by Samia Altaf
For our meeting with the director of the Pakistan Nursing Council, we arrived punctually at a small two-room office tucked away in a corner of the National Institute of Health's campus in Islamabad. In the center of one room was a table covered with a flowered plastic tablecloth, as if awaiting a picnic. Resting on it were a pencil holder, some writing materials, and a telephone. On one side of the table was a rather ornate chair, and on the wall behind it was a framed photograph of Muhammad Ali Jinnah, the man credited with creating Pakistan, in his signature oval cap and a severe black sherwani, a formal knee-length coat. Four rickety chairs, a bit dusty, lined the other side of the table. In the adjoining room were more rickety chairs and another table, on which an elaborate tea service was arranged. A small man wearing stained clothes sat on a stool by the door, and mumbled something as he rubbed sleep deposits from his eyes.
"She's what?" I heard my companion ask in a panic-stricken tone. "Dead! Oh, my God, do you hear that?" she said to me. "The director of the nursing council is dead." She stood still for a minute, as if paying her respects. "How did she die?" she said, again turning to the fellow.
The man looked offended at our misapprehension. "Late. Mrs. S.," he said. Ah, Mrs. S. wasn't dead. She would be late.
My companion, a Canadian, was new to this part of the world and understandably confused by the way Urdu, the national language, is translated into English, the "official" language, especially by people who have minimal schooling. Mrs. S. had gone from merely being late to being "the late Mrs. S." In a way, this slip of the tongue—or of the ear?—was quite symbolic. For in its efforts to make any effective contribution to the changing needs of the health care system, the Pakistan Nursing Council—the federal institution that oversees nursing and all related professions—might as well have been dead.
We told the man that we would wait.
For the past several weeks, my Canadian colleague and I had been traveling through Pakistan as we prepared recommendations for a technical assistance program funded by the Canadian government. She was the external consultant on this project, and I was the local consultant. A pale woman in her early forties, she was dressed that day in loose trousers and a neutral-color top. Privately, I had taken to calling her "Lucymemsahib," after a character in Paul Scott's novel of postcolonial India, Staying On (1977), who exemplifies the imperialist attitude of British hangers-on. True to this model, Lucy had been undergoing a memsahib-like change by barely perceptible degrees each day. Both of us were at times in each other's way, at times at cross-purposes. We were unsure of who was actually in charge—she, by virtue of her status as "lead" consultant, or I, more experienced, though a "local" and hence inferior.
Mrs. S. arrived an hour later quite flustered. She was a shy-seeming, slightly built woman in her fifties wearing a flowery shalwar-kameez. On her head was a starched dupatta—a long scarf—from which raven black hair peeked out. Dyed, no doubt. She looked a bit startled to see me in a sari, wrinkling her nose delicately in what I interpreted as disapproval as she adjusted the dupatta with an elaborate gesture.
"You are not a Pakistani?" she asked, affecting nonchalance.
I told her that I was, and could see that she did not believe me. Why, then, was I wearing a sari? The traditional sari—a single piece of cloth wrapped around the body—is worn by subcontinental women of many religious and ethnic backgrounds. Pakistani women wore saris until the 1970s, when in a period of Islamo-nationalist fervor, and with the tacit encouragement of the government, they adopted the shalwar-kameez–dupatta ensemble—loose, baggy pants and a long tunic with two yards of loose cloth that drape the shoulders. The rejected sari acquired an "Indian" tinge, and came to be seen as vaguely "Hindu" as well as anti-Islamic, a sentiment that hasn't entirely disappeared.
Mrs. S. apologized for the delay, telling us that she had been called away unexpectedly. "Must have been something important," I said conversationally, for she was quite out of sorts. I worried that my sari-clad personage was a contributing factor. This turned out not to be the case. A World Bank delegation was visiting, and she had been called to meet them "right away."
Couldn't she say that she had an earlier meeting and have them wait? Lucymemsahib wanted to know.
"How can you do that?" Mrs. S. asked. "They are the World Bank."
And now, she asked, what could she do for us?
The year was 1992, and Lucymemsahib and I were helping the government of Pakistan prepare a grant proposal for the country's Social Action Program (SAP)—a comprehensive effort to renovate Pakistan's health, education, and water sanitation systems that the World Bank and a consortium of other multinational development organizations had pledged to support. Specifically, we were looking into ways to attract more women to provide midlevel health services in rural areas. As head of the Pakistan Nursing Council, Mrs. S. presided over the governmental organization responsible for the recruitment, training, and certification of nurses at Pakistan's 60 civilian nursing schools and a handful of specialized military institutions.
The SAP we helped prepare, which ran from 1993 through 1998, turned out to be a dismal failure, as was the one that followed in 1999–2003. Subsequent programs, especially since 9/11, show every indication of being as unsuccessful. The critical indicators of maternal and child health tell it all. Estimates of Pakistan's maternal mortality ratio since 1990 range from 300 to 800 maternal deaths per 100,000 live births; even the low end of this range is unacceptable. By contrast, Sri Lanka, another South Asian country, with an income per capita that was roughly comparable to Pakistan's at the beginning of the 1990s, saw its maternal mortality ratio fall from 92 per 100,000 in 1990 to below 50 today. The infant mortality rate in Pakistan in 2003 was 76 per 1,000 live births, as compared with 11 in Sri Lanka. In the developed countries, the infant mortality rate is only about five per 1,000 live births.
Beyond the health care sector, the story is much the same. A report published in 2007 by the Center for Strategic and International Studies in Washington, D.C., concluded that the $1 billion in development and humanitarian assistance the United States has poured into Pakistan since 9/11 has saved lives in areas affected by a massive 2005 earthquake and has improved the lot of a small number of people, but "has done little to address the underlying fault lines in the Pakistani state or society." Assistance from other institutions such as the World Bank and the Asian Development Bank has been equally ineffective.
