Police crack down on Tunisian protesters on July 22 / credit: People’s Dispatch
Editor’s Note: This article was originally published by People’s Dispatch.
Tunisian security forces violently repressed a massive protest in the country’s capital on July 22 against the moves by President Kais Saied to further undermine democratic institutions in the country. According to human rights organizations, police repressed protesters who had gathered at the emblematic Habib Bourguiba Street in the center of Tunis by hitting them with batons and launching tear gas at them. Several people injured during the repression were hospitalized, and police arrested nine people.
Among those arrested are feminist rights activist Olfa Baazaoui of the Workers’ Party of Tunisia, human rights and LGBTQ+ rights defender Saif Ayedi of Damj, Aziz Ben Jemaa of the Workers’ Party of Tunisia, and other progressive activists.
Their arrests were widely condemned by diverse civil society organizations. Damj, the Tunisian Association for Justice and Equality, released a joint statement with organizations such as the Tunisian Association of Young Doctors, the Tunisian Organization Against Torture, and others, condemning the repression and demanding the immediate release of the protesters.
Denouncing the repression, they stated that “police repression had replaced democratic mechanisms” and emphasized their support “for all forms of demonstration, protest, assembly and expression, which they consider one of the most important gains of the revolution.” They added that protest is the central mechanism to exert pressure on the ruling system in order to “review development policies, combat corruption, terrorism and all the elements of tyranny, and guarantee respect for rights and freedoms.”
Egalité, the women’s organization to which detained activist Baazaoui also pertains, wrote in a statement that they hold President Saied responsible for the wellbeing of the detained activists. They also called on all female citizens “to boycott the referendum on a constitution that threatens rights and freedoms and dedicates it to the dictatorship of the individual and the return of the police state with force, which has been clearly and tangibly proven today.”
In a statement released by the Workers’ Party of Tunisia shortly following the arrests, they called for the protester’s immediate release and alerted that the detainees had been deprived of visits from their lawyers and some had been denied medical treatment.
The protest action was held three days ahead of the national referendum wherein Tunisians will vote on a draft constitution presented by Saied. A large number of opposition parties have called for a boycott of the referendum in rejection of the undemocratic nature of the new constitution’s writing process, as well as its proposals. The current constitution, which was adopted in 2014, is seen as a significant achievement of the revolution that overthrew dictator Zine El Abidine Ben Ali in 2011. A major objection to the draft presented by Saied is the proposal to do away with the division of executive power between the president and prime minister, concentrating power solely in the hands of the president.
The referendum on the constitution comes after several other moves by Saied which opposition parties have alleged undermine the democratic institutions in the country. These include the dissolution of judicial bodies, dissolution of the parliament, the persecution of leaders from major opposition parties, and the dissolution of other state institutions. These measures which began with the dissolution of parliament on July 25, 2021 have been met with constant protest from diverse civil society organizations and political parties.
More than 3,000 Accredited Social Health Activists (ASHAs) protested in the city of Kolhapur in India’s Maharashtra state on October 26 after several of their demands, such as the legal status of full-time workers, better working conditions, adequate pay, medical insurance, and others, weren’t met / credit: Sanket Jain
Prajakta Khade walked into a public health center daily for three months in early 2021, without ever receiving medical care. The healthcare worker’s 26 notebooks—containing more than 3,000 pages of community health records—point to why she couldn’t seek treatment for her ailments. She was simply too busy.
In March 2020, India’s health ministry tasked 1 million Accredited Social Health Activists (ASHAs) like Khade with COVID-19 duty in rural areas. This, in a country where 65 percent of its 1.38 billion people live outside cities. Suddenly, ASHAs’ workload increased exponentially. Yet, they remain underpaid and now suffer stress-related chronic ailments.
“If a positive case was found in the area, we had to visit the patient, contact trace, arrange medical facilities, measure their oxygen and temperature levels daily, and ensure they complete quarantine,” Khade explained about the added duties to treat the infectious respiratory disease. But all Khade was given to do her job in the assigned area in India’s Maharashtra state was a single N95 mask and 200 milliliters of sanitizer.
ASHAs, an all-women healthcare cadre, remain the foot soldiers of India’s rural healthcare. One worker is appointed for every 1,000 citizens under India’s 2005 National Rural Health Mission. ASHAs are responsible for more than 70 tasks, including providing first-contact healthcare, counsel regarding birth preparedness, and pre- and post-natal care. Plus, they help the population access public healthcare and ensure universal immunization, among other things.
The World Health Organization announced a pandemic in March 2020. But in many countries, lack of adequate healthcare and no social safety nets amid lockdowns wrecked the lives of ordinary people. In India, for example, an additional 150 million to 199 million people are expected to enter poverty in 2021 and 2022.
