What Can Be Done for Victims Still Fighting for Survival?

By Sheikh Nazmul Huda, Desdemona Khan, Labin Rahman and John Richards
Apr 24 2016 (The Daily Star, Bangladesh)

Three years have elapsed since the collapse of Rana Plaza, Savar, on a fine morning of April 24, 2013. The disaster, one of the deadliest in the world’s industrial history in two centuries, claimed the lives of 1,135 men and women and injured another 2,500, nearly 200 of whom severe enough to keep them hospitalised for months.

Photo: rahul-talukder

Photo: rahul-talukder

In the months following the accident, we, along with other colleagues, surveyed many such survivors with serious injuries. The victims were in the prime of their lives, their mean age being only 26. Two thirds were female and they were much younger than their male counterparts. Over 60 percent of the victims were married and 12 percent were either widows or divorcees.

Currently, we are following up with another survey, contacting as many as possible of those we had met in the summer of 2013. As may be apprehended, given the severity of the disaster, many survivors now face grave difficulties. It is encapsulated by Jorina’s bitter comment : “I think it would have been better if they had cut off my legs. These legs are now the bane of my life. I am completely unable to walk and they are heavy. I can’t move about as I wish to. All the time I have to use a wheelchair.” She comes from Naogaon, a northern district. There was nobody to look after her. “My daughter and son-in-law stay with me. I have two grand-daughters too, but there is not enough room for all of us to stay together in a one-room house. So I live on the verandah, I have to also sleep there.”

Soon after the collapse, the United Nations reviewed Dhaka’s capacity for undertaking a major rescue operation and offered to help out. The Bangladesh Government expressed their confidence in managing the situation and refused their offer. A large number of deeply motivated but untrained volunteers played a key role in medical evacuation and rescue operations there. The Army, the fire service and other national agencies were also active part of these efforts.

Though the rescue operations continued for more than two weeks, almost three fourths of our respondents, fortunately, got rescued on the first day, namely on April 24, 2013. A good 10 percent were rescued on the second day and on the third day another 10 percent of our respondents were dragged out of the debris. According to our data, more than one-third of the victims were found unconscious on rescue. As many as 30 percent of the injured had fractures of one or more limbs.

Approximately 20 percent had spinal or head injury. One-fifth of the seriously injured required amputation of one or more limbs.

Hospitals and clinics in the neighbourhood proved the best; these institutions, coming out of everywhere, provided critical services to the survivors. Enam Medical College Hospital, Savar, has been the most common destination of the injured. Approximately half were directly taken to this non-governmental establishment. Less than 20 percent were taken to CMH (Combined Military Hospital) Savar, devoted exclusively to the armed services of the nation otherwise. After four weeks of the tragedy, we encountered many victims being transferred to CRP (Centre for Rehabilitation of the Paralysed), Savar, one of the best centres in Bangladesh for treatment of spinal injuries.

Approximately one fourth of the seriously injured suffered spinal injuries. Initial medical assessments diagnosed nearly half of these downright. However, only three were referred to CRP for initial treatment. Despite close reach and access to CRP, some complicated cases were sent to smaller hospitals where neither requisite skills nor logistics for advanced care of spinal fractures and other complications were handy. Spinal injuries, for instance, need immediate immobilisation for minimising neurological and other kinds of damage. In many cases that did not happen. The victims often had other injuries (like bleeding, soft tissue infections, fractured limb etc.) that could be handled in multi-disciplinary hospitals. Nevertheless, immediate mobilisation after the rescue could perhaps have prevented paralysis in some cases. Optimal emergency treatment requires effective triage (a process for quick assessment of the type or the urgency of medical problems) where many cases are brought in for treatment. It seems the triage at the site of Rana Plaza could have been better.

Immediate medical care was provided generously by hospitals, community organisations and people in general. This is less evident in terms of long-term care, however. Three years into the catastrophe, we encountered many victims in need of physical and occupational therapy. Others are experiencing post-trauma stress disorder and stand in need of psychiatric help. Many are not gainfully employed anymore. Most have returned to their native villages, taking with them the trauma and consequences of the catastrophe.

Among the survivors we recently met, was a woman, whose arm was amputated from her shoulder. While under treatment she became pregnant. Her baby is now less than three years old and it is very difficult for the mother to take care of her child with only one arm. Once, while taking the baby for vaccination, the baby fell and was injured. No one in the hospital had counselled her on the techniques of managing with one arm only. This case serves to illustrate the importance of addressing the long-term needs of survivors.

What is missing is a systematic initiative for their long-term rehabilitation and wellbeing. It’s a shared responsibility no one can ignore. The garments industry, state health services, NGOs and, not least, civil society itself, can neither deny nor evade their call of duty.

The writers are members of a research collective directed by Prof. John Richards, School of Public Policy, Simon Fraser University, Canada.

This story was originally published by The Daily Star, Bangladesh

Will the IMF Facility Be a Turning Point in the Economy?