These stories of failure are nothing new. They have been repeated over the years in numerous programs all over the developing world. The interesting question is why.
Some of the reasons are familiar. Developing countries—often beset by political instability, outmoded institutions, meager resources, and a host of other woes—are desperate for money. (When, in a conversation with a Pakistani official, I predicted the failure of the SAP, he replied that at least it would bring in "foreign exchange for the national kitty.") At the same time, international lending organizations such as the World Bank are under pressure to make loans; otherwise they are out of business. Some baseline "tangible" results are expected when the project ends, but these mainly take the form of documented capital outlays (schools built, computers purchased, etc.) and published reports. There is little interest in assessing whether the projects have actually had an impact on people's lives.
The development history of Pakistan, long before the first SAP, was full of hastily assembled programs that lacked adequate support institutions or other infrastructure. The legacies of this haphazard approach are everywhere. Health centers cobbled together sit locked and empty—sometimes because they lack staff and supplies, sometimes for reasons that aren't readily apparent. The situation in education is at least as dire. "Ghost" schools, which show enrollment figures higher than the number of malnourished, bedraggled students living in the whole village they supposedly serve, are documented as major achievements.
The specialists who design the programs work for and are answerable to distant development agencies. Most are narrowly trained technicians from Europe or the United States who have very little understanding of the social conditions and institutions in the country they are dealing with. At a personal level, they bring with them something more destructive than ignorance: a certain kind of palpable arrogance. They have been designated "experts": foreigners who represent high-profile donors and who command exorbitant salaries. Most are white, which, given Pakistan's colonial experience, imbues them with a tincture of superiority in the minds of the general public. White Europeans were, after all, the colonial "masters." Being human, these experts very quickly gain an exaggerated sense of their own authority and a disinclination to entertain ideas divergent from their own. Consequently, they end up using their sometimes considerable financial decision-making power not to benefit the country they're supposedly there to serve, but in the interest of their own institutions or to protect their jobs.
Present in the country for a short period of time, they are focused on the product—an impressive report, expenditures made—they signed up to deliver. They favor technocratic "solutions." Sickness is to be combated with clinically skilled people, for example; to deal with illiteracy, it is assumed, you need teachers and reading materials. The relationship between problems and their social context is left unexamined. Grandiose, fuzzy, and unrealistic plans that rely on capital outlays and numbers of people to be trained are quickly drawn up with the representatives of the host government, which participates happily—for this will bring in money—or unhappily, because there is no other option. Most funding agencies work on a short budget cycle, so even if some die-hard planner wants to, there is no time to consider larger issues and long-term solutions.
Yet those who give aid and the governments that receive it have the feeling they are "doing something" to respond to the nation's ills. Most specialists do their jobs to the best of their abilities. People with experience know full well that most of the time they are just muddling through, trying to meet deadlines. In the end, government officials, technical consultants, and aid agencies all hope that "some" good comes out of the muddle. Alas, when muddle goes in, muddle comes out, as we have seen in the years since that afternoon in Mrs. S.'s tidy little office, where we witnessed that muddle with our own eyes.
Mrs. S. started by telling us about the background of Pakistan's nursing system, which was inherited from British colonialists.
"We use the same curriculum that was used to train British nurses during World War II," she said with obvious pride.
"Surely it has been updated since then," said Lucymemsahib jokingly.
"You really mean it has never been updated since then? Why not?" asked Lucymemsahib, quite aghast.
"There was no need to," replied Mrs. S. "Only recently, after all this Alma-Ata business, there is pressure to change it," she added, sounding as if this were completely unnecessary.
That "business" was an international conference held in the city of Alma-Ata, in what is present-day Kazakhstan, in 1978. Considered a watershed event for the design of health delivery systems in developing countries, the conference decreed that services based on the Western model were inappropriate for these countries. Since most health problems in developing countries were believed to be the result of environmental problems such as poor sanitation and malnutrition, it was decided that they should be tackled by making improvements in the environment. Any remaining medical needs could be addressed by minimally trained local health workers.
The wisdom or folly of this policy and the tale of its selective implementation are matters for another time. Most of the developing countries, including Pakistan, signed on to the resulting Alma-Ata Declaration, promising to reorient their programs according to a primary health care (PHC) model introduced at the conference. Since there was little discussion of how this was to be done, however, each institution in Pakistan translated the model as it saw fit.
"To meet the needs of the PHC model, we are going to stress more community medicine and family planning in the nursing curriculum. Nurses will be doing all this along with their regular work," said Mrs. S.
"Why?" asked Lucymemsahib. "Nursing is, as its name says, nursing. And equally important. What hospital can function without good nurses?"
"That is true. But it is in the declaration. We have to do community medicine."
"But what about nursing?" insisted Lucymemsahib, clearly not happy about nurses' involvement in this community medicine business.
"What particular aspects of community medicine?" I asked, knowing full well the many colors and constructions of this much-maligned term.
"Oh, just some things to do with the community," offered the director nonchalantly.
After completing a 24-month curriculum, including a practicum rotation in a hospital, nurses take the examination administered by the Pakistan Nursing Council. Once they pass, they are certified and registered by the council. Sounds good. This means there are standards that can be monitored.
"But it does not matter," our good Mrs. S. said, "whether they are certified or not. A lot of organizations hire nurses without any certification and registration. Especially the private hospitals and clinics. And since these institutions pay a lot more money than does government service, the nurses prefer to work for them rather than for the government. Many do not even wait to complete the training program."
"Do these organizations then train these people themselves?" asked Lucymemsahib.
"Oh no, there is no need to train them. They can work." At least Mrs. S. was honest.
"What do you mean, there is no need?"
"Well, they do know the work."
"What work do they do?" Lucymemsahib was genuinely confused.
