The Cost of Modernization: Tunisia’s Agricultural Evolution and Its Unintended Consequences

Since gaining independence in the mid-1950s, Tunisia’s agricultural development has been deeply influenced by a modernization ideology modeled on the experiences of Western Europe and North America. Spearheaded by the Neo Destour party—later the Destourian Socialist Party in the 1960s—this approach relied heavily on foreign expertise and international intervention, particularly in agriculture. The underlying belief was that modern science and technology could resolve socio-economic challenges such as food insecurity, unemployment, and rural poverty. This trend was epitomized by the adoption of Green Revolution practices during the 1967–1968 season—a technocratic attempt to resolve socio-political challenges [1].

A prominent example of this approach was the introduction of enhanced Mexican soft wheat seeds, developed by the International Maize and Wheat Improvement Center (CIMMYT). While these seeds increased yields compared to local varieties, they came at significant costs. Their cultivation required the intensive use of chemical fertilizers and pesticides, as well as advanced machinery, creating dependencies on international supply chains. This shift disrupted local biodiversity, eroded indigenous farming practices [2], and undermined long-term sustainability.

The agricultural sector in Tunisia has experienced a significant decline in its contribution to the national economy over the decades. In the early 1960s, agriculture accounted for over 20% of Tunisia’s Gross Domestic Product (GDP) but fell to approximately 10% by 2018 [3]. This decline is mirrored in employment figures, while the sector once employed nearly 40% of the workforce in the years following independence, it now accounts for only 15% of total employment [4].

This decline aligns with Tunisia’s shift toward liberal economic policies in the 1970s, which prioritized export-oriented growth. The situation worsened with the implementation of structural adjustment programs (SAPs) in the mid-1980s and the signing of the free trade agreement with the European Union in 1995 [5]. The agricultural structural adjustment program promoted the liberalization of prices and investments and facilitated the gradual privatization of state-owned enterprises within the sector. While these reforms aimed to modernize the economy and attract foreign investment, they often did so at the expense of small-scale farmers and rural communities, who faced mounting challenges in a rapidly changing economic landscape. This policy shift has deepened inequalities, weakened local agricultural resilience, and marginalized those who depend on agriculture for their livelihoods. Despite this reduction in economic contribution, agriculture remains crucial for rural livelihoods, supporting around 470,000 farmers [6]. These farmers play a vital role in maintaining rural stability and food security within the country.

Despite 62% of Tunisia’s land being allocated for agricultural use, the sector struggles to meet domestic nutritional needs. The country has become increasingly reliant on imports for cereals, cattle fodder, and agricultural inputs like seeds, chemicals, and machinery. This reliance raises concerns about food security and Tunisia’s economic sovereignty.

The emphasis on short-term productivity gains, driven by international market incentives, has resulted in significant ecological degradation and exacerbated social inequalities. Approximately 80% of Tunisia’s available water resources [7] are used for irrigation [8], leading to severe over-exploitation. Combined with soil depletion and the excessive use of chemical fertilizers and pesticides, this has caused widespread environmental damage that jeopardizes the long-term sustainability of the country’s agricultural practices.

A major shortcoming of Tunisia’s modernization strategy is the persistent disconnect between agricultural policies and the realities faced by farmers on the ground. This gap has exacerbated the marginalization of small-scale farmers, who are increasingly burdened by the state’s retreat from its regulatory role and the growing dominance of large corporations in the agricultural market [9]. Access to credit [10] remains another critical barrier, as studies on credit market access and profitability in Tunisian agriculture reveal that many rural farmers struggle to obtain the financial resources necessary to modernize their operations. Consequently, a significant portion of the farming population remains underserved by formal financial institutions.

Compounding these challenges is the neglect of local farmers’ expertise and traditional agricultural practices, which are often overlooked in favor of external, top-down approaches. This disregard further weakens the relevance and effectiveness of agricultural policies, leaving small-scale farmers without the necessary support to overcome systemic obstacles and adapt to a rapidly changing economic landscape.

