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Editorial
Steep rise in medicines price severely
hitting the poor and the sick

Next to food and water the vital element needed for human survival is medicine for the sick. In recent times medicine prices are showing great instability. Prices of even the lifesaving medicines are soaring to unprecedented heights. The common people are already undergoing untold privations on account of continuous price rise of essentials and multiple civic woes and the price spiral was not halted even on the eve of Ramadan. The prices of different varieties of rice and flour have touched unprecedented heights and the rocketing prices of lifesaving medicines add to the tale of people’s sufferings. The people are kept wondering what further dose of hardship awaits them.
   The lead story in yesterday’s New Age has exposed some frightful facts about the conditions prevailing in the medicine market. The report quoting sources in wholesale medicine market mentions that drugs used in the treatment of cardiac and kidney diseases, cancer, thyroid disorder and brain haemorrhage have been far short of demand. Diabetes is afflicting a quarter million people in the country and in the more severe cases daily insulin injection is required. Our report says that the price of Mixtard30 penfill injection is not available in the market for a month and can be availed with difficulty at a much higher price. The drugs in short supply are mostly imported ones while some local products are also not available as the drug administration has not approved any application for import of raw materials during the past eight months. If this is the case then the government is clearly answerable.
   If some life saving drugs are not available in the market, it may be preparatory to a further round of price hike. Lifesaving drugs cannot be subjected to the whims of market forces; there has to be some guarantee of supply at stable prices as part of good governance. And it may be noted that availability of essential medicines in this country at steady prices was not seriously affected even when governance in other areas was poor. The management of drug market was not ideal but passably good. This chaotic situation of the medicine market is a new phenomenon. The situation was not left entirely to market forces and the government did intervene but it intervened only to the people’s disadvantage. A few months ago the National Board of Revenue directed the drug administration to increase medicine prices. The government had the compulsion to raise revenue but no thought was given on how it would affect the sick. Stability in medicine was severely jolted when last August prices of some essential medicines suddenly shot up 60 per cent. The government has a duty towards all but more urgently towards the poor and the sick. But what are we witnessing in practice?

The conspiracy theorists

The claim of the acting general secretary of the Awami League, Mukul Bose, that ‘some hired miscreants’ carried out the attack on him and some other ‘dissident’ leaders of the party on Wednesday and that the attack ‘was part of a conspiracy to break up the party’ reminds us of the military-driven interim government’s take on the August 20-22 unrest in Dhaka and elsewhere in the country. Just as the government refused to acknowledge – and it continues to do so – that the unrest may have been a manifestation of the public discontent at a prolonged state of emergency and certain actions and inactions of the incumbents, not the work of ‘some evil forces and opportunist and rowdy elements,’ Mukul Bose also seems intent on taking refuge in the convenient confines of a conspiracy theory, instead of trying to find out whether or not the attack was an expression of grievances that certain sections of the party may have against him and his ‘dissident’ colleagues.
   We are not suggesting, in any way, that his claim is either unfounded or unjustified. On the contrary, given the government’s not-so-covert machinations to create divisions in the major political parties, we do feel that Mukul Bose may have legitimate reasons to smell rats in the untoward incident that took place in front of the Dhanmondi office of the party. However, we must say his conclusion is both premature, came as it did even before the emergency central working committee meeting ordered an enquiry into the incident, and perfunctory, as it does not quite take into account the fact that he and some of his colleagues may have antagonised many within the party by claiming that they were ready to run the party, if required, without its president, Sheikh Hasina.
   Mukul Bose and other ‘dissident’ leaders of the Awami League would be well-advised to remind themselves that the position they have taken resembles, in tone and tenor, the agenda the interim government is seemingly in pursuit of, i.e. introducing a ‘new political order’ by politically neutralising Hasina and the Bangladesh Nationalist Party chairperson, Khaleda Zia. Such a resemblance may be too uncanny to be dismissed as coincidence by their party men; some of them may well arrive at the conclusion that Mukul Bose and co may be toeing the lines of the interim government. As long as such misgivings persist, similar attacks in future cannot be ruled out. The only way to dispel such misgivings is through constructive dialogues. The acting AL general secretary and his ‘dissident’ colleagues should, therefore, initiate moves to reach out to the aggrieved sections of the party with their point of view, instead of shutting them out by coming up with one conspiracy theory or the other.


Water, water everywhere...
Once again, Bangladesh is facing devastating floods that are causing widespread disease, economic ruin and hardship on the rural poor. Bangladeshis are used to the regular flooding that they face, but that people who live daily lives without potable, cheap water should be endangered when water eventually arrives is a terrible irony. Water provision – in Bangladesh and the world in general – must urgently be conceptualised as a right if the basic lives
of the poor are to improve,
argue Mahbubul Haque and Tom Wipperman

