Leaders of World's Rich Nations will be guilty of crime against humanity if they fail Poor by Jonathan Dimbleby The Observer 1:58pm 13th Sep, 2005   September 11, 2005    This week's United Nations jamboree in New York shows every sign of degenerating into a babel of name-calling, point-scoring and agenda-jacking. But if the summiteers allow themselves to be blown off track by the damning critique of the UN system in the Volker report or if they succumb to a narrow but divisive obsession with the 'war on terror', they will be collectively responsible for a tragedy of historic proportions.    This would be tragic for several reasons. Global poverty is every bit as much a violation of civilisation as terrorism and of far greater import than the structural frailties of the UN exposed by the food-for-oil scandal. Kofi Annan had expected to use the summit to broker a 'grand bargain' between the rich and poor worlds to make the planet a safer and fairer place for us all.    Failure now would signal that those leaders who solemnly signed up for the Millennium Development goals five years ago are now ready to abandon them, at precisely the moment when they are in urgent need of reaffirmation. Such an abdication of political and moral responsibility really would be 'a scar on the conscience of the world'.    Already the momentum in this 'make or break year', as Gordon Brown has described 2005, is slowing alarmingly. The optimism around Tony Blair's Africa Commission, which redefined the predicament of the world's poorest countries with clarity and compassion, has been eroded. The G8 summit was oversold as yet another 'historic' breakthrough. The commitments made at Gleneagles, though far from nugatory, now look much less spectacular than the headlines suggested.    In particular, the pledges on debt relief were sold as though the G8 leaders had looted Fort Knox for the benefit of the dollar-a-day citizens of this planet. In fact, Evan Davis, the canny economics editor of the BBC, felt obliged to observe: 'We would normally barely feel it was worth reporting.'    To put this in shaming perspective, if all the G8 pledges were to be honoured - a big 'if' - the world's richest nations would transfer to Africa only an extra 0.03 per cent of their national income. The UN's latest human development report, released last week, is a devastating document, revealing that in crucial ways the world's poorest are getting poorer and that what is missing is the political will. Confirming this bleak assessment, there has been a ghostly silence from most G8 leaders since Gleneagles as their respective number-crunchers squabble over how - or whether - the modest promises of their political masters will be delivered.    Even more dismayingly, the chances of a genuinely 'fair trade' future for the developing world - eliminating tariff barriers and subsidies while protecting the poorest and weakest from sudden exposure to market forces - range somewhere between nought and zero. Even if President Bush were to experience a Damascene conversion over trade, he is so crippled by hurricane Katrina that he will assuredly be unable to confront the US protectionist forces to which he has so long been in thrall.    Somewhere between Bob Geldof's bombast, the apocalyptic visions of some development charities and the 'Africa must put its house in order' lobby lie the harsh, complex and urgent truths which the UN summit should have at the top of its agenda. But it is from these, with the honourable exception of Tony Blair, that world leaders persistently avert their gaze. Presidents and Prime Ministers, whether they live in the rich or the poor world, are insulated and isolated from the devastating impact of global poverty. They read the statistics but they rarely witness at first hand the misery and degradation of life on a dollar a day.    Yet, I have no doubt that if they had been able to share my experience of Malawi last week (as president of Voluntary Service Overseas), they would have been as shocked, distressed, chastened but inspired as I was. They would already know that Malawi is one of the 10 poorest countries in the world but that it has not yet jumped through enough International Monetary Fund hoops to join that select band of 18 which is now entitled to '100 per cent' debt relief. They would also know that its 12 million people live in an open society not unduly plagued by corruption and that they are at peace with themselves and their neighbours. Life should be getting better. In fact, it is getting worse.    Dr Ntaba, the Minister of Health, says quite openly that the vital public service for which he is responsible is 'a catastrophe'. He selects a handful of devastating statistics: that Malawi has only 94 qualified doctors, 300 registered nurses, and that his budget is $15 a head (including all foreign aid), well under the $36 a head required to deliver the most basic of essential services.    Just over two hours from the capital, Lilongwe, Ncheu district hospital is the medical equivalent of a warfront. District medical officer Dr Jonathan Ngoma is the only Malawian doctor in a catchment area of 400,000 people. The ratio of nurses to patients in the hospital is 1:60 and only the support of a Dutch VSO doctor staves off total collapse.    Malawi's rate of maternal mortality is the highest in the world (and rising). The only incubator has broken down and no one knows how to repair it; a two bar electric fire keeps 'the special care unit' heated on cold winter nights.    The hospital has run out of almost every essential drug: no penicillin, nothing to treat malaria (Malawi's biggest killer) and no drugs to combat meningitis. In one ward, an 18-year-old girl with the disease died slowly and in pain. If they had witnessed the grief of her family, our world leaders would assuredly share the dismay of a medical team that could do nothing to prevent her becoming another statistic in a country where life expectancy has now fallen to 37 years.    Shellshocked by all this and much more, it would be easy to indulge in despair; Ncheu district hospital is one of 26 such institutions is a similar state of collapse. But, back in Lilongwe, they would discover that key Western donors are persuaded that, despite it all, the Ministry of Health has a set of coherent and carefully costed plans to confront Malawi's predicament: to arrest the haemorrhage of doctors and nurses from an underfunded and demoralised service either to other parts of Africa, the US and, especially, Britain or into marginally better paid jobs in the private sector.    Indeed, the UK's Department for International Development, with the help of 30 VSO doctors and nurses recruited from around the world, is funding a 'high-risk' emergency programme to provide life-support to the existing service and to recruit, train and retain more staff. To this end, the government wants to rebuild its rotting hospitals; construct more training centres; provide better accommodation; buy more equipment. It is a shameful rebuke to those who prattle about our 'moral responsibility to the world's poor' that they have yet to deliver the funds required to make a difference.    In Malawi, as in so many similar African countries, it would be premature simply to 'give them the effing money'. Despite the talent, commitment and energy of Malawian doctors and nurses working at the front line, the health service is simply too fragile to absorb boundless dollars. As yet it lacks the relevant expertise and the skills ('the capacity') and it is also afflicted by corruption, though by no means on a grand scale.    One of the reasons the district hospitals are in such crisis is that the central system for the procurement and delivery of essential drugs is a sieve through which impoverished officials all the way down the supply chain 'enrich' themselves because demand so far outstrips supply. The donors rightly demand reform and the Minister of Health has promised to deliver but it is taking time.    Conversely, a trickle of anti-retrovirals is at last reaching Malawi and the ministry is now providing these drugs to some 23,000 patients, the first of millions in a country where perhaps 20 per cent of the population is infected. In embryo, the system is working well and giving the lie to those who have said that poor countries could never cope with ARVs.    But the much vaunted global fund is also refusing to deliver Malawi's quota of the drugs required to combat malaria until it has completed a protracted scrutiny of the ministry. The government regards this unofficially as 'degrading and destructive' and Dfid officials here believe it quite unnecessary.    'Making poverty history' is complex and immensely problematic. That is why the 'greatest gathering of world leaders in history' must put global poverty centre stage and keep it there. Otherwise, they will be open to the charge that they are complicit - by neglect - in the greatest crime against humanity of this century.
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