THERE is an old adage that advises people to be cautious while making a wish, lest it come true. The United States regularly demonstrates, through its follies, the wisdom of this advice. It declares its support for democracy and democratic ideals, then moans the outcome of such an exercise, for the results are diametrically the opposite of those desired.

The US is, thereafter, constrained to ignore its own pledges, dismiss election results and demonstrate that its belief in democracy is acceptable only when convenient to its foreign policy interests.

This has happened time and again, especially in the developing countries of Asia, Africa and Latin America. On some occasions, election results have even triggered a violent reaction from the US which has not hesitated to engineer military coups, as happened when the Chilean military leader, General Pinochet, was encouraged to topple the popularly elected government of Salvador Allende.

The need to temper idealism with realism has to be recognized. But the contradictions between the American espousal of democracy, human rights and the rule of law, when challenged by the need for realism or realpolitik, as its best known practitioner, Dr Kissinger, would state, are altogether a different matter. US administrations have had no hesitation in opting for the latter, at the cost of the former. We are currently witnessing a similar situation emerging in the Palestinian territories.

For years Israel, with its American friends, spearheaded an international campaign against Fatah, and its then political head, Chairman Yasser Arafat who was accused of being authoritarian and corrupt. Even this was tolerable, but when perceived as unwilling to give in to Israeli demands, he was accused of being an obstacle to peace. Under pressure from Israel, the Bush administration cut off all contacts with Arafat, leading to his political isolation, and later, virtual imprisonment in his office. Thereafter, it was conveniently claimed that the US and Israel could not promote the Middle East peace process, for the Palestinians lacked a credible leader.

Of course, Fatah was inefficient and corrupt. But the primary reason for its inability to provide even basic municipal services in the occupied territories and failure to ensure law and order was due to the systematic destruction of its political, economic and security infrastructure by Israel.

The election of the moderate Abu Mazen (Mahmoud Abbas) made little difference. In fact, Israel continued to sabotage the Quartet’s roadmap and persisted in discrediting the newly elected Palestinian leader. With nothing to show for his moderation and willingness to enter into meaningful negotiation with Israel, it was inevitable that Fatah would lose support among the increasingly disillusioned populace of the occupied territory. In the meanwhile, the Israeli leadership was able to develop and execute its policy of unilateral disengagement, by agreeing to remove a handful of small, isolated settlements, while expanding and strengthening the larger colonial settlements, earmarked for permanent annexation. This provided the excuse that many authoritarian Muslim states had wanted: to offer their own certificate of Israel’s good intentions.

In fact, the building of new settlements in the Arab sectors continue at full steam. According to Israel’s own human rights organizations, from 1948 until today, some 700 Jewish communities have been established, but not a single Arab town has been founded within the state’s borders. Arab Israelis, who constitute 18 per cent of the state’s citizens, control only 2.4 per cent of its municipal areas.

In elections described by international observers as free and fair, Hamas won the majority in the Palestinian parliament. Instead of welcoming this credible outcome of a democratic process, the Bush administration reacted in an extremely negative manner. It claimed that Hamas was a terrorist organization that could not be entrusted with the responsibility of running the government in the occupied territories. American diplomats and officials were instructed to sever all contacts with Hamas-appointed ministers, even those that were not members of the militant group. This no-contact policy was more sweeping than many had expected because it was made applicable not just to Hamas members, but to independents and technocrats in the new government as well.

There was also a major effort to persuade other governments to refrain from extending any assistance to Hamas. Canada, under its conservative, pro-US government, was the first to fall in line, when it suspended all contacts and ended financial assistance to the Hamas-led government. Earlier, Israel had also frozen tax revenue transfer to the PA, an amount in excess of fifty million dollars.

Now, it has been announced that the European Union, too, has decided to suspend its funding to the Palestinian Authority. Since this amounts to 600 million dollars a year, its suspension will have a crippling effect on some of the most essential social sector programmes in the occupied territories. The EU based its decision on the ground that Hamas must meet the three key commitments set by the international community: renounce violence, recognize Israel and abide by previous commitments. But it is evident that the EU decision came about not of its own volition, but as the result of considerable pressure from the US.