In the progress report for the Millennium Development Goals at the June 2007 halfway stage, the UN secretary general, Ban Ki-moon, noted that $1.5 billion people around the world still do not have access to proper sanitation, and that water and sanitation provision is the greatest need for the MDG process to meet the targets that have been set. Not only is sanitation and potable water vital to the survival of people on a daily basis, but it also underpins the success of development initiatives and efforts in every other field. Dirty water causes diseases that kill children in infancy, and affects the health of people so that they are unable to go to work and earn, thereby affecting poverty reduction efforts. The search for clean water requires family members to walk for some hours in many places just to collect a basic physiological necessity. Usually this is done by female children, preventing them from attending school and getting an education that can help break the generational cycles of poverty, whilst reinforcing gender relationships that undermine efforts to promote gender equality and empower women. Improved access to potable water is at the very heart of the development agenda, crucial to the success of all development activities.
   In Bangladesh, this is a particularly pressing concern. UN-Habitat considers only ten per cent of Dhaka’s population to be connected to a formal water supply, leaving some 10 million people to rely on standpipes, illegal connections, putrid lakes and polluted rivers or any other source they can scrounge. It is a common sight in the slums of the city to see people queuing up to wash in public or collect water from pipes. The indignity of living private lives in public view is but one outcome of poor water provision. In rural areas, the arsenic polluted wells are still causing major health problems for people, and the distrust by some of such wells forces them to use alternative water supplies – lakes, rivers and ponds – which are polluted and detrimental to health.
   A human being can survive no more than three days without water. Like air, food and shelter, it is fundamental to our physiological existence, and our ability in the modern world to reproduce ourselves for the next day’s work. Unlike the other trappings of the modern globalised world – ipods and mobile phones, cars and the internet – we cannot live without water. However, despite its absolute necessity to every single one of us, water is not conceived as a human right, but as a commodity that can be bought and sold in the market. It is strange that many of us can enjoy rights to speech, assembly, religion and political affiliation when none of these are necessary to live, yet the most pressing need that we have is subject to the forces of the market and abstract notions of supply and demand.
   This is the reality of the hyper-capitalist world in which we live, however. The 1992 principles on water agreed in Dublin defined water as a commodity that can be produced, circulated and consumed. In every major international conference since, water has been defined in such a way, not as a right. In instances such as the DfID’s policy on water provision where some acknowledgement has been made to the idea of water as a human right, this is only when it is subject to commodification first. Many countries’ constitutions outline the rights that their citizens have, but none say that they have a right to water. In the past this may have seemed unnecessary, but today, establishing the right to potable water is vital if the development agenda is going to be met.
   Whilst the rural poor can often collect dirty water for free, the urban poor are more unlikely to have this ‘luxury’ and be forced to pay for it. Studies from places as diverse as Mumbai in India, Guayquil in Ecuador and Durban, South Africa show that the poor consistently pay more for their water. Formal supplies are subsidised by central governments so that municipalities can provide water cheaply: in Dhaka, Dhaka Water Supply and Sewerage Authority is the government agency responsible for provision. The subsidy is collected from the population in general, but directed only to those that have connections – the middle and upper classes living in well-built, modern houses. The poor must find other sources at greater cost – in Dhaka the cost is about 600 times greater per unit; in parts of Central America it is 30,000 times! This arrangement ensures that the poor pay twice: once in taxes used as subsidies by the municipality, and then to local vendors who provide them with water. The quality of the water they buy is also not guaranteed, further threatening them with diseases and the social and economic impacts that these have on people.
   The challenge in Bangladesh is not providing water – there is more than enough in this riverine country – but to provide water that is clean and regular in supply, and affordable to the poorest of the poor. Most Bangladeshis, even those with connections to the public water system, have to boil and often filter their water in order to make it safe to drink. The poor have the added challenge of finding that water – in some slums in Dhaka, the nearest water sources are three kilometres away.
   The governance of water by Dhaka WASA needs urgent review. Currently, it is illegal for it to provide water to people who do not hold tenure of the land they live upon. In other words, this law prevents people living in informal settlements from accessing the most basic of services. Dhaka WASA, even if it is willing (and World Bank documents suggest it is not), cannot provide water connections for these citizens. The same conditions exist across the country. As long as the government excludes citizens forced to live where they do due to the economic realities of Bangladesh, then the scourge of dirty water will continue to cause loss of life and undermine development efforts.
   Precedents exist in other Asian countries that serve as good markers for the route that Bangladesh can take. In Mumbai, slum dwellers who arrived in the city before 1995 were given tenure to their land and a large water connection programme has since begun. In Indonesia, authorities invested in water supply as it was a cheaper option than the health and emergency cost of water-related illness: projected savings are in the realm of $600 million. Other governments have begun to recognise the role of water in development; Bangladesh needs to urgently take note. The governance and management of water supply in Bangladesh needs large investment and committed change to make it respond to the needs of the poor, and start to move water from a commodity that can be packaged and sold (at costs way in excess of what the poor can afford) to a service received by all in an affordable manner.
   Part of this shift requires the government and citizens of Bangladesh to begin to consider water as a human right, a use value that cannot be alienated from people by commodifying it. This does not mean free water – for there is certainly a cost of production – but it does mean that water provision must be tied only to one’s existence as a Bangladeshi citizen, not to the taka in one’s pocket, or the land tenure of one’s house, or the place where one lives. Water as a human right means acceptable access to clean water at a cost the poorest of the poor can afford. It means that clean water ceases to be a luxury that only the rich can afford, and instead something that Bangladeshis can expect their government to deliver. It also means, that if that government fails to deliver, empowered citizens can demand their rights are fulfilled.
   Access to a formal, potable, regular water supply must not just be a development goal, but a constitutional right set in the black ink of the law. In the modern world, that people should be so deprived, not because of a lack of water, but a lack of money, is disgraceful. In a country so rich in water as Bangladesh, it is even worse. The development agenda of Bangladesh cannot be met if water is ignored: this has to be the priority of the government. Only when everyone is confident that they have safe and regular water access can they begin to think about education, maternal health, environmental sustainability and other development priorities. In Bangladesh, water is everywhere, and for poor Bangladeshis, it is everything as well. It is time to aggressively insert water into the human rights agenda in Bangladesh, and for us to demand access for all.
   Mahbubul Haque is director, Neeti Gobeshona Kendro (Policy Research Centre), a Bangladeshi research and advocacy organisation working on governance, human rights and livelihoods. Tom Wipperman is a British VSO volunteer who is
   working with Neeti Gobeshona Kendro as a programme officer.

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