Bridging the Gap: The Role of Data in Shaping Tunisia’s Agricultural Policies

Agricultural policies rely heavily on data produced by national and international institutions, highlighting the need for a robust and reliable data ecosystem to design, evaluate, and refine strategies effectively. Yet, statistics are not neutral; it often mirror the priorities and assumptions of the entities funding and overseeing these systems. This bias tends to prioritize economic growth over social and ecological sustainability, emphasizing macro-level trends while overlooking the realities of small-scale farmers and traditional agricultural practices.

Tunisia’s agricultural data ecosystem is centered on two primary institutions: the National Institute of Statistics (INS) and the National Observatory of Agriculture (ONAGRI). Although these institutions provide extensive insights into macroeconomic trends, they fail to fully capture the nuanced and diverse realities faced by local agricultural practitioners.

The National Institute of Statistics (INS), established in 1969 under the Ministry of Development and International Cooperation, serves as Tunisia’s primary statistical authority. It plays a pivotal role in producing critical data on agricultural land use, the number of farms, and crop production. For instance, in 2023, Tunisia recorded approximately 515,548 agricultural holdings spanning a total area of 10,452,740 hectares. Despite its essential function, the INS faces significant challenges, particularly its reliance on foreign funding and technical assistance. A recent example is the 2023 agreement with the Italian Agency for Development Cooperation (AICS) and the World Bank, financed through the “Tunisia Economic Resilience and Inclusion Umbrella Fund.” This collaboration aims to modernize Tunisia’s statistical infrastructure by delivering enhanced and sustained technical support to attract greater investment in key sectors. According to a press release from AICS, the funding aims to “modernize Tunisia’s statistical apparatus” by providing “enhanced and continuous technical assistance” to attract greater investment, particularly in “priority sectors.” The Italian ambassador highlighted that this agreement reflects his country’s commitment to supporting Tunisia’s modernization efforts through a “pragmatic and comprehensive approach that meets the country’s real needs”. Meanwhile, both the director of AICS and the World Bank’s resident representative emphasized the critical role of modernizing Tunisia’s statistical system in achieving sustainable development and inclusive economic growth. Notably, the press release did not specify whether a representative of the INS had spoken at the signing ceremony.

The National Observatory of Agriculture (ONAGRI), operating under the Ministry of Agriculture, focuses on the agricultural and fisheries sectors, collecting and analyzing data across domains such as cereals, livestock, fisheries, and olive oil. While its insights primarily serve policymakers, investors, and researchers, ONAGRI’s data often skews toward export-oriented and market-driven sectors. This reflects an ideology centered on food security and international market incentives but frequently overlooks the needs of small-scale farmers and the importance of local self-sufficiency.

Following Tunisia’s political transition in 2011 and its subsequent entry into the Open Government Partnership [11], significant steps [12] were taken to improve data collection and transparency. Among these was the adoption of Law No. 22 of 2016, which led to the creation of the Access to Information Authority. Despite these advances, the agricultural data ecosystem continues to struggle with structural and accessibility challenges [13][14] that hinder its effectiveness. The centralized nature of Tunisia’s administration exacerbates regional inequalities, leaving rural and remote areas marginalized in terms of data access. Furthermore, the complex and time-consuming procedures required to obtain information often exclude key stakeholders, particularly small-scale farmers, who are typically unfamiliar with bureaucratic systems.

These challenges are compounded by reduced state funding and austerity measures imposed by the IMF, which have severely impacted the activities of institutions like the Agricultural Extension and Training Agency (AVFA). Historically, AVFA played a crucial role in supporting farmers through regular field visits, distributing informational materials, and organizing community events to share knowledge and innovations. However, today, this direct engagement has dwindled, leaving farmers frustrated by the lack of support and access to critical information.

This growing disconnect between agricultural institutions and the needs of the communities they are meant to serve highlights the pressing need for a more inclusive and locally-informed data ecosystem. While the modernization of Tunisia’s agricultural data ecosystem—promoted by international institutions—remains crucial for improving data collection, access, and processing, the manner in which this modernization is implemented raises concerns. The funding agreements that enable these initiatives often come with conditions and priorities shaped by donors, which do not necessarily align with the interests of fostering equitable and inclusive agriculture in Tunisia. This disconnect risks reinforcing existing inequalities in the agricultural sector, where rural communities are already marginalized in terms of resources. 

Modernization must not simply be a technocratic exercise driven by external priorities but a process that empowers small-scale farmers, incorporates local knowledge, empowering rural communities, and building resilience in the face of Tunisia’s broader economic and ecological constraints.

