The Case of Shakil Afridi

The hue and cry over the 33-year sentence handed down to Dr Shakil Afridi, the doctor who may have aided the CIA in tracking down Osama bin Laden in Abbottabad is partly correct. Certainly, the fact that he was tried under the archaic Frontier Crimes Regulations, in secret, and without the chance to defend himself through a lawyer, makes the whole process highly suspect and against the basic principles of a fair trial. Valid questions have also been raised about the hollowness of some of the charges brought against him, including, apparently, 'waging war against Pakistan'.

Dr Shakil Afridi (Photo: Express)

However, some of the apoplectic reaction from members of civil society, which has condemned Dr Afridi being tried at all, is thoroughly misplaced. Some believe he did a great thing by helping rid Pakistan of the world's most dangerous terrorist and so should be thanked or awarded rather than prosecuted. Others have drawn comparisons between his swift trial and conviction and the lack of effective prosecution of real terrorists. Even journalist Najam Sethi, in his programme yesterday, questioned how what Dr Afridi did was any different from the Pakistani state's collaboration with the CIA in going after Al Qaeda's militants and stated that the Americans, after all, are Pakistan's professed strategic allies. All of these are false premises.

Let's be clear about one thing. No country in the world allows its citizens to freelance as spies for another country's agencies, whether friendly or hostile. Which is not to say that people do no do it, just that they know the risks of what can happen to them if they are caught. Forget being spies, the US has laws against its citizens even lobbying public opinion on behalf of foreign interests without revealing their connections. Remember the case of one Dr Ghulam Nabi Fai?  There have been a number of instances of American citizens being convicted of spying or passing information on to its greatest 'ally' Israel. Dr Shakil Afridi apparently confessed (this is a point that is yet to be proved in a fair trial) that he knowingly assisted the CIA in running a fake vaccinations programme set up to obtain DNA samples from the residents of the compound where bin Laden was eventually killed. No matter what one thinks of the outcome, Pakistan has every right to charge him for colluding with a foreign agency, and if the charges are proved in a fair trial, to convict him.

Yes, it's a real and terrible pity that the Pakistani state and Pakistani courts are criminally lax about the prosecution and conviction of far worse people than Dr Afridi, but this line of reasoning, while it scores political points, is really a false equivalence. By this reasoning, nobody should ever be tried for manslaughter in a road accident or theft or kidnapping or for any other everyday crime since they are far smaller crimes than those committed by those terrorists who have killed thousands and got away scot free. Similarly, with respect to Mr Sethi's point about whether what Dr Afridi did was any different from what the government of Pakistan has been doing for years, yes, there is a difference (whether one likes it or not) between a state sanctioned operation and a freelance operation. It is similar to the difference between the police having the right to use firearms versus ordinary citizens using firearms. But more importantly, if the state is violating the law - e.g. by extraditing people to a foreign entity without going through the due legal process - it is something that in and of itself needs to challenged; it still does not confer legitimacy to others who decide to violate the law.

The US Congress' hypocritical outrage over the treatment of Dr Afridi - er, Guantanamo, anyone? - really is not worth commenting over. They are simply looking to protect their asset, their employee.

In my personal opinion, whether Dr Afridi is charged with treason or not, what he certainly should have been charged with is intentional malpractice and stripped of his medical title for violating his Hippocratic Oath. First of all, he placed innocent children and families knowingly in harm's way by running a fake vaccination programme. As detailed by The Guardian's report linked to earlier:

"The doctor went to Abbottabad in March, saying he had procured funds to give free vaccinations for hepatitis B. Bypassing the management of the Abbottabad health services, he paid generous sums to low-ranking local government health workers, who took part in the operation without knowing about the connection to Bin Laden. Health visitors in the area were among the few people who had gained access to the Bin Laden compound in the past, administering polio drops to some of the children. 

Afridi had posters for the vaccination programme put up around Abbottabad, featuring a vaccine made by Amson, a medicine manufacturer based on the outskirts of Islamabad. 

In March health workers administered the vaccine in a poor neighbourhood on the edge of Abbottabad called Nawa Sher. The hepatitis B vaccine is usually given in three doses, the second a month after the first. But in April, instead of administering the second dose in Nawa Sher, the doctor returned to Abbottabad and moved the nurses on to Bilal Town, the suburb where Bin Laden lived."

