been employed to mitigate the spread of disease including careful infection control, the isolation of patients, and social distancing. Management is predominantly focused on the provision of supportive care, with oxygen therapy representing the major treatment intervention. Medical therapy involving corticosteroids and antivirals have also been encouraged as part of critical management schemes.

The COVID-19 Treatment Guidelines have been developed by National Institutes of Health of the Government of the United States, to provide clinicians with guidance on how to care for patients with COVID-19. As per the official website these treatment guidelines were last updated on 27 May 2021. (https://www.covid19treatmentguidelines.nih.gov/introduction/ accessed on 06 June 2021). The recommendations in these Guidelines are based on scientific evidence and expert opinion. Each recommendation includes two ratings: an uppercase letter (A, B, or C) that indicates the strength of the recommendation and a Roman numeral with or without a lowercase letter (I, IIa, IIb, or III) that indicates the quality of the evidence that supports the recommendation [Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials without major limitations; IIa = other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion].

As on date, there is only one recommendation rated ‘AI’ for Managing Outpatients with COVID-19 while the most reliable of recommendations for Managing Patients in an Ambulatory Care Setting have not bettered the ‘AIII’ rating. Critical Care recommendations are still at rating B. Recommendations for managing hospitalised patients with varying severities of disease are still at ‘BIIa’ rating.

These guidelines have a clear disclaimer, “Rated treatment recommendations in these Guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient and their provider.”

The above facts clearly indicate that there is no evidence-based-practice or evidence-based-protocol for treatment of COVID-19 in the allopathic system. Based on frugal, confusing, rapidly changing and often low-quality data, clinicians are using and recommending their best educated guesses for treating COVID-19. It is true that an educated guessing is better than no guessing until such time that research becomes available but there is no evidence to show that an educated guess is any better than an uneducated guess.

Surely you are joking Dr. Jayesh Lele when you say that the treatment-protocols being practiced for treatment of COVID-19 is evidence-based-medicine. There is no harm however in your and your fellow members of IMA at least hearing C. Miller when he tells us, “why the practice of medicine is not science.” (Miller C. “Medicine Is Not Science: Guessing The Future, Predicting The Past” Journal of Evaluation in Clinical Practice, 2014, Vol 20, Issue 6, pp. 865-71).

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First published 06 June 2021

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