1. This is a moment of tragedy for Asia as well, with the U.S. leaving the country in a worse situation than when it came in
Context: The rapidity with which Afghanistan has unravelled has shocked and surprised everyone. The fall of Kabul, and the ignominious end of any resistance to the Taliban within six weeks of the U.S. forces vacating the Bagram airbase (near Kabul) on July 2, reveals how brittle the vaunted Afghan Security Forces were.
- Taliban’s duplicity: At one level the image of a mature group during the Doha talks while at another, perpetuating violence of the most ferocious kind, is clearly evident as events unfold.
- US’s Blunder: The ‘retreat’ of the United States from Afghanistan in 2021 is far more humbling than the Russian withdrawal in the 1990s. The Russians were at least defeated by Mujahiddeens backed by a superpower, like the U.S. This time the Taliban having played fast and loose with the U.S. has left the ‘superpower’ with not even the fig leaf of a honourable withdrawal.
- U.S. President Joe Biden’s decision to set a date for the withdrawal of the American forces, and treat this decision as one carved in stone irrespective of the situation within Afghanistan — without any consideration of the consequences — clearly enabled the Taliban to take over.
- Compared to the situation when the U.S. left Vietnam in 1975 — which was also seen by many as a kind of ‘retreat’— the Afghan ‘misadventure’ has been a disaster. Under the leadership of the Communist Party, Vietnam was able to emerge as a vibrant nation with a thriving economy. Under the Taliban regime, Afghanistan cannot hope for any such outcome. It would remain the ‘sick man of Asia’ for generations to come, a standing folly to perils of outside intervention in the affairs of another nation.
- Failure of Afghan Government: The Afghan Establishment seemed to give up the fight against the Taliban earlier on by ceding authority to private militias, former Afghan warlords and a rabble of disparate armed groups. To expect that this kind of armed rabble would resist the Taliban was clearly a mistake.
- This is also a moment of tragedy for Asia as a whole. It virtually spells the death-knell of any possible Afghan renaissance in the near future. Instead, the situation is far more likely to encourage erstwhile terror groups, such as the one led by Gulbuddin Hekmatyar — a one-time client of Pakistan and a traditional opponent of the Taliban — to return to their erstwhile hunting grounds.
Major Concerns in the Region:
- Paving the way for terror: As the Afghan state implodes, one should now expect a wider cleaving between Pashtuns, Uzbeks, Tajiks, Hazaras and the myriad other clans that populate Afghanistan. The virtual death of the Afghan nation, approximates as it were to the ‘end of history’.
- Afghanistan versus Syria:
- At the worst of times, Syria had a relatively strong President (Bashar al-Assad), while Afghan President Ghani can hardly be compared to him. The territory of Afghanistan is also very different from that of Syria.
- Afghanistan’s borders, with Uzbekistan and Tajikistan, unlike that of Syria are extremely porous and almost impossible to guard or protect.
- More to the point, the end-game in Afghanistan has little in common with the power equations witnessed in Syria. In Afghanistan, the Taliban is intent on keeping absolute control and is counting on China, Russia, and Pakistan to do so. All of them are more intent on keeping out the U.S., and in effect India.
- US’s Indifference: the U.S. cannot shrug off a major share of the responsibility for Afghanistan’s current plight. Apart from the decision of Mr. Biden not to alter the last date for the exit of U.S. troops in Afghanistan — which sent a clear signal to the Taliban of a collapse of U.S. resolve to safeguard the interests of Afghanistan — the stealthy exit of the U.S. from the Bagram airbase also left an indelible impression as far as the Taliban was concerned: that the U.S. had acknowledged the Taliban’s supremacy in return for the safe passage of their troops. All this has diminished the image of the U.S. in Asian eyes. In light of this, U.S. claims to ‘make America great again’ sound extremely hollow.
- Old threats may resurface:
- It is not possible to discern any reduction in terrorism or the demise of any of the better known terror groups, such as the al Qaeda and the Islamic State (IS), or for that matter, of lesser known terror outfits.