Admittedly, these developments represent an important victory for the US campaign to pressure Hamas to accept the “reality” of Israel. But this can only be a pyrrhic victory for the Jewish state, for these punitive measures will drive Hamas even further into adopting hard-line policies. Hamas has already condemned the EU’s decision as “blackmail”, pointing out that the EU decision will not only punish the Palestinian government, but more importantly, the poor workers and peasants.

Given the reactions of the US and the EU, some observers are of the view that the Israeli leadership may be rather relieved at Hamas’s victory, for it has become convenient to tag this organization as terrorist and then demand that it be not only isolated, but ostracised as well. If so, it would be a very short-sighted policy that can bring only temporary benefits to Israel. The peace and security that it desires will remain an elusive goal.

It is clear that these pressures are being mounted by the West to force Hamas to explicitly recognize Israel and give up its resistance to Israeli occupation. This is an extremely shortsighted policy. To believe that Israel’s plan of unilateral disengagement can be anything more than an interim solution, or that this will bring it the peace and stability that it desperately seeks, is highly flawed. Instead, it will reinforce the Zionist character of Israel and destroy any prospect of the Arabs and Jews living side by side.

The reality is that Hamas had already given subtle but significant hints of its growing restraint and maturity. Its election manifesto had omitted the rejectionist formulation of its charter about the Zionist state. More importantly, Prime Minister Ismail Hania had reaffirmed his government’s readiness to enter into negotiations with the Quartet, declaring that Hamas would give talks between President Abbas and Israel a chance. No less significant was its offer of a long-term truce to Israel if it agreed to withdraw to its pre-1967 boundaries.

Instead of appreciating these steps, the UN, too, appears to have buckled under American pressure. It has announced a “restrictive policy” of dealing with the Hamas-led government, stating that political contacts would now be decided on a case by case basis. Since when has the UN arrogated to itself this right? Has it forgotten that it had no hesitation in dealing with the Soviet-installed Karmal regime?

The US had a wonderful opportunity of encouraging the Hamas to transform itself into a political entity. Instead, it chose to punish the democratically elected government. This can only lead to the sidelining of the saner voices in Hamas, giving credence to the views of those that are convinced that the US is under Israel’s strong influence and as such cannot play a useful role in the region.

The US may well be upset that Hamas should have transformed itself into a political party and won the election, thus denying Washington the excuse to allege that the PA lacks legitimacy. Lest we get confused by western propaganda, it is important to recall that the Palestinians voted for Hamas not because of its Islamic agenda, but because of its clean image, its anti-corruption platform and its stance on Palestinian rights. And, of course, because of its rejection of US support to Israel.

If this is a test for Hamas, it is a bigger test for Israel and its policies. Israel has for the first time, a strong, decisive, disciplined “partner” that is as legitimate as itself. Is it regretting the opportunity it had of dealing with the Palestinian “moderates”, who were ever ready with their compromises, for they never enjoyed the authority that only legitimacy confers?

Israel is admittedly a powerful state, it may appear invincible as well, but even the most powerful and invincible ones begin to rot, when they lose their moral authority. This is what is happening in Israel today. If it believes that peace can be secured by building a wall around itself and that too, on stolen land, it is living in a world of make-believe. Israel today is a cruel, occupying power. Resistance against it is getting stronger and more determined. As invariably happens, the occupation is corrupting the occupiers themselves.

If Israel’s leaders had the courage and vision, they would have seized Hamas’s offer of a long-term truce and prepared for genuine negotiations. If Israel fails to grasp this moment, it will later rue a missed opportunity. Instead of seeking to prevent the West from extending Hamas recognition and acceptance, Israel would do better to facilitate this recognition.