Secondly, he has endangered the lives of hundreds of thousands of other children in an area where there were already (unfounded) virulent suspicions about vaccination programmes. As the Associated Press reported soon after the programme was revealed:

"Pakistani health officials held meetings about the alleged CIA scheme on Tuesday and expressed concern that it could have a negative impact on immunization programs in other areas of the northwest, especially in Pakistan’s semiautonomous tribal region along the Afghan border, said a Pakistani official involved in polio eradication efforts… 

One of the Pakistani Taliban’s top commanders, Maulvi Faqir Mohammed, recently called on people in the northwest to avoid vaccines offered by the international community, claiming they were made with “extracts from bones and fat of an animal prohibited by God — the pig.”  

“Don’t fall prey to these infidel NGOs and this U.S.-allied government and its army,” said Mohammed over the illegal radio station he transmits from his sanctuary in eastern Afghanistan. Pakistani officials and their international partners have pushed back against these claims, but the CIA’s reported activities in the country may have made their job that much harder."

You can read more about what impact such kind of rumours have had on immunisation programmes in other places here, which also points out the following:

"[T]he allegation that a vaccine program was not what it seemed — that it was not only suspect, but justifiably suspect — has been very widely reported. This is awful. It plays, so precisely that it might have been scripted, into the most paranoid conspiracy theories about vaccines: that they are pointless, poisonous, covert shields for nefarious government agendas meant to do children harm. 

That is not speculation. The polio campaign has already seen this happen, based on just those kind of suspicions — not in a single poor slum in New Delhi, but across much of sub-Saharan Africa... 

The accusations that polio vaccination was a Potemkin cover for anti-Islamic activities almost ruined the international eradication of polio when they were false. Now, on the basis of the CIA’s alleged appalling ruse in Pakistan, they may be made again. And they will be much more believable, because this time they might be be true."

Finally, he has endangered the lives of his fellow - real - health workers. As noted here,

"InterAction, an alliance of 198 American NGOs, such as the International Rescue Committee, Mercy Corps, CARE, ChildFund International, World Wildlife Fund, Plan International USA, Helen Keller International, Action Against Hunger and Relief International, said the CIA’s tactics also endangered the lives of foreign aid workers. “The CIA-led immunization campaign compromises the perception of U.S. NGOs as independent actors focused on a common good and casts suspicion on their humanitarian workers. The CIA’s actions may also jeopardize the lives of humanitarian aid workers in Pakistan.”"

The Guardian reported that Save the Children was forced to evacuate eight of its international workers last July over fears for their safety:

"A senior western official said Afridi told his wife he was working for Save the Children when he was in fact running the fake CIA programme. The allegation emerged during interrogation. 

A senior aid worker corroborated that account, saying Afridi may have mentioned Save the Children "during the early stages of his interrogation". Save the Children said it was horrified that Afridi had abused its name. "We are shocked by the allegations that our name has been falsely used in this way. Save the Children's work in Pakistan is helping the most vulnerable children and their families," said [SCF spokesperson Ishbel] Matheson."

So, yes, demand a fair trial for Shakil Afridi by all means. This is his and all of our right. But let's not build a mercenary rogue into a hero. And I for one would not in the least shed tears if, at the end of an open and fair trial, he were to be convicted not of treason but of unabashed medical malpractice. After all, even the mobster Al Capone was convicted only for tax evasion, wasn't he?

Video of the Day

Sometimes we like to share things that are actually brilliant...

From the BBC's documentary series "The Joy of Stats", featuring Professor Hans Rosling, described as a "superstar boffin" whose "eye-opening, mind-expanding and funny online lectures have made him an international internet legend." This is what the description of this particular clip says:

"Hans Rosling's famous lectures combine enormous quantities of public data with a sport's commentator's style to reveal the story of the world's past, present and future development. Now he explores stats in a way he has never done before - using augmented reality animation. In this spectacular section of 'The Joy of Stats' he tells the story of the world in 200 countries over 200 years using 120,000 numbers - in just four minutes. Plotting life expectancy against income for every country since 1810, Hans shows how the world we live in is radically different from the world most of us imagine."

Enjoy!

The Unbearable Lightness of Brainless Journalism

I’m going to do a breakdown of an Express Tribune feature about mental illness, simply because its lackadaisical treatment of an issue that doesn’t get enough attention summarizes one of the most significant problems in print journalism today, i.e. muddy thinking.

Let me begin with the article heading, "The Unbearable Burden of Being Mentally Ill." This tells me two things. One, mental illness is unbearable and a burden so, if I am depressed or bipolar and have reached for the morning paper in an effort to stay connected to the world, I should screw that and go ahead and drown myself in my coffee. Two, the writer (Mahnoor Sherazee) or sub-editor has read Milan Kundera’s The Unbearable Lightness of Being. Or it’s title. Or possibly had it thrown at them.

