Saturday, August 8, 2020

Yemen's Multilayered War: The Failing Healthcare Infrastructure

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Anant Jani

Article Title

Yemen's Multilayered War: The Failing Healthcare Infrastructure

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Global Views 360

Publication Date

August 8, 2020

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Air strike Al-Thawra hospital, Hodeida on August 2, 2018

Air strike Al-Thawra hospital, Hodeida on August 2, 2018 | Photo credit: ABDO HYDER/AFP/Getty Images | Source: Felton Davis via Flickr

This is the 6th and last part of a short explainer article series on the current crisis in Yemen. To read the earlier parts of the series click on the link.

To read the 1st part of the series click on the link.

To read the 2nd part of the series click on the link.

To read the 3rd part of the series click on the link.

To read the 4th part of the series click on the link.

To read the 5th part of the series click on the link.

The civil war in Yemen, more so after 2015 has taken a toll on the civic infrastructure of the already fragile and poor country. Among these, the healthcare infrastructure of the country was one of the worst affected.

Apart from the physical damage to the hospitals and clinics due to the aerial bombings by the Saudi Arabia led coalition, the naval blockades exacerbated the dire situation. In June 2015 itself, aid agencies warned of the humanitarian risks brought by the US and UK-backed Saudi blockades.

The humanitarian situation aggravated further as there was a consistent famine since 2016 and Yemen was dependent on foreign aid for feeding almost 80% of its population.  According to UNICEF reports, over 3.3 million children and pregnant or lactating women suffer from acute malnutrition.

In 2017, the World Food Programme estimated that an additional 3.2 million people would be pushed into hunger. If left untreated, 150,000 malnourished children could die within the coming months.

Save the Children, the international charity and aid agency, estimated that 85,000 children under the age of five have starved to death in between 2015 to 2018.

Major healthcare operatives are dying due to the active bombing and conflict in Yemen, including personnel from MSF and United Nations Office for Coordination of Humanitarian Affairs (OCHO).

The MSF (or Doctors Without Borders), who have been in Yemen since 2007, have reported that fears of stigmatization are causing people to stay away from hospitals, with misinformation and lack of medical services only compounding the healthcare issue during the pandemic.

As of 24th July, the country reports 1640 confirmed infections and 458 related deaths.  Al Jazeera reported that “Cemeteries in Aden are overflowing with graves, suggesting that the number of people killed by the new coronavirus is higher than the official count.” Yemen and its related aid agencies also suffer from lack of PPEs and adequate information about the pandemic.

As of April 2020, there are 800,000 internally displaced persons in just one province of Yemen Marib. The number of verified civilian deaths stands at 7,700.

The United Nations has been continually asking for donations, but has failed to collect as much as it requires. While it collected $4 billion last year, it has only received $700 million, halfway into 2020.

The UN urged for $2.4 billion this year to fight the humanitarian crises and the Coronavirus. As of 2nd June, 29 countries and the European Commission pledged a total of $1.35 billion to support humanitarian efforts in Yemen, just over half of the amount needed to sustain programs through the end of this year.

In April 2020, the Saudi deputy defence minister, Prince Khalid bin Salman, said Saudi Arabia “will contribute $500m to the UN humanitarian relief program for Yemen in 2020, and an additional $25m to help combat the pandemic. It is up to Houthis to put the health and safety of the Yemeni people above all else.”

There are 41 major UN programmes in Yemen, and it is estimated that more than 30 of them will close due to lack of funds. The UN stated, “Due to the COVID-19 suppression measures, all integrated outreach activities, which include the Expanded Programme on Immunization, Integrated Management of Childhood Illness, Maternal and Newborn Health,and nutrition activities, were suspended.”

Most of Yemen's 3,500 medical facilities have been damaged or destroyed in air strikes, and only half are thought to be fully functioning. Officials warn that monetary relief may not be enough to assist in the war against the pandemic alongside the Civil War. A solution to the war must be found soon, before the pandemic eviscerates more of the healthcare infrastructure.

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April 13, 2021 7:47 AM

Are India's Antitrust laws effective at controlling monopolies?

On 15th of July 2020, Reliance Industries Ltd (RIL) held its annual general meeting of the shareholders. The chairman and managing director Mukesh Ambani, announced that global tech giant Google would be investing $4.5 billion in Jio Platforms. Facebook also has acquired a 9.99% stake in Jio Platforms. This is the first time in the world that both the global tech giants have invested in the same entity. These investments have boosted the confidence for Jio Platforms and also for India’s growth but there have been questions and speculations about the potential anti-competitive makeup of these deals.

The objective of this article is to explore the interpretation and the effectuality of Antitrust laws in India.

Anti-competitive practices are those business practices which firms engage in to emerge as the or one of the few dominant firms, who will then be able to restrict inter firm competition in the industry in a bid to preserve their dominant status. The Collins English dictionary defines antitrust laws as those laws that are intended to stop large firms taking over their competitors by fixing prices with their competitors, or interfering with free competition in any way. These laws focus on protecting consumer interests and promoting a competitive market. The word ‘Antitrust’ is derived from the word ‘trust’. A trust was an agreement by which stakeholders in several companies transferred their shares to a single set of trustees.

In present-day India, talking about market dominance Reliance Industries Ltd (RIL), resembles American company—John D Rockefeller's Standard Oil Company—of the early 20th century. Mukesh Ambani holds the highest ability to influence markets and policy in every sector in which RIL is present—petrochemicals, oil, telecom, and retail. Many industry experts and critics suggest that Ambani has used his political clout to twist the regulatory framework in his favor.

