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81. Financial Analysis of Health System Shifts in Egypt: Searching for “gratuitousness” and the right to health

Author:
Mohamed Gad
Publication Date:
05-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
Throughout the formation and development of the modern state of Egypt,1 health policies played two key roles: First, the state played a powerful and efficient role in the provision of medical services through facilities funded by public treasury revenues. Secondly, it strived to provide these services at the lowest possible costs or free of charge in what is known as the “gratuitousness” policy. Like many other free social policies that took root during the interwar period and were given new impetus with the advent of Arab socialism in the 1960s, the “free public hospital” principle was a subject of conflict between two movements that fiercely competed to control public policy in recent decades. The first movement defended the “gratuitousness” policy through tax-based expansionary fiscal policies targeting the wealthiest segments of society — a model similar to the welfare state adopted in some Western European countries. The second movement believed that tax reduction and redistribution policies in general were of vital importance to help the country attract investments and achieve the highest possible rate of economic growth and capital accumulation — in parallel with the rise of neoliberalism globally. The second movement recommended fiscal policies aimed at reducing the budget deficit, claiming that the latter affects investment opportunities in a multitude of ways. For example, it contributes to the rise of inflation rates, not to mention that public debt crowds out private borrowing opportunities, etc. This movement calls for transforming the interwar and Arab socialism policy legacy into a new pattern relying less on the public treasury and more on middle-class contributions, with “gratuitousness” policies being restricted to the poorest segments of society. This system requires continuous updates to the citizens’ income distribution database to help identify affluent and disadvantaged groups. This movement managed to gain traction in Egypt thanks to two major financial crises in the country. The first took place in the late 1980s with the steep rise in external debt, which led Egypt to adopt economic liberalization policies in the early 1990s known as stabilization and structural adjustment programs, which were supported by the International Monetary Fund (IMF) and the World Bank. The second crisis happened when the global financial crisis reached Egypt and political instability following the 2011 revolution, with the subsequent emergency of a black market for hard currency in 2016, leading to a new phase of financial and monetary policies with the support of the IMF and international donors. During the two crises, international financial institutions were reinforcing their policies in Egypt, particularly the scaling down of social protection policy costs covered by the public treasury. In this context, a new health insurance law was introduced and approved in 2018. The provisions of the new law represented a major transformation in the role of the state in the health sector in Egypt. The law is the first piece of legislation aimed at restructuring the health insurance system in Egypt since the 1960s. In essence, it aims to reduce dependency on “gratuitous hospitals funded by the public treasury” model and, instead, to adopt a new model that is more reliant on the middle-class to fund the public health system via deductions from their income. This model could improve public health services, while enabling the state to maintain its social role in supporting the disadvantaged. As the new health insurance law created a major shift in the history of health policies in Egypt, it also sparked widespread controversy. It is likely to stir even more controversy during its 15-year implementation period. So far, the law has only been applied in a small number of the least populated governorates.2 This research paper is not biased towards either of the two abovementioned movements, as both of them entail numerous contradictions. The “gratuitous” hospital model funded by the public treasury has long been criticized for the poor quality of services, even during its beginnings in the 1960s. The movement defending this model also did not propose any broader perceptions on distributive tax policies to increase public treasury resources, and it focused on the improvement of medical services.
Topic:
Health, Health Care Policy, Finance, and Financial Development
Political Geography:
Africa and Egypt