Chronic Illnesses Spike
One day about a year ago, while surveying people in her village of Vhannur in India’s Maharashtra state, 40-year-old Khade felt dizzy. But she couldn’t take a break. “At one point, my face was swollen, and I could barely see anything.” It turned out her blood pressure level had surged to 252/180 mmHg (millimeter of Mercury), much higher than the standard limit of 120/80. That is how she got diagnosed with hypertension.
However, a month’s worth of medications didn’t help because she continued to experience stress as her workload increased. Senior officials at the health center had early on issued an order to submit patient records daily by noon.
ASHAs, who aren’t considered full-time workers, receive performance-based incentives paid on the number of tasks completed. “For COVID duty, the government decided our worth as merely 33 Indian Rupees per day (43 U.S. cents),” she said. “We received this amount only for three months in the past two years.”
Moreover, during the peak of COVID-19 cases in 2021, salaries for Maharashtra’s ASHAs were delayed by five months, according to Khade. Netradipa Patil, an ASHA from Maharashtra’s Kolhapur district and leader of a union that represents more than 3,000 ASHAs, confirmed this.
One day last year, Khade’s supervisor asked for a list of hypertension and diabetes patients from her village of about 1,200 people—at 10 o’clock at night.
“How could I survey the entire community in the night?” she asked.
Often, such orders meant skipping lunch and staying hungry for 11 hours at a stretch. ASHAs worked four hours prior to the pandemic. Now, 12-hour days are normal.
When medications didn’t help, Khade consulted two private doctors. “After six months of hassle, the doctor doubled my dose to 50 milligrams.” Khade lost over 10 kilograms (22 pounds) of weight and was placed on medications to address anxiety. Even today, she suffers from fatigue.
“I was never this weak,” she asserted.
Chronic diseases among ASHAs are rising rapidly because of the workload, says Patil. “We protect the entire community, but there’s no one to look after our health.” ASHAs in Maharashtra, she says, average a monthly income of Rs 3,500 to 5,000 ($45 to $66 USD).
This reporter spoke to ASHAs’ senior officials from Maharashtra’s Kagal block. (In India, a cluster of villages form a block and several blocks form a district. Vhannur village is in the Kagal block of Maharashtra’s Kolhapur district.) Senior officials said they are not responsible for ASHAs’ deteriorating mental and physical health, and pointed to the Indian government’s order to submit data. The officials didn’t want to be named. Instead, they relayed that they also are overworked.
“ASHAs do the majority of the health department’s work, and they are massively underpaid for their duty,” said Dr. Jessica Andrews, a medical officer at Kolhapur’s Shiroli Primary Health Center. She has been handling mental health cases. “Without them, the health system will collapse.”
‘Not Treated As Humans’
Several ASHAs across India have worked for over a year without a break. One of them is Pushpavati Sutar, 46, diagnosed with hypotension (low blood pressure) and diabetes within seven months of COVID-19 duty in November 2020. Like Khade, she experienced constant spells of dizziness.
“Often, there was fake news of community COVID transmission in my area,” she said.
Every day, senior officials at the health center hounded her to find more details about such instances.
An ASHA for 13 years, she’s never made an error in her surveys and was sure of no community transmission. “After investigating, I found that the accused was COVID negative. Instead, two of his relatives were positive.”
She had to clear such misconceptions almost every day, answer senior officials’ questions, collect records and perform her regular duty. “For several days, I couldn’t sleep,” she remembered.
Further, fearing COVID-19 guidelines and quarantine rules, community members began demanding ASHAs hide COVID-19 cases. “People even accused us of spreading COVID as we would survey the entire village,” Sutar recounted. Moreover, she said senior officials asked ASHAs to visit the families of COVID-19 patients—instead of allowing data collection over the phone—putting them at risk of infection.
“At several places, there have been instances of community violence, where ASHAs were beaten up,” said Patil, who has filed legal complaints on behalf of the assaulted workers and is helping them mentally recover.
Kolhapur’s ASHA union has written to several government authorities, including Maharashtra’s chief minister and Indian Prime Minister Narendra Modi, highlighting the mental toll of COVID-19 duty. Still, none of their letters have garnered a helpful response.
“Forget adequate pay,” said Khade, as she continued surveying, juggling between completing her task and trying to keep her mind at ease. “We are not even treated as humans.”