- As a matter of fact, there has been a resurgence in al Qaeda activities recently. The IS, after some earlier setbacks, is again regrouping and currently poses a real threat to areas abutting, and including, Afghanistan. Radicalised Islamist terror and the forces of ‘doctrinaire theocracy’ have, if anything, thus become stronger. The collapse of the Afghan state will ignite many old threats.
Relations in the region
- Stakes for India, Iran: Among Afghanistan’s neighbours, India and Iran are two countries that would find accommodation with a Taliban-dominated Afghanistan very difficult. India, even more than Shia-dominated Iran, may be the outlier among Afghanistan’s neighbours for a variety of reasons, including its warm relations with the Karzai and the Ghani regimes in the past two decades.
- Pakistan may be an enigma of sorts, but the Taliban will need Pakistan at least in the short and medium term. Relations between Taliban Afghanistan and Uzbekistan and Tajikistan may not be easy, but will not lead to any major problems for now.
For India, the virtual retreat of the U.S. from this part of Asia; the growing China-Russia-Pakistan nexus across the region; and an Iran under a hardliner like Ebrahim Raisi, all work to its disadvantage.
2. A Pandemic of non-communicable diseases (NCDs): Doorstep health-care delivery can mitigate the effects of disruption caused by pandemics
Context: The COVID-19 has exposed the chinks in what was traditionally believed to be the armour of health care — institution-based treatment.
- When access to these institutions was severed all of a sudden, States had to introspect about how they could bolster their health-care set-up in ways that would protect it from such disruptions.
- Tenacious link between NCDs such as uncontrolled diabetes and hypertension and COVID-19 outcomes has been apparent. It is clear that control of these health parameters was paramount and would necessitate uninterrupted access to health-care services.
- According to the India: Health of the Nation’s States report, 2016, 55% of the total disease burden in India was caused by NCDs, with the burden of NCDs increasing across all States from 1990 to 2016.
Non-Communicable diseases: are a group of diseases that cannot be communicated from one person to another; They affect individuals over an extended period of time causing socio-economic burden to the nation.
Major behavioral, environmental & natural risk factors-
- Lack of physical activity
- Unhealthy diet,
- Use of tobacco and alcohol,
- Ageing, rapid unplanned urbanization and globalization.
- Air-pollution: Is the most prevalent risk factor among surveyed the population (76%), followed by low physical activity (67%), poor diet (55%). These three factors even beat stress, tobacco consumption, obesity.
Challenges:
- The disruption of access to health care during the pandemic did affect compliance to drug regimens, and led to uncontrolled disease, with implications for quality of life too.
- Lack of awareness.
Response to the Crisis:
- ‘Makkalai Thedi Maruthuvam’ scheme: a community-based intervention to tackle and treat NCDs and to address the crucial issues of prevention and early detection introduced in Tamil Nadu. It involves a tentative budget in excess of ₹250 crore.
- It includes population-based screening for the 18-plus population for 10 common conditions — hypertension, diabetes, oral, cervical and breast cancers, TB, leprosy, chronic kidney disease, Chronic Obstructive Pulmonary Disease, mental health — and the delivery of hypertension/diabetes drugs to patients aged 45-plus besides to those with restricted or poor mobility.
- Data indicates very low community control rates for hypertension (7.3%) and diabetes (10.8%) among patients in Tamil Nadu.
- The efficacy of its chosen method of door delivery of drugs has been proven earlier with the supervised drug regimen, or DOTS therapy used in tuberculosis control.
- Conclusion: Ultimately, the success of a well-conceived programme rests in the proper implementation of each of its components. If Tamil Nadu is able to demonstrate, with this scheme, that it is possible to maintain the continuum of care even in the most trying of circumstances, then, here is a model that could inspire other States to follow suit.
The National Health Policy(NHP) 2017 has recognized the growing burden on account of NCDs and advocates an important change from very selective to comprehensive primary health care package. It focuses on diseases like Cancer, Diabetes, Hypertension etc. It also seeks to utilize the expertize of traditional medicine in this regard.