82. Impacting policies: Waste management and advocacy in Lebanon

Author:
Samar Khalil
Publication Date:
06-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
Since 1994, Lebanon's waste management policy has consisted of implementing a series of emergency plans, each partially and poorly executed, and extended until a new crisis emerged. Devoid of any measures to move to long-term, sustainable planning, these local emergency fixes to the lingering waste crisis have incurred high financial costs for citizens as well as negative environmental, health, and safety impacts. Lebanese citizens are paying a high price for solid waste management (SWM). Lebanon spends $154.5 to manage every ton of solid waste, compared to Algeria, Jordan, and Syria which spend $7.22, $22.8, and $21.55, respectively (Human Rights Watch, 2020). The solid waste sector ranked first in terms of environment-related government spending in Lebanon, with a total of $647 million spent between 1998 and 2008 (Arif & Doumani, 2014). Expenditures on SWM reached $2.2 billion between 1996 and 2015 (Akiki, 2019). Despite these high expenditures, the cost of environmental degradation (COED) from the solid waste sector was around $66.5 million (0.2% of national GDP) in 2012 (Arif & Doumani, 2014), increasing to $200 million (0.4% of GDP) in 2018 (MoE, UNDP, 2019). To date, around 20% of the waste is recovered, out of which only 6% reaches recycling facilities, 36% is landfilled, and 44% is dumped in around 940 open dumps scattered throughout the country (MoE, UNDP, UNHCR, UNICEF, 2020). At the same time, the private company contracted since 1994 to collect and treat much of Lebanon’s waste – Sukleen (part of the Averda Group) – has generated over $170 million in revenues per year, one of the highest waste management revenues in the world (Chaaban, 2016). Sukleen has held a monopoly in waste management in Beirut and Mount Lebanon since the 1990s, when it won a contract for building, testing, and operating a waste incinerator located in the city of Amrousiyeh. Operation at that site was short-lived as angry residents burned the plant down in 1996, but through other contracts, Sukleen came to handle around 50% of the waste generated nationally, serving around 400 municipalities (Chaaban, 2016). The company’s contract was renewed three times by the Council for Development and Reconstruction (CDR) without an open tender. With each contract renewal, collection and processing fees increased, all paid using transfers from the Independent Municipal Fund, an intergovernmental grant system that disburses taxes and fees to municipalities. Successive plans for integrated solid waste management (ISWM) – in 2006, 2010, 2014, 2015 and 2019 – never bore fruit. Instead, Sukleen’s monopoly persisted in Beirut and Mount Lebanon, with its contracts managed by the central government rather than the municipalities. Meanwhile, in other regions, municipalities and federations of municipalities managed their waste following a decentralized approach, with international aid being channelled to finance Mechanical-Biological Treatment (MBT) plants for sorting and composting, achieving low diversion rates from landfills and dumps (Azzi, 2017).
Topic:
Governance, Decentralization, Waste, and Management
Political Geography:
Middle East and Lebanon