Gautam Adani, founder of Adani Group | Source: Twitter

Furthermore, economic power in aviation infrastructure is clustering into a few hands as well. In 2019, the Adani Group bagged the 50-year concession to operate all the six Airports Authority of India-operated airports—Lucknow, Jaipur, Guwahati, Ahmedabad, Trivandrum, and Mangaluru—which were put up for auction. The company also obtained a controlling stake in ‘The Chhatrapati Shivaji Maharaj International Airport, Mumbai’ from GVK Airports. Moreover, Adani Group is now set to construct the Navi Mumbai International Airport. The group is now eyeing Indian Railways while they have already established an alarming monopoly in green energy and sea ports. While Airports are natural monopolies, one private company controlling more than 8 important airports is not good news to airlines.

India has established antitrust laws to promote competition. For 40 years, India followed the Monopolies and Restrictive Trade Practices Act 1969 (MRTP). This act was based on principles of import substitution and a command-and-control economy. However, over time several amendments had to be made to the act. In 2002, the Indian approved a new comprehensive competition legislation. This is called the Competition Act 2002. The act focused on regulating business practices in order to prevent practices having an appreciable adverse effect on competition (AAEC) in India. The act primarily regulates three types of conduct: anti-competitive agreements (vertical and horizontal agreements), abuse of a dominant position, and combinations such as mergers and acquisitions. The act lists out the cartel agreements that it intends to prevent. This list includes price-fixing agreements, agreements between competitors seeking to limit or control production, market-sharing agreements between competitors and bid-rigging agreements. These agreements are called “cartel” arrangements.

The competition Act is enacted by the Competition Commission of India (CCI), which is exclusively responsible for the administration and enforcement of the Act. It comprises a team of 2 to 6 people appointed by the government of India. The CCI has previously handled high-profile cases. In 2018, CCI imposed a fine of Rs135.86 crore on Google on the grounds that Google misused its dominant position and powers to create a search bias. In another important case, the CCI, ordered a probe into Idea, Vodafone and Airtel when Reliance Jio owner Mukesh Ambani lodged a complaint against the three for forming a cartel and denying Jio the POI required for network connection, causing multiple call failures. The Cellular Operator Association of India was also probed for encouraging the same.

In some cases, the Competition Commission has been successful in tackling activities that are against the free competitive market. However, critics and economists believe that the act is now unable to adapt to the changing business environment in e-commerce, telecom, technology and the government’s role in distorting competition. Demonetization and GST drove the formalization of the economy. One consequence of them was that bigger, better organized players gained at the cost of smaller ones with lesser resources. The Insolvency and Bankruptcy Code (IBC) was designed to solve the problem of non-performing assets (NPAs) of banks. But consequentially, it has also led to a consolidation in many sectors.  

However, CCI has expressed inability to consistently adjudicate punitive measures due to obligation in several cases. This points to the loopholes in the very provisions of the Competition Act 2002. In an Economic and Political Weekly (EPW) article, Aditya Bhattacharjea—an Economist—argues that even though the 2002 Act represents an improvement from the MRTP Act which was extremely restrictive, the present act also remains riddled with loopholes and ambiguities. According to Bhattacharjea, this creates unnecessary legal uncertainty, which acts in advantage of lawyers and law firms. For instance, the act allows the CCI to leave some scope of flexibility for “relative advantage, by way of contribution to the economic development.” Bhattacharjea argues that this may allow large firms to justify their anti-competitive practices in the name of development.

Mark Zuckerberg and Mukesh Ambani having online interaction after Facebook invested in Jio Platforms | Source: NDTV

Data portability plays a significant role in determining market power of certain firms. In 2017, the CCI closed cases against both WhatsApp and Jio involving allegations of predatory pricing and privacy violations. In both these decisions, the regulator did not consider the restrictions around data portability as a competitive advantage. The possible data leveraging advantage for the attempted monopolization could be the ‘portfolio effect’. Portfolio effect refers to increasing the range of brands, by bundling of telecom or messaging service and other service offerings or illegal vertical restraints, even predatory pricing. This in turn may lead to greater ability of further leveraging, deterring innovation and results in degradation of quality. Another possible advantage is explained as the theory of leveraging. The best example of leveraging is when Microsoft entered the media-player market by extending its quasi-monopoly on the operating systems market by taking advantage of the indirect network effects. In case of Facebook acquiring 10% of Jio’s shares, it is a concern that both entities could potentially use WhatsApp’s market dominance in telecom and social networking services and establish dominance in e-commerce market through anticompetitive acts.

There was a consensus among Indian policymakers at the time of the 1991 economic reforms that economic liberalization would eliminate the nexus between the business elites and the policymakers. On the contrary, the relationship between these two groups got further strengthened.

On the other hand, few critics and industrialists argue that extreme restrictions on growing companies hampers the progressive growth of the national economy. While RIL’s Jio looks like a cause for concern, the company has also saved Rs. 60,000 crores for annual savings in India. In addition to that, the entry of Jio to the telecom industry has led to a rise in data consumption and improved accessibility and affordability of the internet across the nation.

However, the concern still lingers as the question of whether this growth is a result of actual innovation or crony capitalism remains unsolved.

However, the fact that telecom, organized retail, ports and airports have two or three players controlling the bulk of the sector needs to be addressed. A healthy competition is quintessential for long-term growth and innovation. Harmful trade practices and cartelization does not only affect small manufacturers but also the general public.

The government, CCI and other lawmakers must closely examine the present laws and provisions and need to see if they are required to amend the act.

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