"Nursing work," responded our hostess calmly, adjusting some papers on her desk.
"But nursing is a skilled profession. A nurse, to be effective, has to perform certain tasks which are technical, and many times critical." Lucymemsahib looked at me, her face flushed and eyes shining with indignation. She was a registered nurse herself. In Canada, nursing is a highly skilled, well-organized, and respected profession.
"Ah, but you see, there is no rule which says that you are not allowed to work as a nurse without certification," Mrs. S. explained patiently. "And practically speaking, even if there were, there is no way we can reprimand them. There is no way to enforce this rule."
"Can you not change the rules and put in regulations?" Lucymemsahib turned again to Mrs. S.
"What rules?" asked the lady mildly.
"The rules regarding the employment of people who are not properly qualified to do the job."
"No, no, rules should not be changed, for this would lead to a lowering of standards, and it is very important to maintain high standards." Mrs. S.'s voice rose with emotion. For all her life, she told us, she had fought to adhere to standards "against all odds."
"What standards are you talking about?" Lucymemsahib's voice was also high.
"The standards of nursing, the noblest profession in the world. It must have the highest standards in the world." Mrs. S.'s voice cracked on the high note.
And, just as suddenly, both ladies stopped talking. Their faces were red and they were out of breath.
Lucymemsahib's worry was justified. Even today, one need only visit any facility in the large cities to see what is going on. "Nurses," whose only claim to the title is their little starched uniform, are blundering through people's lives. I saw a nine-year-old boy die after a routine appendectomy because a nurse did not know that she needed to give him a test dose before administering penicillin, to check for allergic reaction. A hypertensive man had a stroke because the nurse who was monitoring his blood pressure did not think she had to alert the doctor when it became dangerously high. There are nurses who do not know how to read a thermometer.
At the same time, nurses have thriving private practices in towns where they are called "doctor." They dispense medicines, suture wounds, treat ingrown toenails, perform abortions. One enterprising young lady was doing outpatient cataract removals in a small town just 50 miles from where we sat. Her name came up again and again whenever the subject of private medical care or palatial houses—the two go hand in hand in Pakistan, as in other countries—was under discussion. She had done well enough to build a mansion within two years of opening her "practice," complete with marble foyer and imported toilets, which, though completely unusable because of the inadequate water supply, were nevertheless the cause of much envy.
"Why do employers hire unregistered nurses, when they know that these women might not be adequately trained?" My friend was persistent.
"Because there is an acute shortage of nurses in the country, and no clinician can work without nurses," replied Mrs. S. This, too, was a fact, consistently documented. "To date, 19,000 nurses are registered with the council, and given the population, this is an extremely poor nurse-to-population ratio. This means we have one nurse for 6,000 people. On top of that we think that easily half of these 19,000 are out of the country, and the other half are trying their best to get out too. As you can see, there are just not enough nurses to meet the demand. That is why even untrained girls are hired. That is why we need to train more nurses." (According to the World Health Organization, Pakistan had 48,446 registered nurses in 2004—though there is no way to know how many of these nurses were actually in the country—and the fact that health indicators have barely budged shows this is mostly an improvement on paper.)
"This situation exists only in urban areas, does it not?" I asked, for Pakistan is certainly more than its three large cities; almost 70 percent of the population is rural, and rural-urban disparities are a major hurdle in developing standard programs or uniform employment salaries, benefits, etc.
"Of course. What need is there for nurses in rural areas where there are no hospitals? As it is, we do not have enough nurses for urban areas," said Mrs. S.
"Why do you then not increase the output? Surely in a country where there is a shortage of jobs, this should be a very attractive option for women." Lucymemsahib was being logical, applying the law of supply and demand. But this was Pakistan, and there were yet another 10 layers to the problem.
"This is easier said than done," Mrs. S. replied, with a pursing of her lips. "It is not easy to attract girls and women to go into the nursing profession, especially if they come from good families."
"What on earth do you mean!" Lucymemsahib was horrified. "Is it because of poor salaries? Is the pay that low?"
"Oh, no, pay has nothing to do with it," replied Mrs. S. "Girls prefer to go into teaching, although that has still lower pay. It's just that nursing is not considered a . . . a decent profession."
Lucymemsahib looked from me to Mrs. S. and back again, her mouth opening and closing like a fish's.
"But you are a nurse, aren't you?" she said, once she got her breath back.
"Oh, no, no I am not." Mrs. S. was quick to correct her. She was from the federal bureaucracy, a civil servant. Down to the present day, no nurse has served as the director of the Pakistan Nursing Council.
The institution of nursing in Pakistan is a strange hybrid. It is built on the foundations of the health and medical system created by the British in the 19th century to serve the colonial and local elite. Initially, nurses came from Britain. Later, especially during World War II, nursing programs were set up in local hospitals, and, as in Britain, women were recruited. This was a challenge. Educated women from middle-class households, who had some schooling, were reluctant to go into professions. Those that required close contact with people, especially males who were not part of a woman's immediate family, were even less attractive. At the same time, Christian religious missions were well established on the subcontinent, and they had their own schools and hospitals. The missions also took in abandoned infants and children, most of whom were the offspring of English men (often soldiers) and local women. These Anglo-Indians, like the mestizos of Latin America, were mostly the products of nonmarital unions and were shunned by society. They were therefore prime candidates for conversion to Christianity, and for less desirable jobs. Almost all Anglo-Indians on the subcontinent are Christians. At first, most of those who went into nursing were Anglo-Indian Christian girls who lacked other options. From the beginning, nursing in Pakistan thus suffered a double handicap, and it is still seen as an "inferior" profession.
"You have mentioned that nurses leave the country at the first opportunity. Is that a major problem?" I restarted the conversation on a topic that seemed safe.