Towards a More Inclusive Agricultural Data Ecosystem

To address these challenges and build a more inclusive agricultural data system, Tunisia must:

1. Decentralize Data Collection and Analysis: Empower regional and local actors to contribute to the data ecosystem, ensuring it reflects the diverse realities of rural communities and small-scale farmers.
2. Prioritize Local Needs: Shift the focus from export-oriented policies to supporting sustainable, small-scale farming and local food systems.
3. Engage Farmers and Agricultural Practitioners: Actively involve farmers in data collection, policy development, and decision-making processes to ensure policies are grounded in real-world experiences and challenges.
4. Enhance Accessibility and Transparency: Simplify bureaucratic procedures to make data more accessible to all stakeholders, particularly small-scale farmers and marginalized communities.

By addressing these gaps, Tunisia can create a more balanced and inclusive agricultural policy framework that supports economic growth while safeguarding social equity, environmental sustainability, and national sovereignty. This approach will not only enhance policy effectiveness but also restore trust between agricultural institutions and the communities they serve.

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References

[1] Cornilleau, L., and P. Joly. “La Révolution Verte, Un Instrument de Gouvernement de La « faim Dans Le Monde ». Une Histoire de La Recherche Agricole Internationale.” Le Gouvernement Des Technosciences: Gouverner Le Progrès et Ses Dégâts Depuis 1945, Dominique Pestré, La découverte, 2014, pp. 171–201.
[2] Ajl, M., & Sharma, D. (2023). The Green Revolution and transversal countermovements: Recovering alternative agronomic imaginaries in Tunisia and India. Canadian Journal of Development Studies / Revue Canadienne d’études Du Développement, 43(3), 418–438. https://doi.org/10.1080/02255189.2022.2052028
[3] World Bank Data, Tunisia: https://data.worldbank.org/country/TN
[4] « Emplois par secteur économique en Tunisie 2008 – 2018 [archive] », sur fr.statista.com
[5] Mohamed Salah Bachta et Anouar Ben Mimoun, « Libéralisation des échanges, agriculture et environnement en Tunisie », Options Méditerranéennes, no 52,‎ 2003
[6] Ministère de l’Agriculture des and Ressources Hydrauliques et de la Pêche. 2021. Projet Annuel de Performance de La Mission Agriculture, Ressources Hydrauliques et Pêche Pour l’année 2022. Ministère de l’Agriculture des Ressources Hydrauliques et de la Pêche. http://www.gbo.tn/sites/default/files/2022-01/PAP%202022%20Agriculture.pdf.
[7] “Tunisia | Water Efficiency, Productivity and Sustainability in the NENA Regions (WEPS-NENA) | Food and Agriculture Organization of the United Nations.” https://www.fao.org/in-action/water-efficiency-nena/countries/tunisia/en/
[8] “Water Use in Tunisia.” Fanack Water. https://water.fanack.com/tunisia/water-use-tunisia/
[9] Gasmi, Haithem, and Roxanne Dovdar. من أجل نظام فلاحي وغذائي صامد ومستدام وشامل. Consultation, AFSA, June 2021, https://drive.google.com/file/d/16lQNI6_-EMxopALzE-CNubseeN_Tpapu/view?usp=drive_link.
[10] Foltz, Jeremy D. 2004. “Credit Market Access and Profitability in Tunisian Agriculture.” Agricultural Economics 30(3): 229–40. doi:10.1016/j.agecon.2002.12.003.
[11] Mohamed Salah Bachta et Anouar Ben Mimoun, « Libéralisation des échanges, agriculture et environnement en Tunisie », Options Méditerranéennes, no 52,‎ 2003
[12] Ministère de l’Agriculture des and Ressources Hydrauliques et de la Pêche. 2021. Projet Annuel de Performance de La Mission Agriculture, Ressources Hydrauliques et Pêche Pour l’année 2022. Ministère de l’Agriculture des Ressources Hydrauliques et de la Pêche. http://www.gbo.tn/sites/default/files/2022-01/PAP%202022%20Agriculture.pdf.
[13] “Tunisia | Water Efficiency, Productivity and Sustainability in the NENA Regions (WEPS-NENA) | Food and Agriculture Organization of the United Nations.” https://www.fao.org/in-action/water-efficiency-nena/countries/tunisia/en/
[14] “Water Use in Tunisia.” Fanack Water. https://water.fanack.com/tunisia/water-use-tunisia/

This article examines the significance of EMRs in enhancing care quality, highlighting ongoing initiatives in Tunisia to implement EMRs in public health facilities. It also addresses the challenges of EMR adoption and offers solutions for ensuring effective and responsible use of these crucial digital tools for improved patient care.