ASHA Rehana Mujawar, of Maharashtra’s Tardal village, shows COVID-19 records she is required to fill out every day by visiting her community of more than 1,000 members / credit: Sanket JainASHA workers Rekha Dorugade and Mandakini Kodak trekking the Dhangarwada hill to complete their survey, a steep patch of 5 kilometers (3.1 miles) in Kolhapur’s Pernoli village / credit: Sanket JainAn ASHA worker took a selfie as part of their protest on July 21 in Maharashtra’s Kolhapur city / credit: Sanket JainASHA workers protest outside the district collector’s office in Kolhapur city with placards mentioning their workload. In the center, wearing a red saree, is ASHA union leader Netradipa Patil, who has been fighting for better working conditions for over a decade / credit: Sanket JainASHAs across India have been protesting for better pay, full-time worker status and proper working conditions / credit: Sanket JainIndia has 810 district hospitals for 833 million rural people. In mountainous regions like Kolhapur’s Masai Pathar, ASHAs often trek, risking their lives to save pregnant women and make healthcare facilities accessible / credit: Sanket JainAn ASHA worker explains breastfeeding and taking care of a newborn to a community woman in Maharashtra’s Khutwad village / credit: Sanket JainIn Kolhapur’s Khutwad village, ASHA Maya Patil informs a migrant sugarcane cutter, whose relative gave birth to a child a month prior, about post-natal care and how they can access public healthcare facilities / credit: Sanket JainTo inspire fellow ASHAs, Netradipa Patil shares a WhatsApp status quoting lyricist and poet Gulzar: “Milta To Bahut Kuch Hai Is Zindagi Me, Bas Ham Ginti Usi Ki Karte Hain, Jo Hasil Na Ho Saka. (We get many things in life, but we only count the things we couldn’t achieve) / credit: Sanket JainASHAs also distribute iron, calcium, and vitamin tablets, among others, to community women and children every month. “For distributing these medicines, we’re merely paid Rs 100 ($1.30 USD),” says ASHA Netradipa Patil / credit: Sanket JainASHA Prajakta Khade collected the sputum of a patient she suspects to be a tuberculosis patient / credit: Sanket Jain“Be it any health record, the health department relies on our surveys and fieldwork,” says Khade, who has been an ASHA since 2009 / credit: Sanket JainWomen often share their health and mental issues with ASHA workers, as they have built a safe bond over the past decade / credit: Sanket JainAs part of the Health Ministry’s program of reducing non-communicable diseases, ASHAs across Maharashtra are tasked with surveying communities by asking them more than 60 questions. “We will merely be paid Rs 5 (6 U.S. cents) per form for collecting and filling in all the details,” says Khade / credit: Sanket JainA significant part of Khade’s time goes into filling out by hand medical records. “If any record is incomplete, our seniors immediately probe an inquiry, and even the pay is deducted,” she says / credit: Sanket JainSo far, Khade has spent over Rs 10000 ($131 USD) on doctors, medical tests, and medications, an equivalent of three months of her salary. “ASHAs don’t receive any health support system from the government, nor any medical insurance,” she says / credit: Sanket JainASHA Jayashree Khade from Kolhapur’s Vhannur village tested positive for COVID-19 in May 2021. “None of my seniors even once asked about my health. It was only the fellow ASHAs who helped me,” she says / credit: Sanket JainPrajakta Khade gives a plastic bottle to a community woman asking her to submit sputum for tuberculosis detection / credit: Sanket JainPushpavati Sutar, as part of postnatal visits, often counsels women on breastfeeding, seeks regular updates on the health of both the mother and the newborn, and provides the required medications / credit: Sanket JainAn ASHA worker filling out health records of a newborn in Kolhapur’s Shirol region, noting important details / credit: Sanket JainSutar distributes iron and folic acid tablets to her community members / credit: Sanket JainTo ensure community members take medications and supplements on a schedule, ASHAs often write instructions in the native language on the box / credit: Sanket JainSutar ignored her hypotension symptoms for several months and continued the survey because of the tremendous workload / credit: Sanket JainASHA workers always counsel community members on proper healthcare. Here, she is talking to a woman in Kolhapur’s Shirol region about early childhood health / credit: Sanket JainAs part of the health ministry’s Anemia Free India program, ASHAs are given a long notebook to maintain the records of 6- to 51-week-old children and 5- to 10-year-old children from their community. ASHAs regularly provide tablets to prevent anemia / credit: Sanket JainASHAs’ role doesn’t end with distributing medications. They answer questions people raise / credit: Sanket JainASHA Rani Koli, from Kolhapur’s flood-affected Bhendavade village, surveying her community after the July floods. “Even my house was ravaged by the 2019 and 2021 floods, but we keep working to make sure everyone remains safe,” she said / credit: Sanket JainASHA Kavita Patil talking to senior citizens in Kolhapur’s Bhendavade village to understand the mental toll of living through two floods / credit: Sanket JainASHA workers Netradipa Patil and Maya Patil surveying a community to learn more about how two floods and lockdowns affected the lives of rural community women / credit: Sanket Jain
Sanket Jain is an independent journalist based in the Kolhapur district of the western Indian state of Maharashtra. He was a 2019 People’s Archive of Rural India fellow, for which he documented vanishing art forms in the Indian countryside. He has written for Baffler, Progressive Magazine, Counterpunch, Byline Times, The National, Popula, Media Co-op, Indian Express and several other publications.