"Oh, yes! It is a terrible loss," Mrs. S. said, with genuine feeling. "Our own country desperately needs the manpower. But what can we do?"
"All governments can stop the qualified personnel from leaving the country," said Lucymemsahib. "The government can mandate this." Poor Lucymemsahib! For the life of her, she could not understand why it was so difficult for a government to stem the exodus of its trained womanpower, especially since the training was financed by taxpayers or other government-funded programs, as in the case of nurses and physicians.
"All government servants who wish to leave the country need only obtain a No Objection Certificate from the government, and they can go wherever they like," Mrs. S. told us. "Most of the time people are granted this certificate. But it can be withheld in case of essential personnel."
"Aha!" Lucymemsahib pounced on this opening. "Then the government can refuse to give this document to people that it thinks are needed in the country. And it is clear that nurses, being in short supply, are essential personnel."
"But why do it?" Mrs. S. asked patiently and sincerely. "As it is, there are not enough jobs in the country to absorb all the qualified nurses. They go, for they too have families to take care of." She looked to me for understanding. "They work for some years on short-term contracts, and after they have made enough money to build a house, or educate a brother, or collect a dowry for themselves or for a daughter, they come back again." She added, after a brief pause, "In fact, it is better to let them go. Otherwise, they create trouble for us."
The fact that international assistance pays for the training of new personnel but not for salaries to employ them is a major and unresolved problem in all rural health programs in Pakistan. Aid organizations assume that trained workers are an asset to the government, and expect local health service delivery systems to absorb them. In reality, local governments do not have the institutional capacity to deploy, pay, and utilize the trained work force. Hence, senior officials hope that trained personnel, who can be demanding and vocal, will just go away. Their exodus, though contrary to the objective of these programs, relieves the government of blame for not using these workers.
But because policymakers and development experts agree that skilled manpower is essential for improved services, they continue to design and fund training programs. Pakistan has been a recipient of aid for such programs many times. International experts don't try to figure out how the workers turned out by these programs might be used. That is left to the host governments. In unstable regimes, administrators—who are often political appointees with little accountability and slim hope for long tenures in their jobs—have neither an interest in doing this nor an inkling of how it could be accomplished. Or their hands are tied because programs that have been developed outside the country rigidly bind funding to specific activities, even if they are of little use.
Unfortunately, most program evaluations, usually conducted in-house by the donor organizations, rate the training programs as successes, since their products are tangible and can be measured. The host country is happy because the programs bring in lots of money. The local managers are happy because they receive personal rewards—special remuneration, a vehicle, trips to donor countries, and so on. Lending agencies, such as the World Bank, and grant-giving agencies, such as the U.S. Agency for International Development, are happy because they are able to disburse funds in time for the next budget request.
"Oh, good," said my companion, seeing some advantage even in this bizarre situation. "Once these nurses come back, they are more experienced and thus more valuable, so they can be hired at that time. At least the government will have the trained manpower it can use."
"Oh, no, no." Mrs. S. almost recoiled at this suggestion. "Now they cannot be hired at all. The government has placed a ban on re-employment of returning nurses. Any nurse who has worked outside the country in her private capacity cannot work for the government again."
"But why not? They are more experienced. . ."
"Because," and here Mrs. S. did a wonderful imitation of being hurt, "they have rejected us in the first place. Now why should we accept them?"
Actually, the ban is not based on sentimentality alone. Government rules forbid the hiring of anybody 35 or older in regular federal jobs. This, so the explanation goes, is because a government employee can retire with full benefits after 20 years of service. Older people will be more likely to depart as soon as they are eligible, taking their experience with them and drawing full benefits. Most nurses who return after spending some years out of the country are nearing or past age 35, and thus are automatically ineligible for federal employment.
Not enough nurses. Not enough jobs. Nurses working as "doctors." Trained nurses being encouraged to leave the country. Untrained and uncertified "nurses" being recruited in sheer desperation by private hospitals. What a strange and paradoxical situation! Yet there is no discussion of these crucial issues. And new training programs are being developed, because there is pressure from international organizations to include more women, supposedly to meet the human resource shortage.
My companion sat shaking her head. Mrs. S. was starting to look restless. She signaled to the attendant for tea. In a government office, a tea break can become a project unto itself.
"The problem with women," Mrs. S. volunteered conversationally, again adjusting the dupatta delicately on her hair as the tea service was laid out, "is that they all want to get married." Quite a problem, and one the world over. "So eventually they must leave the profession to take care of their husbands and children."
We let this pass, and raised another possible solution to the "problem" with women: training more male nurses. As the primary wage earners, they would not be compelled to leave once they married, and they could tend to the male patients, making it easier to attract women to the profession.
"Not a good idea," according to Mrs. S. And why not?
"Because men are very unreliable. As students, they will agitate the girls," she continued in the same conversational mode, oblivious to the effect of her remark on her audience. "If they are in classes together, they will induce them to strike on petty matters."
"But the girls are under no obligation to do their bidding," Lucymemsahib said.
"Yes, but the poor girls have no choice but to follow the boys. It is natural for them to do so. By themselves, girls never cause any problems. They quietly do what they are told or get married and go away." Mrs. S. warmed to her subject. "Look what is happening in Liaquat National Hospital, Karachi." Liaquat hospital is a major training institution for nurses, one of the few in the country that prepare male nurses. About a third of each entering class was male (as is still the case today). During the weeks before our visit to Mrs. S., the nursing students at Liaquat had gone on strike, demanding better living conditions, apparently at the instigation of male students.
"All because of these boys!" Mrs. S. continued. "So many headaches these boys are causing us." She struck her forehead with the palm of her right hand in the traditional gesture of frustration, causing the dupatta to flop off her hair. She hastily retrieved it. "And the girls are not listening to us either. They are naturally listening to the boys. Stupid things!" She shook her head in indignation.