By Team Barr Al Aman

In today’s digital age, electronic health records (EHRs) [1] have become the cornerstone of modern healthcare systems. These systems go beyond merely digitizing patient files; they form the foundation of eHealth, fundamentally transforming the medical landscape. The World Health Organization (WHO) has underscored the numerous benefits of EHRs in its third global survey on eHealth, highlighting their critical role in enhancing healthcare service quality. As a result, many countries have implemented national eHealth strategies, particularly focusing on EHR deployment.

In Tunisia, the public health sector is embarking on a significant initiative to deploy Electronic Medical Records (EMRs) [2] across public health facilities. This project aims to reduce disparities in digitization among healthcare establishments and address the fragmentation of subsystems that generate patient data. In recent years, the implementation of Electronic Medical Records (EMR) has begun in several public hospitals, with Habib Thameur University Hospital leading the way, followed by other university hospitals. This initiative is steadily expanding to additional healthcare facilities, including six regional polyclinics, with the aim of establishing a unified patient file system. Pilot projects have also been launched in a district hospital and two primary health centers in the Hammamet region, as part of the “Essaha-Aziza” program, which focuses on digitizing primary healthcare services. Most recently, Jebiniana Regional Hospital [3] in Sfax has also adopted the EMR system.

At the heart of these efforts is the Ministry of Health’s IT Center (CIMS) [4], which plays a pivotal role in advancing eHealth in Tunisia. The center actively supports public health institutions in their digital transition while ensuring compliance with current security standards.

Enhancing Patient Care through EMRs

Electronic Medical Records (EMRs) are essential for establishing and organizing patient data governance, which encompasses the collection, sharing, storage, and security of medical information. Electronic Medical Records (EMRs) offer significant advantages over traditional paper-based systems by overcoming common limitations such as illegible handwriting, insufficient detail, the risk of document loss, and challenges in accessing patient information efficiently. The existence of multiple medical records across different departments and facilities often results in scattered and incomplete data, creating significant challenges during medical follow-ups.

The adoption of EMRs represents a transformative leap in medical data management. They streamline the identification and reporting of missing information through integrated alert systems that promptly notify users about data entry errors. By minimizing reliance on free text and employing standardized reference dictionaries, EMRs enhance data reliability and provide classification tools that allow healthcare providers to quickly retrieve information based on various criteria such as data type (clinical, biological, imaging), date, name, and condition type.

The integration and communication among various systems involved in a patient’s care pathway significantly enhance the comprehensiveness of patient data. This interconnection -known as interoperability- enables healthcare staff to collaborate effectively by providing seamless, real-time access to relevant information while ensuring confidentiality through customized access levels for providers.

As a result, clinicians gain a thorough and up-to-date view of a patient’s medical history, which is crucial for understanding their overall health status. This comprehensive perspective allows healthcare professionals to make more accurate diagnoses and informed decisions regarding treatments and care adjustments. Ultimately, improved care coordination minimizes disruptions in continuity of care.

EMRs serve as a holistic framework essential for both preventive care and chronic disease management. By facilitating better communication and data sharing, they contribute to improved patient outcomes [5].

For instance, EMRs are designed to minimize the risk of medical errors by providing alerts for potential mistakes based on medical histories, current treatments, and known allergies. This functionality helps prevent prescription errors and dangerous drug interactions while enhancing patient safety and reducing adverse events. Additionally, EMRs can flag critical values for clinical staff and detect duplicate tests or treatments, thereby reducing unnecessary healthcare costs and improving overall efficiency [6].

Major Obstacles to EMR Adoption in Public Healthcare Establishments

Despite their advantages, several obstacles hinder the widespread adoption of EMRs in public healthcare facilities. Budget constraints significantly slow down this process; high costs associated with procuring and maintaining EHR systems pose substantial financial challenges for many institutions striving to meet necessary technological infrastructure requirements.