The election results reflect the frustration and anger of the Palestinian masses, who have lost faith in never-ending negotiations that have not brought liberation any closer. In asking Hamas to give up its position on Israel, the Jewish state is asking the Palestinians to give in even before the start of negotiations. Instead of Israel asking the Palestinians to recognize it, it should be the other way round. It is the Palestinian right to a sovereign, independent state, that has to be recognized. In fact, by its willingness to negotiate with Israel, Hamas has already conferred de facto recognition on the Jewish state. As regards the demand that Hamas renounce violence and disarm itself, this is frivolous. No national liberation movement, fighting against a foreign occupation force, has ever accepted these humiliating terms and the Palestinians are certainly not going to be the first to do so.

As regards the US, it must realize that the carte blanche that it has provided to Israel to perpetuate its occupation is slowly but surely destroying its credibility in the region. The invasion of Iraq had not helped matters. Now by its rejection of the election results in the occupied Palestinian territories, Washington is making a grave mistake. Has the West not learnt from the catastrophe that it engineered by denying the FIS its election victory in Algeria?

Palestine’s Arab neighbours face a dilemma. Having denied their own populations the opportunity to exercise their right to free and fair elections, they are hardly in a position to be critical of the US for its failure to respect a democratic outcome. The Arab League secretary-general has appealed to Arab governments and institutions to come to the aid of the Palestinians and has underscored the fear that the impoverished Palestinian territories might otherwise become a breeding ground for extremists.

There are also apprehensions that Iran would step in with aid, thereby increasing its influence in the region. The Arab response is, however, not expected to be prompt or meaningful. Most of these countries with unrepresentative regimes are unlikely to do anything to upset the Americans.

The writer is a former ambassador.

TEHRAN has claimed that it has enriched uranium, a first step toward nuclear weapons capability. The question now is whether the Bush administration has learned from its mistakes in Iraq, or will it set our nation on a road that leads to military confrontation with Iran?

No one concerned about US national security wants Iran to obtain a nuclear weapons capability. It would be a destabilizing force in the Middle East and throughout the world. That’s exactly why we need strong American leadership, working toward a verifiable diplomatic solution.

Instead, the administration reportedly is intent upon relying on the failed doctrine of preemption and new Pentagon planning that stokes the prospect of military conflict. If this is true, Americans ought to be deeply concerned.

The doctrine of preemption, first articulated by President Bush at West Point in June 2002, was spelled out in the September 2002 National Security Strategy: “The greater the threat, the greater the risk of inaction — and the more compelling the case for taking anticipatory action to defend ourselves.”

Just a few weeks ago, the doctrine was reiterated in the latest National Security Strategy. According to this document, the US may use force before it is attacked because the nation cannot afford to “stand idly by as grave dangers materialize.” Yet it is the doctrine itself that is dangerous.

First, it demands that our intelligence be right — every time. This is difficult, if not impossible, in the shadowy world of terrorism and WMD. As we’ve seen in Iraq, intelligence not only can be wrong, it can be manipulated. Our nation’s credibility and stature have taken a huge hit as a result, and the US is in no position to garner support in the international community for military confrontation based on preemption.

Second, the doctrine of preemption may lead to a less stable world in general — especially if our adversaries believe they are safe from preemptive action only if they possess nuclear weapons. Iran has no doubt noted the difference in our dealings with North Korea, which possesses nuclear weapons, and Iraq, which the administration believed was still developing them. So the administration may have encouraged the very proliferation it is seeking to prevent.

Third, an overreliance on preemption can lead to the downplaying of diplomacy. By the administration’s own account, Iran is years away from possessing nuclear weapons; there is time to engage in forceful diplomatic action.

The dangers inherent in preemptive action are only multiplied by reports that the administration may be considering first use of tactical, battlefield nuclear weapons in Iran: Specifically, nuclear “bunker busters” to try to take out deeply buried targets.

There are some in this administration who have been pushing to make nuclear weapons more “usable.” They see nuclear weapons as an extension of conventional weapons. This is pure folly.