Lucymemsahib looked at Mrs. S. as if she had come from another planet. Thankfully, the tea arrived at this point, and we fell to it with gusto, under Mr. Jinnah's enigmatic smile from his perch on the wall. Mrs. S. very generously ordered her attendant to run out for some mint chutney to go with the samosas, which were really out of this world.
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Samia Altaf, a public-health physician who has worked in the United States and Pakistan, is the 2007–08 Pakistan Scholar at the Wilson Center. She is currently at work on a book about aid effectiveness in the health sector in Pakistan.
Reprinted from Winter 2008 Wilson Quarterly
This article may not be resold, reprinted, or redistributed for compensation of any kind without prior written permission from the author. For further reprint information, please contact Permissions, The Wilson Quarterly, One Woodrow Wilson Plaza, 1300 Pennsylvania Avenue, NW, Washington, D.C.
Muntazer al-Zaidi has not been seen in public since he hurled his shoes at President George Bush. In Baghdad, Afif Sarhan talks to witnesses who claim that a series of savage attacks left him with a broken rib and serious damage to his eye
- Afif Sarhan
- The Observer, Sunday 21 December 2008
The Iraqi journalist who hurled his shoes at President George Bush was viciously beaten after being taken into custody, according to a police officer who accompanied him to prison.
Left Shoe: THE MOTHER OF ALL SHOES
Right Shoe: NUCLEAR SHOE
Podium: SHOCK AND AWE
Wrestled to the ground and then buried under a frantic mound of security officers, Muntazer al-Zaidi was last seen being dragged into detention. Controversy has since raged over what treatment was meted out to the man hailed a hero in many parts of the Arab and Muslim world for his protest against the invasion of Iraq. Yesterday there were further demonstrations in the Middle East calling for his immediate release.
Witnesses to his arrest and imprisonment have told the Observer Zaidi was badly beaten, during and after his arrest last Sunday, and that he risks losing the sight in one of his eyes as a result.
He is expected to be charged with insulting a foreign leader, which carries a prison sentence of up to two years. His family have received offers from hundreds of lawyers across the region willing to represent him.
An Iraqi judge appointed to investigate his treatment, and who has seen him in his prison cell, said Zaidi has bruises on his face and around his eyes. These, said the judge, had been sustained during his arrest at the Baghdad news conference during which Zaidi threw both his shoes at Bush, shouting: "This is the farewell kiss, you dog."
His family, who have been denied access to him, have claimed he suffered far more extensive injuries and was subjected to a prolonged and vicious beating, suffering a broken arm, broken ribs and internal bleeding. The allegations appear to be borne out by those who have seen him since his arrest.
One police officer, who accompanied him to prison, said the journalist, a Baghdad correspondent for the Cairo-based Al-Baghdadia TV, had been subjected to violence throughout the journey. The officer, who asked not to be named, said he witnessed security forces beating Zaidi in the car with such force that his ribs were broken. "I felt sorry when I saw them beating him. His mouth was badly injured and he did not utter a single word throughout until one of the guards hit him in his left eye with a gun. Then he cried out that he couldn't see, and I saw blood inside his eye. I am a police officer but even I have to say I felt proud of what he did."
A doctor called to examine Zaidi said his right arm had been broken and he had haematomas - indicative of internal bleeding - all over his body, particularly on his left leg, shoulders, face and head. The doctor, who also asked to remain anonymous, said specialists called in to treat him warned security guards that they must make sure his eye was protected for fear of a further haemorrhage which could cause him to lose his sight.
Zaidi's family allege that it is because of the severe nature of his injuries that he has not been called before a public court. As calls for his release were continuing, details of how he planned his extraordinary protest have begun to emerge.
Born into a traditional Shia family, Zaidi made no secret of the fact he was vehemently against the US-led occupation of Iraq and, according to family and friends, had said many times he would like revenge on Bush. A younger brother, Haythem, said Zaidi had unexpectedly found himself called on to cover the press conference held by Bush and Iraqi prime minister Nouri al-Maliki. His first action, it seems, was to return home immediately to change his foreign-made shoes into Iraqi-made ones.
A colleague at the TV station said Zaidi mentioned just before going home that "if something had to be done, it had to be 100 per cent Iraqi".
"Muntazer had repeated many times that if he had the chance, he would take revenge against the US president," said the colleague. "He held him responsible for the deterioration of the conditions we were living in. He just didn't have the chance before, and being asked to cover the conference was an opportunity for him. I am proud of him because he did what all of us have dreamed of doing, but were too scared to do."
Yet there is some confusion over whether the world's most famous shoes were indeed Iraqi. While another brother, Durgham, has insisted they were from the Baghdad factory of Iraqi shoemaker Alaa Haddad, cobblers from Turkey, Lebanon and even China - where most of Iraq's shoes are produced - have lodged rival claims.
Istanbul producer Ramazan Baydan insists the brown thick-soled shoes are his and currently known as Model 271 but soon to be renamed the Bush Shoe, or the Bye-Bye-Bush Shoe. He has hired an agency to promote them, claims to have taken 300,000 orders since the protest and plans to employ 100 extra staff to meet demand.
The originals, however, have been destroyed by investigators trying to determine whether they had contained explosives, which may come as a blow to Zaidi when he learns that Saudi Arabian Mohamed Makhafa had, reportedly, offered $10m for his 'shoes of dignity' and their 'high moral value'.
Friends of Zaidi speak of a dedicated journalist who lives in a small flat filled with books, many of them religious, and who was deeply interested in humanitarian issues. His political beliefs, however, remain unclear.
One colleague alleged he had been a Baathist under Saddam Hussein's rule and after the US-led invasion turned into a defender of religious cleric Muqtada al-Sadr's ideals. "I know people are seeing him as a hero, but he would do anything to become famous," said the colleague. "He said many times that he would like to become president of Iraq." Others, however, vehemently disagree with these claims.