Achieving seamless interoperability is one of the most significant technical challenges facing EMR adoption [7]. The diversity of information systems currently in use across healthcare facilities can impede progress towards this goal, making it difficult to integrate these disparate systems and ensuring that patient data can be easily shared across various settings. The integration process can be complex and time-consuming, often requiring significant technical expertise and resources. Healthcare organizations must navigate various data formats, protocols, and system architectures to facilitate effective data exchange between EMRs and other clinical information systems.

While there is consensus against reverting to paper records, transitioning from paper to digital records does not guarantee user acceptance [8][9].  This shift requires not only the adoption of new digital tools but also the transformation of long-standing practices, which can sometimes result in resistance from staff.

The adoption of EMRs is strongly influenced by users’ perceptions of the system’s expected performance and the effort required for its implementation. Various organizational factors [10] also play a critical role in shaping these perceptions- especially given the increasing workload on doctors. The situation is further complicated by healthcare professionals migrating to the private sector or abroad for better working conditions and higher salaries.

Additionally, a lack of awareness among stakeholders about the medical, ethical, and innovative challenges associated with data compromises commitment to addressing these issues.

Ensuring Responsible and Effective Engagement with EMRs

To foster responsible engagement with EMRs, careful planning and appropriate support are essential. This includes enhancing digital skills within the healthcare sector through targeted training programs tailored to various professionals’ specific needs. These programs should emphasize data governance issues and their ethical and medical implications, equipping healthcare providers to use digital tools responsibly and effectively.

Healthcare organizations should also conduct regular assessments of progress and challenges during EMR implementation. Evaluations should inform efforts aimed at improving on usability [11][12] and security within EMR systems. Thoroughly assessing the user experience [13] before making adjustments ensures that systems evolve according to healthcare professionals’ needs while incorporating user-friendly interfaces.

A user-centric approach to EMR design is essential to overcoming resistance [14] and ensuring successful implementation within healthcare organizations. By focusing on the needs of healthcare professionals and offering adequate support, organizations can create an environment that promotes effective engagement with EMRs. This approach not only enhances healthcare delivery efficiency but also improves patient outcomes.

Conclusion

As Tunisia embarks on the journey of healthcare modernization, the adoption of EMRs signifies more than a technological advancement; it represents a transformative step toward a more efficient and patient-centered healthcare system. By integrating these digital tools, Tunisia has the opportunity to improve the quality of care, achieve better patient outcomes, and align its healthcare standards with international best practices.

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References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738989/#ref7
[2] http://www.santetunisie.rns.tn/fr/prestations/programme-de-d%C3%A9veloppement-de-la-%C2%ABsant%C3%A9-num%C3%A9rique%C2%BB-en-tunisie?start=3
[3] https://lapresse.tn/2024/12/14/tunisie-sante-lancement-du-dossier-medical-electronique-a-jebiniana/
[4] http://www.cims.tn/
[5] https://www.sciencedirect.com/science/article/abs/pii/S1386505619300255
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738989/
[7] https://www.ncbi.nlm.nih.gov/books/NBK551878/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878018/
[9] Boonstra, Albert, and Manda Broekhuis. 2010. “Barriers to the Acceptance of Electronic Medical Records by Physicians from Systematic Review to Taxonomy and Interventions.” BMC health services research.
[10] https://pubmed.ncbi.nlm.nih.gov/20691097/
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068432/
[12] https://healthcare.utah.edu/press-releases/2023/09/when-electronic-health-records-are-hard-use-patient-safety-may-be-risk
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068432/
[14] Ben Hammouda, Seif, and Slim Hadoussa. 2018. “Projet e-santé Tunisie : étude des facteurs d’acceptation du Dossier Médical Informatisé (DMI) par les médecins auprès des hôpitaux.” Management & Avenir. https://www.cairn.info/revue-management-et-avenir-2018-4-page-15.htm

In this regard, it is crucial to consider territorial disparities in terms of both the characteristics of the populations and their health status, in addition to the geographical distribution of health services. For this purpose, a reliable and up-to-date data system providing precise geospatial information is required. This information will help produce the necessary indicators for analyzing disparities in access to care and identifying deficiencies.