As a matter of physics, there is no missile casing sufficiently strong to thrust deep enough into concrete or granite to prevent the spewing of radiation. Nuclear “bunker busters” would kill tens of thousands, if not hundreds of thousands, of people across the Middle East.

This would be a disastrous tragedy. First use of nuclear weapons by the United States should be unthinkable. A preemptive nuclear attack violates a central tenet of the “just war” and US military traditions.

There is no question that in the post-9/11 era, a full range of policy options for dealing with new and uncertain events should be on the table. But in my view, nuclear options cannot be considered as an extension of conventional options.

So what steps should the United States be taking?

The US should engage Iran diplomatically. So far, England, France and Germany have led the negotiated effort to halt Iran’s uranium enrichment, while Russia has explored other alternatives. It is time for the US to lead such efforts, not stand by.

We must push for a complete halt to Iran’s enrichment activities and full access to all nuclear sites by the International Atomic Energy Agency. If Iran refuses, international sanctions should follow, and inspections with UN forces if necessary.

At the same time, the US needs to build international alliances to create a unified front opposed to Iran’s quest for nuclear weapons.

The United States should learn the lesson of Iraq. It should not make the same mistake twice. There is broad agreement that Iran cannot be allowed to proceed with its nuclear programmes and continue to flout the international community. Now is the time for tough diplomacy, joined by our allies, not a premature military confrontation that could include nuclear devastation. —Dawn/Los Angeles Times

The writer is a senior US Senator.

IN the prehistoric days before Ghulam Mohammed decided, like all sensible bureaucrats, that Pakistan was not yet ready for any sort of government which involved the participation of the people, the dishing out of portfolios was often left to the functionary who was least qualified for the task.

And so when the ministries were being doled out, after a careful assessment of the inadequacy and unsuitability of the candidates, the prime minister’s favourites invariably opted for those departments where they could make the most money. At the bottom of the list were education and health which politicians accepted with infinite reluctance, which probably explains why these two departments have always been in such a shoddy mess.

The medical profession is still highly sought after in Pakistan. But no government in this country has as yet been able to pull out all the scalpels and swabs and stitches that would ensure that a student who is qualified to enter a medical university will end up doing so. There are literally thousands of students in Pakistan who clear their First Year Science examination in the first division and are anxious to pursue a medical career, but are unable to gain admission in government medical colleges.

Readers often get turned off by cold statistics, but a few numbers are being tossed around to illustrate a point. According to A.J. Khan, principal of the Frontier Medical College, around 30,000 students clear the F.Sc premedical examination in the first division in Pakistan every year, after securing over 60 per cent marks. As a matter of course they apply for admission in public sector medical colleges and around 4,000 strike gold. Of the remaining 26,000, around 800 who can afford it head for Russia, one of the former Soviet republics, China, the Philippines or one of those tiny islands in the Caribbean famous for reggae, sun, sea and surf.

Collectively, these students are supposed to be costing the exchequer around 36 times what the speaker of the National Assembly, Chaudhry Amir Hussain, paid for his eleven-million-rupee Mercedes Benz, bought at the taxpayers’ expense. It takes them a year or two to learn the language and another six months to understand the textbooks. Now here’s the catch. Once they’ve obtained their degrees, after slogging for five to seven years, depending on the number of diversions that come their way, some of them learn, to their mortification, that they would have been better off if they had taken up banking, information technology or the law.

Apparently, a number of the universities which have gleefully accepted students’ fees are not recognized by the Pakistan Medical and Dental Council which acts as a regulatory authority. In plain English, it means that these doctors and dentists will not be able to practise in Pakistan. A great deal of time and money could have been saved if the students had taken the trouble of doing a little investigation before hopping on to an airplane for those exotic lands. This underscores the need for the establishment of many more medical colleges in the country in the private sector. Besides saving Pakistan foreign exchange it would help to overcome the desperate shortage of doctors in the country.