Ahmed Ayssam, who graduated with him at the Communication College in Baghdad, described him as hard working and preferring to spend time with his books and family rather than going out. "He wanted to make a difference since he was a student, and he did it,' said Ayssam. "He is an example of faith and strength. He is a loyal friend, a hard worker, and if the Iraqi government allows it, a brilliant journalist without limits."
Zaidi, according to the prime minister's spokesman, has since written a letter begging for a pardon and regretting his "ugly act". His family are sceptical about this, believing it either to have been written under duress, or to be a straightforward fake. "I am suspicious ... because I know my brother," said Durgham.
The family believe his actions may have placed both them and himself in danger and claim to have received threatening calls. "There are thousands of supporters out there who applaud what he did, but there are also thousands that regret his actions and it has put his life in danger," said another brother.
"I am worried this has become dangerous for him, and about how long he will be alive for when he comes out of prison. It is a very delicate situation. I believe we will have to fight to stop him becoming a martyr."
By Yousuf Nazar
Admiral Mullen (first from left), the US Joint Chiefs of Staff, Pakistani Army Chief Gen. Kayani (third from left) and next to him, the ISI Chief Ahmed Shuja Pasha (then Major Gen. and Director General Military Operations) aboard the US naval carrier Abraham Lincoln in Indian ocean; in a secret meeting on August 26, 2008. Pasha was promoted to the rank of Lt. Gen. and appointed as the head of the Inter-Services Intelligence on Sept. 29, 2008.
The Pakistani media was quick to dismiss Indian allegations about the complicity of elements from Pakistan in Mumbai attacks. Some channels even carried stories that there was no Aslam Amir in Faridkot, only to contradict themselves later. We need to reflect upon the whole paradigm of 'terrorism'. For this purpose, it is essential to to take a holistic view including examination of some important and critical events since 9/11, US's strategic interests in the Middle East and Central Asia, the relationship between the US and Pakistan authorities, and the murky nature of CIA's involvement with the so-called Islamic militants.
In Pakistan, there are two extreme viewpoints. One view sees things through a conspiracy paradigm where India-US-Israel nexus is out to destroy Pakistan and Pakistani establishment is an innocent bystander. The other view sees fundamentalism as purely a home grown issue that has gone out of control. There are elements of truth in both the views. But the reality, as always, is far more complex.
It has been made more complex due to the fact there is big money involved on both the sides. The Americans have poured money into so-called Pakistani think-tanks and media groups. Some of these think-tanks have clear and identifiable linkages to those run by neocons or are indirectly funded by the US. Their views are given platforms by large and respected groups such as DAWN and GEO TV without bothering to make disclosures about conflict of interest; a standard practice.
Some of the so-called funadamentalists enjoy cosy relationship with the Arab kingdoms and the Pakistani intelligence agencies. These agencies are very close to the CIA and the Pentagon. Hence, the exponential increase in militancy and terrorist attacks in Pakistan since 2004 cannot be analysed in isolation from the role of the establishment, the US policies, and the biggest ever [ongoing] covert operations of the CIA since the end of the Afghan war in 1989.
Now let us ask why does it take the UN declarations to prompt actions from Pakistan? Why does Pakistan wait for external pressure to mount to act against militant groups? This lends credence to the view that militancy in Pakistan is, in part at least, a policy tool of the security establishment. But it is hard to argue or believe that the "elements within Pakistan" have or could have operated independently of its benefactors in Washington. This aspect may be away from the glare of TV screens and the front pages of the leading newspapers in the US, India, and Pakistan but there are strong reasons and reports to believe that the so-called Islamic militants continue to be tools of also the western intelligence agencies such as the America CIA and the British MI-6. And at points, they are alleged to be joined at the hip.
That is not to say that Pakistan does not have an inner cancer. But contrary to the view held by many in Pakistan, the cure lies in putting a distance with the Americans and not working with and for them. The only way to get out of this predicament would be a well thought out and carefully planned policy of gradual disengagement from playing the great game and support of militancy at whatever level - state or non-state, over the course of next several years. In the absence of a clear policy and unwillingness to reduce dependence on the United States in exchange for fighting its proxy wars in Central Asia, the risk of Pakistan sinking deeper into the quagmire will only increase at a great cost to the national security interests. Let's see why?
US Intelligence had advance knowledge of Mumbai attacks
A CNN report claimed that the US intelligence had warned the Indian government about a potential maritime attack against Mumbai at least a month before Mumbai attacks . "US intelligence indicated that a group might enter the country by water and launch an attack on Mumbai", CNN reported. One has to wonder if the top Pakistani authorities were informed and if not, why not? Pakistan would have been a likely point of origination of such a maritime attack by terrorists entering by water. The CNN story raised another question. Given the extremely close relationship between the US and Pakistani authorities and between the US and some of the militant groups, the United States has the greatest motive and capability to expand the terror war that is not going any where in Afghanistan or which it is losing. Given the distant and recent history of CIA covert operations, it is not beyond the realm of possibility that the US would use the widely known presence of CIA assets inside Pakistan to instigate a terrorist attack inside India.
CIA has a history of using terrorist groups
One example of the CIA using terrorist attacks to further US policy objectives was a car bombing in Beirut in 1985. The car was placed outside a mosque. The bomb was timed to go off when people were leaving to make sure it killed the maximum number of people. It killed, according to the Washington Post, 80 people. It wounded over 250, mostly women and girls leaving the mosque. There was a huge explosion so it blew up the whole street, killing babies in beds and so on and so forth. The bomb was set off by the CIA in collaboration with British intelligence and Saudi intelligence and specifically authorized by William Casey, according to Bob Woodward's history of Casey and the CIA. It may be recalled that after the Bali bombing in 2002, senior Indonesian intelligence had suspected that the CIA was behind the bombing and then Indonesia President Megawati had condemned "a superpower that forced the rest of the world to go along with it." Mrs. Megawati went on to say, "We see how ambition to conquer other nations has led to a situation where there is no more peace unless the whole world is complying with the will of the one with the power and strength." More recently, the US and Pakistani media sources have carried reports of active support by the CIA of militant groups in Pakistan as described later in this article.