By Editor, Sunday Times, Sri Lanka
Apr 24 2016 (The Sunday Times – Sri Lanka)

The IMF Extended Fund Facility (EFF) of US$ 1.5 billion with an agreement on an economic program supported by the IMF is now imminent. This could be a turning point in the economic fortunes of the country. The IMF facility would replenish the reserves, add confidence in the economy and have a salutary effect on capital inflows.

In as much as the loan is vital for getting the country out of the current critical balance of payments crisis, the commitment to the suggested economic reform program is essential to stabilise the economy and lay the foundation for a high trajectory of economic growth. The suggested corrective measures by ensuring fiscal discipline and prudent fiscal and monetary policies could get the country out of the current crisis, restore economic stability and provide the conditions for rapid economic growth.

Econ-Cartoon3-300x186IMF statement
The IMF statement of April 11th points towards the IMF granting a facility of US$ 1.5 billion with agreement on an economic program supported by the IMF. While the IMF agreement on the Extended Fund Facility (EFF) is not a fait accompli, the tenor and thrust of the statement leaves little doubt that it will be granted after the on going Annual Spring Meetings of the IMF Board and the discussions that are currently taking place in Washington D.C. between the IMF and the Sri Lankan authorities.

Economic recovery
The loan facility and the concomitant economic reform program could usher an economic recovery. The government must however have the political resolve to implement the associated economic reforms that are vital to strengthen the fiscal position, foreign exchange reserves and balance of payments.

Objectives
The broad objectives of the proposed economic program, according to the IMF, is to achieve “high and sustained levels of inclusive economic growth, restore discipline to macroeconomic and financial policies, and rebuild fiscal and reserve buffers.” The IMF identifies the key objectives underlying the reform agenda as improving revenue administration and tax policy; strengthening public financial management; reform of state enterprises; and structural reforms to enable a more outward-looking economy, deepen foreign exchange markets, and strengthen financial sector supervision.

Tax reform
One of the weakest features of the Sri Lankan economy is the low collection of government revenue. The revenue to GDP ratio has declined over the years from around 20 per cent of GDP to only 12 per cent, despite average annual GDP growth of around 7 per cent in recent years. This tax to GDP ratio is too low for the country’s level of per capita income. Countries with similar per capita incomes gather more than 20 per cent of GDP as revenue.

The low revenue collection results in high fiscal deficits and accumulation of public debt and leaves inadequate fiscal space for education, health and infrastructure development. The foreign funded high cost of infrastructure development in 2010-2014 has been the main reason for doubling of foreign indebtedness.

The reduction of the fiscal deficit is vital for economic stability. The IMF economic reform program lays considerable emphasis on fiscal consolidation. Its objective is “A durable reduction of the fiscal deficit and public debt through a growth-friendly emphasis on revenue generation.”

The cabinet has, according to the IMF statement, decided to reduce the 2016 fiscal deficit to 5.4 per cent of GDP. Although this is inadequate, it may be a realistic target. The government should take steps to achieve a fiscal deficit of 3.5 per cent of GDP in 2020 as targeted in the Prime Minister’s Economic Policy Statement of November 2015.

Strategy
The IMF strategy to increase revenue consists of broadening the tax base by reducing tax exemptions and introduction of a new Inland Revenue Act. The medium term revenue effort will be based on further reform of tax and expenditure policies, modernizing revenue administration and public financial management by implementation of key IT systems.

Pragmatic tax measures
Tax exemptions, tax avoidance and tax evasion are widespread endemic features. An effective tax system must take into account the inefficiency and corruption that prevails. The IMF proposals are essentially medium term and based on the assumption of an effective administration. New tax measures should be unavoidable and certain of collection such as withholding taxes and license fees. Otherwise the good intentions of curtailing tax evasion and tax avoidance would remain a delusion. Tax exemptions are easier to remove if the government is determined to not permit discretionary exemptions.

State enterprises
The other important economic reform that has been mooted is “a clear strategy to define and address outstanding obligations of state enterprises”. The colossal losses of state enterprises have been a heavy burden on the public finances. The reform of these enterprises is vital to redeeming the public finances. Drastic reforms, including the privatisation or part privatisation of some state owned enterprises are imperative. Will the government have the political will and courage to implement a privatisation program as was done by Chandrika Bandaranaike‘s government.

Reserves
The IMF loan facility will strengthen the country’s diminished reserves and add considerable international confidence in the Sri Lankan economy. The enhanced international confidence in the Sri Lankan economy would stem capital outflows and reduce the cost of international borrowing. As the Governor of the Central Bank, Arjuna Mahendran has stated “Depending on the success of the Extended Fund Facility with the IMF on which discussions are currently underway in Washington D.C. other global lending agencies will look at us much more favourably in the coming months.” He also said that the People’s Bank of China has given authorization to issue bonds in China in renminbi the official Chinese currency and that all these would enable the raising of US$ 3 billion at lower interest rates quite easy.

Concluding reflections
The expected IMF facility of US$ 1.5 billion will replenish the reserves and add confidence in the economy. This would have a beneficial impact on capital inflows. The corrective measures by the IMF of ensuring fiscal discipline and prudent fiscal and monetary policies are essential to get out of the crisis and restore economic stability and create conditions for higher investment and rapid growth.

This story was originally published by The Sunday Times, Sri Lanka