83. Iraqi youth in contexts of conflict: Fragmentation, divergent strategies, and the impossibility of inclusion

Author:
Adel Bakawan
Publication Date:
07-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
What are the various consequences on a young person’s life trajectory when she or he comes into adulthood in a context of conflict? What happens to anticipated plans for the future – education, marriage, first employment – when they are profoundly disrupted by the eruption of conflict, and what types of coping mechanisms and strategies are adopted by youth in the face of such disruptions? And how does the transition into adulthood in a fluid normative context – where violence can be abundant, gender traditional roles can be upended, and trauma widespread – shape individual political values and beliefs as well as social relations with the community and within the family? In exploring how youth navigate their own lives and construct themselves when the transition to adulthood occurs in a context of conflict, evidence shows that conflict acts as both an opportunity and a constraint to youth in terms of livelihood opportunities, pathways for wellbeing, experiences of political inclusion, and feelings of empowerment and disempowerment. At the same time, though, youth trajectories during contexts of conflict are neither linear nor strictly dependent on the structure of available opportunities. Indeed, how youth make decisions with regards to their own lives, and the factors that influence their decision-making, demonstrate complex processes involving specific contextual factors, the configuration of social relations, and positionality within conflict dynamics, among others. In this sense, youth trajectories in contexts of conflict are both highly diverse and often unexpected but also, critically, can shift repeatedly. Unpacking this complexity is of critical importance, though, if we are to grasp the multiple and even contradictory ways in which conflict impacts the trajectories of young adults. It also critical to understanding the broader implications at the societal level in terms of future patterns of political participation, beliefs, and attitudes as well social and gender relations within and between communities and generations. From 2020-2021, the Arab Reform Initiative undertook a broad research program to investigate the personal trajectories of youth in conflict, focusing on those who have come into adulthood since 2011 in Libya, Iraq, and Syria. This research, based on 75 qualitative semi-structured interviews in each country and, where possible, focus group discussions, has investigated the perceptions and decision-making processes of youth and broader-term implications in political, economic, social, and personal terms. More precisely, this research investigated youth trajectories and broader social and political implications through analysis at three distinct levels. At the micro-level, the research investigated the personal narratives of youth and how they view the impact of the conflict in terms of personal self-construction. This included investigating their decision-making matrices and aspirations, the coping strategies they have found, as well as how they have felt empowered/disempowered in the context of conflict. At the meso-level, the research explored the contextual factors mediating youth’s decision-making and their margins of maneuver, including war and peacebuilding economies, existing programming and external aid for youth, shifting power structures and social hierarchies, and normative fluctuations, conducting intersectional analysis to understand how different social positions (ethnicity, religion, gender, class, etc.) shape different narratives and strategies. Finally, at the meta-level, the research sought to assess the diverse political and peacebuilding content with regards to youth values, agency, and forms of engagement, focusing in particular on youth meaningful political participation, everyday practices of peacebuilding, and the establishment of gender equality if and where it occurred. The study presented here relays the outcomes of the research undertaken with Iraqi youth, where field interviews took place in 2020 in the cities of Mosul and Basra, sites where different types of conflict have occurred, ranging from the violent conflict with ISIS to the transformative social conflict of the Tishreen protest movement. In taking stock of these in-depth and highly personal interviews, this study contributes new knowledge and insights regarding how the transition to adulthood under conflict has impacted the acquisition of experiences and skills, needs and aspirations, and changes in perceptions and perspectives of Iraqi youth. The research presented here thus explores how youth narrate their personal trajectories and the impact of events on their own lives, but also how they understand the country’s political evolution and the nature of the conflict itself. The study explores what factors (moral, ideological, political, social, economic, personal, or other) motivate or drive their decisions, how they perceive of opportunities and constraints for their own pathways, and how they find or create opportunities for themselves. The study also investigates how gender norms and gender performative roles been transformed as a result of the conflicts and the impact of these changes in their own social relations and aspirations for the future. Finally, the study sheds light on Iraqi youth’s personal attitudes towards violence and non-violence, what concepts such as peace, justice, and reconciliation actually mean to them and what they look like in practice, and the extent to which youth perceive of agency in their own lives and the roles they seek to play in renewing the political order and social contract of Iraq.
Topic:
Youth, Youth Movement, Identity, and Inclusion
Political Geography:
Iraq and Middle East

84. Unpacking solid waste management policies in Lebanon: Public policies based on power-sharing politics rather than evidence-based decision-making