US has made the greatest strategic and tactical gains
The United States stands to make the greatest strategic and tactical gains by dragging India into the so-called 'War on Terror." While the US officials were quick to point fingers towards Pakistan and rush to Islamabad to put pressure on Pakistani leadership, Iran and Russia advised caution. Chinese were careful to avoid any reference to Pakistan while they condemned the attacks. Iran's parliament Speaker Ali Larijani urged both India and Pakistan not to fall into trap set by certain countries. Russia Ambassador to New Delhi Vyacheslav Trubnikov said: "India should not yield to provocation. It should not listen to hotheads." He refused to get drawn to the finger-pointing towards Pakistan, as he maintained that he will not like to jump to conclusions when the investigations are on.
The US administration and its claims
The timing of Mumbai attacks coincided with the announcement of Robert Gates as Obama's Secretary of Defense, signalling the continuity of the current strategy in Afghanistan and Pakistan. The attack came at a time when the new Pakistani government had been conducting the most intense and vigorous campaign ever undertaken by Pakistan against the militants in the tribal areas. On Nov 12, 2008 the Washington Post reported that CIA Director Michael V. Hayden was likely to lose his job in President Obama's administration. The following day, Hayden raised the bogey of Osama bin Laden again saying he was "hiding in the lawless tribal areas of the Pakistan-Afghanistan border but was spending most of his time on his own security, making him ineffective." Hayden described Osama bin Laden's network as a "determined and adaptive enemy" in a "war that is far from over" and warned: "If there is a major strike on [the US], it will bear the fingerprints of al-Qaida."
Hayden is closely linked to the Bush administration's controversial warrantless wiretapping program, the so-called Terrorist Surveillance Program. Hayden was the head of the National Security Agency, which was responsible for intercepting phone conversations and e-mails, when the program was initiated. Hayden has also publicly supported the enhanced interrogation techniques authorized by President Bush and used by the CIA against high-value terrorists caught overseas and held in secret prisons around the world.
Now Hayden claims Al Qaeda leaders have extended their tentacles to North Africa and Somalia and were using partnerships to establish new bases. Elsewhere, Mr. Hayden said, Al Qaeda was "strengthening" in Yemen, and he added that veterans of the fighting in Iraq and Afghanistan had moved there, possibly to stage attacks against the government of Saudi Arabia. Can we take Mr. Hayden's unsubstantiated claims on their face value or even seriously? Mr. Hayden's statement implies he knows about the whereabouts and activities of Osama. This is ridiculous. How can he even imply this after more than seven years of 9/11 and with no success in getting even anyway nearer to Osama or his deputy Ayman al-Zawahiri let alone capturing them?
Credibility of US claims about Al Qaeda
No US official or journalist or think-tank has ever raised or answered the question that Alan Greenspan posed in his book, The Age of Turbulence:
"There was no bigger question in Washington than, Why no second attack? If Al Qaeda's intent was to disrupt the US economy, as bin Laden declared, the attacks had to continue. Our society was open, our borders porous, and ability to detect weapons and bombs was weak. I asked this question of a lot of people at the highest levels of government, and no one seemed to have a convincing response."
Mr. Greenspan is no ordinary person. He is not just a former Chairman of the Federal Reserve. He has known George Bush, Dick Cheney, Donald Rumsfeld, and other top leaders for years and has had access to everyone who is any body in Washington. The reason he did not get a convincing response is that the people at the highest level of [US] government do not have one. Why?
On December 21, 2007, US Defence Secretary Robert M. Gates said a resurgent al-Qaeda terrorist network has shifted the focus of its attacks to Pakistan. "Al-Qaeda right now seems to have turned its face toward Pakistan and attacks on the Pakistani government and Pakistan people," Gates told press reporters.
The Washington Post noted that the Pentagon chief did not specify the nature or location of the group's operations in Pakistan, and quoted Pentagon specialist on counterterrorism efforts on the Afghanistan-Pakistan border, who dismissed the defence secretary's assessment. "Gates is drinking the . . . Kool-Aid like this administration has for the last six years". He also said that the fighters there are not affiliated with al-Qaeda. He spoke on the condition of anonymity because he wants to keep his job.
Nor is it clear that al-Qaeda is the real threat in the rest of Pakistan, commented Teresita C. Schaffer, a former deputy assistant secretary of state for South Asia. "Clearly, extremist violence has emerged as the biggest danger to the Pakistan state," she said. "I don't know if it is al-Qaeda or not."
US destabilising Pakistan: TIME
On Sept. 17, 2008, Time magazine published a story "Risking War with Pakistan" written by an ex-CIA officer (for the Middle East) Robert Baer. He wrote:
"As Wall Street collapsed with a bang, almost no one noticed that we're on the brink of war with Pakistan. And, unfortunately, that's not too much of an exaggeration. On Tuesday, the Pakistan's military ordered its forces along the Afghan border to repulse all future American military incursions into Pakistan. The story has been subsequently downplayed, and the chairman of the joint chiefs of staff, Mike Mullen, flew to Islamabad, Pakistan's capital, to try to ease tensions. But the fact remains that American forces have and are violating Pakistani sovereignty. You have to wonder whether the Bush administration understands what it is getting into. In case anyone has forgotten, Pakistan has a hundred plus nuclear weapons. It's a country on the edge of civil war. Its political leadership is bitterly divided. In other words, it's the perfect recipe for a catastrophe. All of which begs the question, is it worth the ghost hunt we've been on since September 11? There has not been a credible sighting of Osama bin Laden since he escaped from Tora Bora in October 2001. As for al-Qaeda, there are few signs it's even still alive, other than a dispersed leadership taking refuge with the Taliban. Al-Qaeda couldn't even manage to post a statement on the Internet marking September 11, let alone set off a bomb."