"KARACHI: Why me? This emerged as the dominant theme among parents of children with special needs when asked about their role as primary caregivers."

The sub-heading tells me this is going to be an article about the challenges faced by parents of children with special needs. Since I do, for some reason, believe that the symptoms of ‘mental illness’ generally manifest themselves clearly around adolescence and after, when I think of children with ‘special needs’, I think of autism, Down’s syndrome, physical disabilities.

"Parenting on its own can be a tough job and parenting a child with limited cognitive development is significantly more challenging. Of course there are some parents who are quick to move past the denial and forward with the responsibilities of providing for their children but in such situations acceptance can extend beyond just one person’s understanding."

According to this paragraph, parenting is tough, parenting a kid with limited cognitive development is even more challenging, and the inevitable response to said challenge is denial. In other words, nowhere on God’s earth is a parent who has held their newborn in their arms (for some reason I am still thinking Down’s Syndrome or something akin to it), listened as the circumstances of its birth and life are explained to them and thought ‘it doesn’t matter, this too is creation, and this too is love.’ And then there is the line ‘in such situations acceptance can extend beyond just one person’s understanding.’ If you’ll excuse me for a minute, I’m going to think about this line very hard.

I have been thinking about this line very hard for some time now and have come to the conclusion that I don’t understand it. This can mean one of two things. One, that it doesn’t make any sense. Two, that my cognitive development is limited.

I blame my parents denial.

“While some mothers come out of denial very quickly then they face resistance from not just their family members but also in some cases their husband,” says Sadaf Shahid, a speech therapist, adding that, “In fact, often the child is not given the same privileges as their siblings.”

Speech therapist? When did speech therapists become the first port of call for expert opinions on mental illness? Do they also know for whom the bell tolls? Or where I put that sock? But on to what the quote implies: Some mothers do have ‘em. And love ‘em. But to date there have been no recorded instances of human fathers.

"According to psychiatrists, traditionally the “burden of care” for a mentally ill child or person falls on the single female(s) of the family or the daughter-in-law. The reason for this is there are no real institutions to help provide care or train individuals who are caring for people with such illnesses thus creating a dangerous lack of professional understanding of the psychological issues at stake. This also adds a financial burden on the person. And when society at large provides no support and even less understanding, the stress can be immense on a caregiver."

Fair enough. The burden of care generally does fall on women. And it is indeed tremendously difficult to cope with a person with complicated psychological issues. In fact, caregivers sometimes end up developing psychological issues themselves. Not that that’s worth mentioning. Because that would detract from the focus of the piece, which is…

"Dr Murad Moosa Khan is a consultant psychiatrist and chair at the Department of Psychiatry at the Aga Khan University (AKU). Speaking at a seminar organized by AKU he said, “Between 40 to 50 per cent of the nation is affected by some minor or major mental illness (MI).” Minor or common illnesses constitute up to 30 per cent and include depression and anxiety whereas major or psychosomatic disorders include illnesses such as schizophrenia, brain damage and resistant depression."

Enter the big quote gun to finally name, several paragraphs in, some of the things people think of when they see the term ‘mentally ill’; schizophrenia, depression, anxiety, psychosomatic disorders, resistant depression. That point about the stress of dealing with complicated issues earlier was really an excellent one. I’ve only been exposed to Ms. Sherazee’s muddy thinking for about five minutes and I’m already thinking why me? And also, Crouching Psychiatrist, Hidden Speech Therapist.

"With such eye-opening statistics it is sad to see that mental illness remains a “stigma or mark of shame”. This is also one of the reasons behind the neglect of these individuals even though according to a 2007 study published in the Lancet medical journal, mental illness makes up about 14 per cent of global disease, more than cancer or heart disease."

What is the Lancet medical journal? Why is it being quoted at me now? Why would I care what some scholarly tome says when I already know what the (say it with me) speech therapist thinks?

"“The US versus THEM attitude of social exclusion adds to the myths and issues that are present surrounding mental illness,” explains Dr Haider Ali Naqvi, a consultant psychiatrist. “Society has common names for people with illnesses – loony, nutcase, charia, pagal and psycho. This is then added by their general behaviour and attitude towards those are different,” he added.