Author:
Cynthia Kreidy
Publication Date:
08-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
iles of garbage have again been accumulating on the streets of major Lebanese cities.1 2 A scenario that is all too familiar and takes us back to 2014 when Sukleen – the company contracted to manage solid waste in Beirut and Mount Lebanon – halted its operations and streets were filled with piles of garbage for months. 3 Once again Lebanon is on the verge of another waste crisis, but this time from a more vulnerable and dire state. Solid waste has been ravaging the streets of Beirut and Mount Lebanon for numerous reasons. These include the contractor not getting paid, the high cost of transportation which reduces the frequency of collection,4 the closure of landfills which are at capacity, or even the obstruction of works at the landfills due to trespassers waiting to collect metals and other valuable materials to sell them amid Lebanon’s heaviest economic and financial crises.5 The absence of sustainable and integrated solid waste management (SWM) in Lebanon has denied citizens their right to health.6 Open dumping and burning, which have been occurring due to the inaction of regulatory authorities, have negative health impacts on nearby residents. Some individuals have reported respiratory illnesses and skin problems, while others complain about bad mental health.7 Additionally, open burning could be linked to cancer and heart disease. These practices have disproportionately affected poor communities, given that burning sites are often in their vicinity and that they cannot afford health care.8 Moreover, the cost of environmental degradation due to the lack of a comprehensive SWM plan was equivalent to $66.5 million in 20129 ) and $200 million in 201810 . The cost of environmental degradation is reflected by a loss of welfare demonstrated by the degradation in the quality of life, economic losses, and environmental losses, among others.11 The solid waste sector contributed to around 10% of the country’s greenhouse gas emissions in 2011, largely due to open dumping and burning across the country.12 13 An integrated solid waste management strategy at the national level is the only long-term solution to the solid waste problem. In the absence of such a plan, and following the solid waste crisis in 2015, several grassroots movements, civil society organizations and municipalities have tried to remedy the absence of a national plan by leading small-scale interventions based on sorting at source and waste valorization in order to minimize volumes of waste sent to landfills.14 15 16 However, none of these projects is implementable at the national level, since these initiatives rely on a municipality’s rare, and voluntary will. This paper employs a systems analysis to explore how solid waste mismanagement has been an intentional political decision-making process tailored to nurture and protect dysfunctionality through elite capture and clientelism. The hypothesis will be presented using a Causal Loop Diagram (CLD) which will then be analyzed and validated via case studies involving the municipalities of Beit Mery, Dhour Choueir, and Brih.
Topic:
Leadership, Waste, and Resource Management
Political Geography:
Middle East and Lebanon

85. Perceptions and Trajectories of Youth in Baghdad, Al-Basra, and Mosul after the 2014 Conflict with ISIS

Author:
Farah Al Shami
Publication Date:
09-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
This infographics report analyzes and interprets quantitative data that was collected by the Arab Reform Initiative (ARI) in Summer 2021 using an extensive in-person/face-to-face survey targeting 676 youth (aged 18-28) in three Iraqi cities (Baghdad, Al-Basra, and Nineveh-Mosul). By doing so, the report aims at assessing the impact of the 2014 conflict with ISIS in Iraq on the perceptions, aspirations, and actual trajectories of youth living in these three cities, namely in terms of education, employment and livelihoods, political participation, civic engagement and peacebuilding efforts, as well as choices for personal life. The survey is part of the Arab Reform Initiative’s broader work on how youth in Iraq and other Arab countries have navigated armed conflicts in the last decade. We find that the conflict has had a significant negative impact on Iraqi youth’s education and employment, and that this impact is more pronounced on education compared to employment. This impact happened mainly through the channel of economic hardship and – to a lesser extent – the channel of fear, uncertainty, and security concerns. This impact has also largely shaped the surveyed youth’s personal lives and choices. Moreover, surveyed youth expressed apathy towards formal politics and fear of engaging in politics or expressing political views/affiliations/support because of security concerns. The 2014 conflict has had a significantly more negative impact on Iraqi youth’s political participation than on their civic engagement. Although our data shows that the overall impact of the conflict on these different dimensions is significant, the magnitude of this impact is substantially less than one may have expected. We found that the negative impact of the conflict is of a higher magnitude on the actual status quo of Iraqi youth compared to their aspirations and their perceptions of its actual impact. For instance, when asked general questions about the factors affecting their trajectories, Iraqi youth did not or rarely chose “the Iraqi ISIS conflict,” whereas when they were directly asked about the impact of this conflict on their trajectories, their answers exhibited a significant importance given to the conflict. In our report, we present various reasons that explain these observations and discrepancies, some of which come from our data and others from our understanding of the Iraqi context.
Topic:
Security, Youth Culture, ISIS, Youth, and Conflict
Political Geography:
Iraq and Middle East

86. On the Experience of the Sudanese Professional Association: Personal Testimonial

Author:
Mohamed Nagi Alassam
Publication Date:
09-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
Despite the divisions that plagued the SPA, trade unions and professional associations have since the coup retained a complementary and supportive role to the resistance committees. However, they remain marginal. Despite continuous strikes in various sectors, the collective and joint action of unions has remained underwhelming and failed to meet the hopes and expectations of the Sudanese.
Topic:
Labor Issues, Community, Professionalism, and Labor Unions
Political Geography:
Africa and Sudan