Thus, public health authorities would have the ability to determine which areas require the most healthcare services and where resources should be allocated as a priority. This approach would effectively improve healthcare services management, with a focus on territorial planning and combating health inequalities.

Accessibility and utilization of healthcare services

Accessibility to healthcare is the ability of patients to obtain necessary care and medications from healthcare professionals when needed. In reality, access to healthcare remains constrained by various factors such as an insufficient healthcare supply and a shortage of healthcare personnel. Further, medical care costs are high and social coverage is limited. It is also important to note that disadvantaged populations frequently face mobility challenges that impede their access to healthcare.

The World Health Organization (WHO) has raised a major concern about limited healthcare access, affecting nearly half of the global population. This situation represents a crucial challenge for public health due to its complexity related to several critical aspects. On the one hand, it is essential to identify optimal locations for healthcare services. It is also essential to understand the correlation between current service locations and actual health needs. This analysis helps comprehend geographical disparities that may limit healthcare access, especially for rural and disadvantaged populations. On the other hand, it is crucial to identify the health needs of the population to efficiently allocate healthcare resources and meet population demands. This evaluation helps us recognize the most pressing health issues, and the most vulnerable population groups. In fact, targeted health policies ensure that resources are utilized efficiently while addressing the specific needs of a particular population.

Information management for healthcare access assessment 

Assessing healthcare access is essential to understand inequalities in healthcare provision and identify areas where healthcare is most needed. Any study of healthcare services accessibility and utilization must take into account several key factors, such as socio-economic variables, needs, supply, and demand.

A range of tools and methods are used to address healthcare planning issues. They provide management proposals that improve limited accessibility to healthcare service locations.

Health dashboards and health maps are highly useful tools for presenting health data in a simple and understandable manner. They provide general statistics on population health and well-being from different perspectives. They allow tracking the temporal evolution of various health indicators and highlighting disparities based on socio-economic levels, rural and urban environments, and local/regional health networks.

Combining these tools will provide a precise and comprehensive picture of healthcare accessibility in a particular country or region.

Often, a study of the available resources is conducted in order to characterize the service potential, both in terms of human and institutional resources, as well as material resources. An accurate count of healthcare facilities, healthcare equipment, and healthcare providers (general practitioners, specialists, nurses, etc.) can provide insight into healthcare distribution and disparities within it. This can be used to identify areas where healthcare is available and areas where it is scarce or insufficient.

In Tunisia, the national health service map “Carte sanitaire” provides statistics and a graphical representation of healthcare services distribution. This allows a clear visualization of their geographical spread at the level of each governorate.

In order to fully understand healthcare accessibility, we must look beyond healthcare provision evaluations and take into account inequities in access to care. It is therefore necessary to analyze the alignment between healthcare services and the served population, within the context of a healthcare system’s territorial planning policy. This approach facilitates the efficient planning and organization of material and human resources to improve healthcare access for all. This is regardless of geography or socioeconomic status.

However, to implement such analyses, having access to a robust and well-defined data system is crucial, allowing the collection of geolocated data related to socio-economic, environmental, epidemiological, and individual health factors. Statistical analysis must be conducted to identify all factors influencing the population’s healthcare needs. This will highlight the key factors contributing to healthcare access inequalities. It will enable the planning of effective interventions to address population health needs and ensure efficient resource distribution.

Recognizing the importance of data in assessing healthcare access is crucial. Organizations and public health authorities must integrate analytical approaches and rigorous statistical methods when considering strategies for healthcare service distribution. However, these approaches heavily rely on the availability of accurate data on the population, its health status, and environmental risks.

Data dependence poses a major challenge for specialists involved in in-depth surveys and spatial analyses. Therefore, it is essential to develop more comprehensive health information systems that efficiently collect, analyze, and share the necessary data. This will improve evaluation quality and develop more equitable and effective health policies.