Ethiopians in Lebanon took to the streets in December to protest U.S. and Western meddling in the Horn of Africa / credit: Twitter / Xinhua News
Editor’s Note: This article originally appeared in People’s Dispatch.
The Ethiopian diaspora across the Western world is condemning the United States and the European Union for “emboldening” the Tigray People’s Liberation Front (TPLF), which resumed war in the northern part of the country on August 24, ending the truce initiated by the federal government in March.
“Deploring the international community, in particular the UN, United States and the EU Member states, for their continued sympathy” towards the TPLF, the Ethiopian Advocacy Organizations Worldwide (EAOW) passed a resolution on Friday, September 2. The EAOW, a consortium of 18 organizations representing Ethiopian nationals in the United States, Canada, United Kingdom, South Africa, and 11 European countries, condemned the TPLF’s alleged systematic large-scale forced conscriptions—including of child soldiers—in the northernmost state of Tigray.
Thousands have been fleeing Tigray, which is under the TPLF’s control, in order to escape forced conscription. However, hundreds have been caught and arrested by the TLPF, which is waging a war against the Ethiopian federal government. Tens of thousands of conscripts were sacrificed in human wave attacks launched by the TPLF, which had advanced south into the neighboring states of Amhara and Afar last year before being beaten back into Tigray.
The resolution alleges that in order to conscript more soldiers for another round of invasion into Tigray’s neighboring states, the TPLF instituted a “one family, one soldier” policy, as the war became increasingly unpopular in Tigray itself. The group is allegedly denying food aid to families unable or unwilling to contribute soldiers. This is when, according to the World Food Programme (WFP), 83 percent of Tigray’s population is food-insecure and over 60 percent of pregnant or lactating women were malnourished as of January.
On resuming the war on August 24, the TPLF looted 12 full fuel trucks from the WFP and tankers with 570,000 liters of fuel meant to facilitate food aid delivery. Hundreds of WFP trucks which entered Tigray to distribute food aid had already been seized by the TPLF and used to mobilize its troops during its offensive last year.
“This has only reaffirmed the view [that] the TPLF should not be playing a central role in the distribution of aid in Tigray,” Bisrat Aklilu, a board member of the American Ethiopian Public Affairs Committee (AEPAC), said in a letter to WFP’s Ethiopia country director Adrian van der Knaap.
He called on the WFP “to undertake an urgent review of its processes and to identify any misuse of aid by the TPLF… Given the sheer number of Ethiopians in need in Tigray, Afar and Amhara regions, it would be an unforgivable scandal if WFP’s humanitarian assistance is ending up in the hands of rebel forces rather than the vulnerable communities who are suffering.”
“Deploring the deafening silence of the International Community in condemning such blatant violation of international law by TPLF,” the resolution urged the international community to force the TPLF to come to the negotiating table.
The federal government led by Prime Minister Abiy Ahmed has kept the door open for negotiations under the African Union (AU). AU’s High-Representative for the Horn of Africa, former Nigerian President Olusegun Obasanjo, had met with the government’s and TPLF’s leaders several times during the months of truce.
The EAOW resolution has called on the international community to “reiterate the peace process under the undisputed leadership” of the AU.
However, dismissing the AU as incompetent, the TPLF had effectively called for Western intervention only two days before resuming the war. It made particular references to the United States and the EU, whose envoys had met its leaders only weeks before it resumed the war.
“To date, the American Ethiopian community has been disappointed with the United States Government’s approach to the conflict, which has been perceived as more favorable to the TPLF terrorist group than the democratically elected government of Ethiopia,” the American Ethopian Public Affairs Committee (AEPAC) said in a press release.
AEPAC, which is a part of the EAOW and a signatory to its resolution, will be holding demonstrations and rallies on Tuesday, September 6, in Washington D.C., and other cities in the United States.
“The rallies will have a clear objective—to call on the U.S. government to support peace over violence in Ethiopia,” its statement said. “The only way to give peace a chance for the people of Ethiopia and ensure stability in [the] Horn of Africa is to end the TPLF’s violence. AEPAC will continue to engage U.S. legislators and the administration to educate them on the facts on the ground and views of the diaspora.”
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