87. Who Benefits from Tunisia's Green Hydrogen Strategy?

Author:
Aida Delpuech
Publication Date:
12-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
As the global energy sector sought to revamp itself over recent years, several countries around the world have joined a race toward green hydrogen –labelled “energy of the future”. Unlike grey hydrogen, made by fossil fuels (natural gas) and a significant source of greenhouse gases,1 2 green hydrogen is generated by electrolysis whereby water is split using electricity from renewable energy sources. The combustion of 1kg of this gas produces almost four times more energy than one kilogram of gasoline.3 In 2021, the production of green hydrogen produced represents only 5% of the 94 million tons of overall produced hydrogen globally.4 However, this quantity is bound to rise, given the various strategies developed in the post-Covid economic recovery plans or by strategies to power Europe with alternatives to Russian gas.5 While a global market for green hydrogen is being shaped, Tunisia launched in early 2022 the development of its very own national strategy for green hydrogen to be finalized by 2024. The country has already announced that it will prioritise export6 of this green fuel over local use.7 “Promoting green hydrogen, a growing market in today’s world, is very important to Tunisia,” affirmed GIZ, 8 the Tunisian government’s lead partner in this strategy development project. Although the Tunisian Ministry of Energy has made green hydrogen one of its projects of high importance, civil society, scientists, and potentially affected communities have so far been left out of all conversations. Hence, the country misses a chance to map out eventual risks, environmental and social concerns and to address emerging concerns from the outset. The large-scale production – powered by solar and wind energy megaprojects – requires vast mobilization of several types of resources along the entire production chain of this fuel. When the Ministry of Energy asserts that: “these projects do not entail obvious negative impacts on the environment,” nothing is less verified than such statement. Current discussions focus mainly on Tunisia’s position in this emerging global market, but they rarely touch on the social and environmental costs of this type of major projects. Nonetheless, multiple studies9 were published more recently, warning of the impact of these projects on natural resources – water, land, etc. – in countries heavily affected by climate change. In addition, the benefit of this new sector is questionable in terms of Tunisia’s climate commitments. To this day, the country depends as much as 97% on Algerian gas to produce electricity10 and the energy transition has stagnated. However, it plans to export the bulk of the green hydrogen potentially produced on Tunisian soil mainly to Europe, This was confirmed in interviews and meetings in the context of this report While green hydrogen is a more preferable alternative than more polluting options, its mass production would primarily benefit the energy needs of Europe. This raises another fundamental issue as it is replicating an extractivist model oriented towards international export markets and build on the overexploitation of natural resources. To develop a green hydrogen production strategy, Tunisian authorities along with their European partners, namely Germany, seek to prolong the exploitation of resources of neighbouring countries without sufficiently considering the energy needs of locals, the social and environmental risks, the fact that Tunisia is a water stressed country or the financial debt resulting from such investments.
Topic:
Climate Change, Environment, Green Technology, and Green Transition
Political Geography:
Africa and Tunisia

88. The Tower of David Museum: Venue for Co-Existence

Author:
Rony Ohad
Publication Date:
12-2022
Content Type:
Research Paper
Institution:
Mitvim: The Israeli Institute for Regional Foreign Policies
Abstract:
Jerusalem has been studied extensively by scholars across a range of disciplines in the social sciences and humanities. However, the arts, specifically public performance arts, have rarely been leveraged as a primary source to inquire into the city’s social structures. This research project examines how cultural institutions within the Old City of Jerusalem (focusing on the Tower of David Museum site) reflect and shape the relationship between citizenship and cultural performances. The article inquires how a cultural institute in a contested city can become an allied sphere, a source for joint creation, and even a venue for peacebuilding. The events and performances addressed in this article provide examples of both straightforward and indirect peace process approaches, revealing culture’s potential use and limits in a contested environment. The author suggests that a multicultural approach, yet not a neutral one, leads the museum to reveal its agenda, becoming “The City’s Museum” for joint cultural creation and initiative. This is the fifth in a series of papers of a joint project by the Mitvim Institute for Regional Foreign Policies and the Davis Institute for International Relations at Hebrew University examining selected actors’ contribution to the advancement of Israeli-Palestinian peace.
Topic:
Culture, Peacebuilding, and Coexistence
Political Geography:
Israel, Palestine, and Jerusalem