Interestingly Dr Naqvi added that people, even those who are well educated, seem to know more about physical illnesses than psychological ones. In fact when they do witness someone with a mental disorder they resort to black magic and prefer to go to quacks than trained professionals for help."

Yes Ms. Sherazee the Us vs. THEM approach to people with mental illness is a bad, sad thing. It alienates, marginalizes and makes it more difficult to address an issue that, as you pointed out earlier, affects a large number of people across the world. You know what else doesn’t help? Your ignorance, lack of focus, and constant harping on extreme cases that cement the very mythology you presumably want to combat. It is not interesting that Dr. Naqvi pointed out that people tend to know more about physical illnesses than psychological ones. What is interesting is the line ‘when they do witness someone with a mental disorder they resort to black magic.’ Because, you know, everyone who has a mental illness is visibly deficient and apt to chew on the furniture.

"Not all mental illnesses are biological or genetic, some stem from environmental or lifestyle choices e.g. financial woes or drug and alcohol abuse causing – severe – depression, respectively. Doctors attribute a very high risk of mental illness where drug and alcohol abuse is involved. Drug Free Pakistan 2008 statistics show at least five million people in the country are drug users. However, a bigger problem now is the easy access and availability of alcohol in the country. Excessive use affects not only the drinker biologically with liver damage but the family emotionally as it may have to suffer violent behaviour. “I cancelled my wedding with only a month left,” said Sara (not her real name). “My fiancée used to drink a lot. At first I didn’t pay much attention to his aggressive demeanor but then one day he pushed me during an argument and I fell down the stairs and got hurt pretty badly.” That was the day Sara decided she could not deal with her fiancée’s illness any more. “He wasn’t a bad person, it was just when he drank, he lost control of himself.” Dealing with an alcoholic is a full-time job, especially when the person is “totally dependent on the alcohol and in absolute denial.”"

Right towards the end, the writer decides to muse aloud on the root causes of mental illness. Apparently, not all are biological or genetic. So some are? Should you perhaps have mentioned that when you were talking about the denial some parents feel when they have a special child?

"Some stem from environmental or lifestyle choices." For example not enough space to exercise or commune with something other than concrete? High concentrations of lead in the water? Ceaseless exposure to blood and gore on TV? The stress of a joint family system? Both parents at work all day? Nope. "Financial woes or drug or alcohol abuse."


If you, like me, think this is the bit where solutions and options for the rather drastically disenfranchised people featured above should make a dramatic, if belated, entrance, don’t hold your breath. We are left, instead, with the thought that substance abuse is always a cause rather than a symptom, and that people with mental illnesses exist on the peripheries of society rather than being a faceless, misunderstood part of it. We do not know who they are but we will know them when we see them, from their speech impediments and their uncontrollable rages. They will be the ones who are shunned by their parents. They will be the ones who are dragged to quacks by ignorant relatives. They will be the alcoholic men looming over their sobbing fiancés at the bottom of the stairs. They will never be the special child who hears music when others don’t, the CEO who harnesses his obsessive-compulsive attention to detail into material success, the alcoholic poet who marries lyricism and mysticism, or the artist who pins his heightened sensitivity and capacity for wonder onto canvas before taking his own life.

"Experts say the most important thing is self-awareness and communication, both of which do not come easy and that is when a strong, supportive family or friend is needed the most."

Physician, heal thyself. Editor, wake up.

The Soft Head of TV Journalism

Can I just say how sick I am of silly television anchors' idea of "hard-nosed journalism"? Can no serious issue be covered without dragging it down to the level of bathos? Or without trying to make politically loaded connections that are tenuous at best and whose only purpose is to showcase the anchors' populist credentials?

Here we have a truly tragic incident in Lahore, where a 36-year-old rickshaw driver, Akbar Ali, not only committed suicide, but poisoned almost his entire family as well. Two of his young daughters died with him, while his wife and another daughter are struggling for life in a hospital. One young son escaped the poisoning. The fact that a working man should feel despondent enough about his and his family's future to commit such a terrible act should definitely serve as a wake-up call for society on a number of fronts. Not least of them, about the state of mental health and the social fabric in the country: it is instructive to note that Akbar Ali had a number of siblings, relatives and neighbours, as well as elderly parents, none of whom apparently had a clue about the storm raging inside Akbar. And of course it should lead to circumspection about how economic hardship and the lack of social safety nets are affecting the poor.