Getting back to statistics, 110,000 doctors are at present registered in Pakistan. Of this total it is estimated that around 25,000 are working abroad. This leaves 85,000 for a population of around 150 million — a ratio of one doctor for 1,764 persons. This ratio has, of course, been arrived at by taking the country’s population as a whole. It is much lower in cities like Karachi, Sialkot, Faisalabad, Islamabad and Lahore, where there is no shortage of physicians, and specialists earn by the hour. And considerably higher in the interior of Sindh, Balochistan and Punjab where patients have to often trek hundreds of miles before they come across a specialist.

The ratio recommended for developing countries by the World Health Organization is one doctor for a 1,000 inhabitants — which, according to European standards, is still very high. But even if one were to strictly implement this ratio in Pakistan the number of doctors required would touch the 150,000 mark. This demonstrates that there is a requirement for another 65,000 doctors to fulfil the country’s needs — a shortage which public sector medical colleges cannot possibly tackle.

There are some other interesting statistics. Around 2,000 doctors peg down from natural or unnatural causes every year, around 500 leave the country to practise abroad, and about 200 doctors, mostly women, stop practising altogether. This means that around 1,300 doctors are added to the tally each year.

According to a reliable source it costs around Rs 6 million to train one doctor in this country. Against this the government had been charging a nominal tuition fee of between Rs 20,000 and Rs 50,000 staggered over five years. Appreciating the importance of training more doctors, the government increased the number of seats in medical colleges in the 1970s. Unfortunately, the administration saw the application of the law of diminishing marginal utility. There was a lot of overcrowding which adversely affected the standard of education, and therefore, on the advice of the Pakistan Medical and Dental Council the number of seats in medical colleges had to be reduced. That’s how the private sector jumped into the fray.

Currently there are 16 medical colleges in the public sector and another 16 in the private sector. Eight medical colleges were apparently closed down earlier on the recommendations of the PMDC. The most outstanding in the private sector is, of course, the Aga Khan University Hospital but the only problem is that not every patient can get to the place.

Fortunately, one still finds medical practitioners in Karachi who believe that a doctor’s basic concern is his patient’s health and not how he is going to construct his second block of high-rise apartments. There are still surgeons in the city who, at the drop of a hat, could take off for Acapulco, but who, nevertheless, choose to regularly turn up every morning at government hospitals and operate for hours without charging a red cent, and physicians who still charge the princely sum of two hundred rupees for helping a patient get back on his feet, and frequently waive their fee when the patients are particularly wretched and poor and ply them with samples of new medicines sent by pharmaceutical companies.

Unfortunately, the general perception is that in the big cities the specialists charge far too much for consultation and in some cases indulge in what could, for want of a better phrase, be described as ‘wholesale therapy.’ This writer got a taste of this over 30 years ago when he took his son who was suffering from a chest infection to a child specialist. And from what he has subsequently seen, nothing seems to have changed. The identity of the specialist must remain confidential because in this country it is the custom to protect the guilty.

Inside the whitewashed waiting room children, accompanied by their elders, waited patiently to be summoned. Every 10 minutes an assistant, with much pretentious rumbling of voice called out the first names of three children in rapid succession. The children subsequently entered the consultation room accompanied by their elders. After a wait of 30 minutes, during which time this writer’s son managed to practise on somebody else’s offspring some of the holds in the ancient Japanese art of self-defence, he was called in along with two other families.

As we entered the specialist’s inner sanctum along with two other families, a young boy, his shirt still rolled up to his neck, and his mother and two young girls along with their father were preparing to leave. My son was given eight minutes. One minute for temperature taking, one minute for checking if he really had a sore throat, and one minute for prescription writing.

The rest of the time was taken in extolling the virtues of a new drug which had just been launched in the market which the doctor appeared most anxious to flog. We were charged two hundred rupees for eight minutes, which was a lot of money in those days. If one took into consideration the fact that two other patients were being dealt with at the same time, the specialist was earning something like 30,000 rupees for an eight-hour shift. One never found out how many yachts the specialist owned and where they were anchored.