89. Women’s Peace Groups in Formal Peace Processes: Benefits of Participation, Price of Exclusion

Author:
Shiri Levinas
Publication Date:
09-2022
Content Type:
Research Paper
Institution:
Mitvim: The Israeli Institute for Regional Foreign Policies
Abstract:
Women’s peace organizations work to end violence and promote peace agreements almost everywhere where conflicts occur. Studies and observations from the past 20 years show that these organizations contribute significantly to peace processes, despite their variation in forms, methods, and the extent of their involvement. In the context of formal negotiations and the formulation of peace agreements, the integration of women’s peace organizations was found to increase the prospects of reaching an agreement, as well as to change and enhance the nature and content of the agreement itself (including governance, social justice, rehabilitation, gender equality, etc.). Their integration was also found to significantly increase the feasibility of implementing the agreement and promote women’s representation in the political system. However, in Israel, as in most countries, decision makers marginalize women’s peace organizations despite their extensive work and significant contributions. This article examines the main barriers preventing the participation of women’s peace organizations in Israeli-Palestinian peacemaking, the price of their exclusion, and the actions needed to integrate them and express their potential. The article is based on interviews conducted in 2019 and 2020 with women-peace activists from Israel and beyond, as well as a review of research literature and case studies of women’s peace organizations in Israel and abroad. It outlines some of the prices Israeli society pays for women’s exclusion and recommends actions that may promote their integration into formal peacemaking efforts. This is the third in a series of papers of a joint project by the Mitvim Institute for Regional Foreign Policies and the Davis Institute for International Relations at Hebrew University examining selected actors’ contribution to the advancement of Israeli-Palestinian peace.
Topic:
Women, Peace, Participation, and Exclusion
Political Geography:
Middle East, Israel, and Palestine

90. Does the Road to Peace Pass Through Prisons? The role of former and current inmates in advancing Israeli-Palestinian peace

Author:
Udi Golan
Publication Date:
11-2022
Content Type:
Research Paper
Institution:
Mitvim: The Israeli Institute for Regional Foreign Policies
Abstract:
Prisoners and former prisoners constitute a significant and distinct group among the Palestinian public, both due to their numbers (hundreds of thousands of Palestinians have served time in Israeli jails since 1967) and their position in society. This position paper examines whether former and current Palestinian inmates can contribute to advancing Israeli-Palestinian peace, and how. The article discusses theoretical aspects that place them in a position to contribute to advancing peace, and provides examples from other countries where prisoners played an important role in advancing or attempting to advance peace. Based on the theoretical knowledge and examples, the article discusses the possible role of Palestinian prisoners in advancing peace. It describes the complexity and legal, moral and security-related issues involved, and points to positive developments, such as a process of moderation and adoption of support for peace undergone by some Palestinian inmates, who over time turned into prominent peace supporters. The article also points to measures that can be promoted in order to realize the potentially positive role of inmates in advancing peace, including dialogue with serving inmates, using the incentive of prisoner release to support moderate positions and to promote peace, and adopting policies of de-radicalization, dialogue and prevention, alongside punishment and deterrence measures, in order to turn some prisoners into actors contributing to peace. This is the fourth in a series of papers of a joint project by the Mitvim Institute for Regional Foreign Policies and the Davis Institute for International Relations at Hebrew University examining selected actors’ contribution to the advancement of Israeli-Palestinian peace.
Topic:
Security, Prisons/Penal Systems, and Peacebuilding
Political Geography:
Middle East, Israel, Palestine, and Golan Heights