Newsbeat's Meher Bokhari: empathy theatre

Instead we have Ms Meher Bokhari of Samaa TV's flagship current affairs programme Newsbeat, turning up from Akbar Ali's home with the young son draped over her arm, doing a show taglined "Ijtimayi Khudkushi... Budget Ke Munh Pe Tamancha" ['Collective Suicide...A Slap on the Face for the Budget']. Huh?? Is this all she could relate it to, the budget?!? Now don't get me wrong, I appreciate the fact that Samaa and Ms Bokhari wanted to give this incident due attention (even if I found the drama of doing a show in the midst of wailing family members and the melodrama of having the exhausted and no doubt traumatized son sleeping in Ms. Bokhari's lap rather unsettling and in poor taste). And expressing empathy with the bereaved family members is also commendable. But what exactly was the content of the show beyond superficial berating of officialdom?

It's the easiest thing in the world to attack governments and their wasteful expenditures. And heaven knows they richly deserve it. But when anchors focus on the current president and prime minister in very personal attacks, making it seem as if all was hunky dory in days gone by, you begin to get a whiff of either a political agenda or utter and complete naivete. Meher Bokhari's intro to the programme attacks Asif Zardari for not knowing the number of rooms in the presidency, Yousuf Raza Gilani for being overly concerned about his sartorial trimmings, and ministers for having too much security protocol, all in the service of showing how disconnected this government is from the people. But can she seriously claim any different under General Musharraf, for example? Unfortunately she probably thinks she is being a hard-nosed and edgy commentator. Geo has a lot to answer for.

When Ms Bokhari took on PPP Information Secretary Fauzia Wahab with a rambling and incendiary non-question, I felt sympathy for Ms Wahab, probably for the first time. You really have to see this performance theatre to understand what got my blood really boiling. The Fauzia Wahab portion begins around 6:36 in this clip:




Ms Bokhari seems insistent in linking the suicide to the presentation of the federal and provincial budgets. It sounds almost absurd, as if Akbar Ali waited to listen to the budget speeches before deciding his course of action.What possible evidence does she have to imply cause and effect? None. But no facts dare stand in the way of our intrepid analyst.

During the entire programme, Ms Bokhari also touts a figure of 7,000 suicides in Pakistan over the last two years (once again, decontextualized from the situation before the PPP government came into office). First of all, even though she claims this is "on the record data", the sources for her figure seem highly dubious. As this report from the Daily Times quoting an academic study says:

"There are no official data on suicide from Pakistan. Data on suicide is not included in the national annual mortality statistics. As a result, national rates on suicide are neither known nor reported to the WHO."

This is not of course to say that suicide rates have not increased in the last few years (there is compelling anecdotal evidence to support this), just that there are no figures.

When Fauzia Wahab points out (though getting the mathematics horribly wrong) that Ms Bokhari's figure implies roughly 10 suicides a day (she thought it meant 1000 a day), Ms Bokhari immediately agrees to revise the figure down, falling back on the soft emotionalism of 'even 100 suicides is not okay.' This is journalism?

Even if we accept Ms Bokhari's figures of the number of suicides in Pakistan, how do we immediately connect all of them to economic despondency? Surely not every suicide in Pakistan is related to poverty. It would also be instructive to look at the global figures for suicide, which experts tell us has increased dramatically all over the world in last few decades. Incidentally, Japan and Korea, two of the most industrialized and prosperous countries in the world, have among the highest rates of suicide. What does that mean for Ms Bokhari's analysis?

Once again, I am in no way discounting the effect of increasing poverty (for which there are figures) and the increasing wealth gap (ditto) on the apparent rise in despondency in Pakistan. The point I am trying to make here is that serious issues, and particularly such tragic incidents, need to be dealt with in a more sober and thoughtful manner. By making easy and dubious political judgements, based on nothing but grandstanding, the media does no one any favours.

Oh, and someone should tell Ms Bokhari that shouting like Jasmin Manzoor - as she is increasingly wont to do on her show - does not make one a more credible journalist. Just irritatingly loud.

Funnyman Blues

You know how you feel guilty for sometimes finding humour in something deeply noble (or serious or tragic)? That's how I felt upon reading this:

"President Asif Ali Zardari on Wednesday became the first president to donate all his body organs after signing a bill to enact a law to regulate transplant of human organs in the country.The president made the announcement of donating his whole body after he inked the document at a ceremony held at the Aiwan-e-Sadr, also attended among others by federal ministers and health experts. President Zardari said he took the decision in light of Shaheed Benazir Bhutto’s philosophy of living for others."

I'm not even going to go into what crossed my mind. It's a long-needed, noble thing, dammit, and I should be ashamed of myself!