Professor Anthony DiMaggio of Illinois State University, who teaches American Government and Politics of the Developing World, commented on Robert Baer's report in the Counterpunch:
"The comments above, cited from Time magazine, are the only commentary I've managed to find in all of the American press that warn about the dangerous game the US is playing in destabilizing Pakistan. American media coverage, conversely, is driven by a warmongering that's remarkably indifferent to the dangers involved in escalating the conflict. US attacks on Pakistan inevitably carry the risk of further inciting Pakistani anger against the US. In the New York Times, editors depict the conflict in an Orwellian fashion, framing Pakistan, rather than the US, as the true threat. Illegal U.S. attacks are framed innocently as a response to terrorism, with the Pakistani government's promises of reprisals against invading troops seen as "threatening" the safety of US troops. American reporters have long been known for their stenographic role, faithfully reflecting the official debate in Washington, rather than independently promoting their own reasoned, critical dialogue."
Prof. DiMaggio could have added; they have also buried critical and troubling facts about 9/11, Al Qaeda, and the role of the US and Pakistani establishments. Here are some concrete and well documented reasons why the US claims about Al Qaeda are not credible and cannot be taken at face value.
The unresolved questions of 9/11 investigation
John S. Pistole, Deputy Assistant Director of Federal Bureau of Investigation's Counter-terrorism Division, testified before the US Senate Committee on Governmental Affairs on July 31, 2003. The following part of his testimony is extremely intriguing:
"The FBI conducted a detailed financial investigation/analysis of the 19 hijackers and their support network, following the September 11th attacks. This investigation initially identified the Al Qaida funding sources of the 19 hijackers in the UAE and Germany. The financial investigation also provided the first links between Ramzi Binalshibh and the 9/11 operation. A continuing investigation, in coordination with the PENTTBOMB Team, has traced the origin of the funding of 9/11 back to financial accounts in Pakistan, where high-ranking and well-known Al Qaida operatives played a major role in moving the money forward, eventually into the hands of the hijackers located in the U.S."
There was no investigation into the grave and startling revelations made by the FBI. The FBI testimony was consistent with what the Wall Street Journal had published on Oct. 10, 2001. The WSJ never followed up or contradicted this story but other sources such as AFP confirmed it.
Quote from the Wall Street Journal:
Our Friends the Pakistanis
Yesterday we noted a report from a Pakistani newspaper that Lt. Gen. Mahmud Ahmad had been fired as head of Islamabad's Inter-Services Security agency after U.S. linked him to a militant allied with terrorists who hijacked an Indian Airlines plane in 1999. Now the Times of India says Ahmad is connected to the Sept. 11 attacks: Top sources confirmed here on Tuesday, that the general lost his job because of the "evidence" India produced to show his links to one of the suicide bombers that wrecked the World Trade Centre. The US authorities sought his removal after confirming the fact that $100,000 was wired to WTC hijacker Mohammed Atta from Pakistan by Ahmed Omar Sheikh at the instance of Gen Mahmud. Senior government sources have confirmed that India contributed significantly to establishing the link between the money transfer and the role played by the dismissed ISI chief. While they did not provide details, they said that Indian inputs, including Sheikh's mobile phone number, helped the FBI in tracing and establishing the link. Unquote.
Cover up of 9/11 Investigation
The 9/11 commission itself charged the US government of a cover up. On January 2, 2008, Thomas H. Kean and Lee H. Hamilton who served as chairman and vice chairman, respectively, of the 9/11 commission wrote an op-ed piece in The New York Times, accusing the US government of a cover up as no one in the administration ever told the commission of the existence of videotapes of detainee interrogations. "As a legal matter, it is not up to us to examine the CIA's failure to disclose the existence of these tapes. That is for others. What we do know is that government officials decided not to inform a lawfully constituted body, created by Congress and the president, to investigate one the greatest tragedies to confront this country. We call that obstruction", they concluded.
The commission itself was not keen to pursue the full facts. On page 172 of its report, it stated that ultimately the question of who financed the attacks "is of little practical significance", noting that "to date the US government has not been able to determine the origin of the money used for 9/11 attacks." That's right. The 9/11 Commission concluded in its report that it wasn't important to follow the money trail leading to those ultimately responsible for the crime.
Ahmed Omar Saeed Sheikh, who was alleged to have wired money to the 9/11 hijackers, was sentenced to 'death' in 2002 but his "appeal" has been pending since then. He kidnapped Daniel Pearl of the Wall Street Journal but the US never pressed for his extradition. Musharraf wrote in his book that Omar was an MI6 agent. Omar was also a "Kashmiri jihadi' and associated with Jaish-e-Mohammad. Pakistan's former chief of Intelligence Bureau; Brig. (retired) Ijaz Shah was the handler of Omar Saeed Sheikh. Sheikh surrendered to him in Lahore although Daniel Pearl was kidnapped from Karachi. Brig. Ijaz Shah was also accused by Benazir Bhutto of plotting to assassinate her.
It is a matter of record that even after more than five years of his arrest, the US government has refused to try the alleged master mind of 9/11, Khalid Sheikh Mohammed, in a normal civil federal court. He was arrested in March 2003 and handed over to the US but never faced open trial. According to the 9/11 Commission Report he was "the principal architect of the 9/11 attacks." On October 12, 2006, Time magazine reported that "KSM confessed under CIA interrogation that he personally committed the murder" of WSJ journalist Daniel Pearl.