The post Data challenges in healthcare access evaluation first appeared on Research Media.]]> https://www.researchmedia.org/data-challenges-in-healthcare-access-evaluation/feed/ 0 https://www.researchmedia.org/valueofhealthdata/ https://www.researchmedia.org/valueofhealthdata/#respond Fri, 28 Jul 2023 06:43:14 +0000 https://www.researchmedia.org/?p=5973   Manel Ben Fdilen, Meriem Ben Tarjem Several commonly observed pathologies in healthcare services, such as acute or…

 

Manel Ben Fdilen, Meriem Ben Tarjem

Several commonly observed pathologies in healthcare services, such as acute or chronic neurological and cardiovascular diseases, systemic diseases, and hereditary diseases, continue to present challenges in terms of diagnosis and patient orientation. These diseases have been extensively studied to constantly evolve management recommendations.

Despite advancements in prevention, diagnosis, treatment, and monitoring, these diseases still represent a public health problem due to their high frequency, multifactorial and clinical polymorphism, as well as their significant impact on morbi-mortality, and economic costs.

In Tunisia, the lack of national registries that establish the epidemiological profile of various diseases hinders our understanding and care protocol improvement. To address this, it is crucial to continuously update the data. This will enable the development of guidelines for diagnosis, treatment, and follow-up, while reducing healthcare burdens. By doing so, we can improve disease management and optimize healthcare resource allocation.

In this context, it is essential to emphasize the importance of health data in establishing national registries and their pivotal role in advancing scientific research and enhancing care quality. By doing so, we gain valuable insights that directly inform the development of effective health policies firmly rooted in current epidemiological information.

National Registries: An Essential Resource for Public Health Surveillance and Research in Tunisia

National registries are defined as “the continuous and comprehensive collection of individual-level data pertaining to one or more health events in a geographically defined population, for the purposes of surveillance, research, and evaluation in public health, by a team with appropriate expertise.”

The geographical definition of national registries encompasses several key aspects, such as the scope of diseases, medical specialty, population defined by age and sex, coding nomenclature, and data accessibility.

When determining the scope of diseases covered by the registry, consideration is given to the relevant medical specialties and domains pertinent to data collection. This ensures that the registry captures comprehensive information specific to the designated medical areas.

By defining the population in terms of age and sex, the registry provides precise demographic data. This allows for a better understanding of the characteristics of the population affected by recorded health events.

The registry’s coding nomenclature plays a vital role in organizing and analyzing recorded health events. It entails the use of a standardized classification system to assign specific codes. This facilitates data management, comparability, and interoperability across different registries and healthcare settings.

Lastly, data accessibility entails determining the appropriate access to recorded data, including the conditions and purposes for which it can be accessed. Striking the right balance is essential to sensitive data confidentiality and protection. It also enables authorized individuals and organizations to utilize the data for research, policy development, and initiatives aimed at improving healthcare.

In Tunisia, scientific societies play an essential role in managing registries by establishing the necessary policies and strategies for their implementation. These registries are specifically designed to address healthcare priorities, needs, and essential decision-making criteria. Furthermore, certain registries are part of national public health strategies, such as regional cancer registries. This demonstrates their importance in tackling major health challenges.

A concrete example is the Northern Tunisia Cancer Registry (NTCR), which was established by ministerial decree. The Epidemiology, Medical Informatics, and Biostatistics Department of the Salah Azaiz Institute was designated NTCR headquarters. These registries play a crucial role in providing a clear picture of cancer epidemiology in Tunisia. They allow for an accurate assessment, identifying existing disparities between genders and different regions of the country regarding cancer prevalence and access to care.

Furthermore, these registries play a crucial role in detecting epidemiological changes. They guide awareness strategies, individual or mass screenings, and cancer combat efforts. They also contribute to making well-informed decisions regarding patient management while fostering innovation in treatments, monitoring, and research.

However, despite progress, the epidemiological profile of many diseases is insufficiently covered by national health registries and remains unknown. It is in this context that the Tunisian Society of Cardiology and Cardiovascular Surgery initiated, for the first time in Tunisia, an international registry called “The Big 4 CVD Registry” (Africa and MENA). This registry aims to establish the epidemiological profile, improve management, and monitor therapeutic adherence for four major cardiovascular diseases: atrial fibrillation, heart failure, coronary insufficiency, and valvular heart diseases.

This ambitious initiative requires significant financial resources and expertise, but it promises to contribute significantly to scientific research by providing relevant data. It also highlights the fundamental role of coordination, both at the national and international levels, in developing health data for scientific research.

Data roles in health registry development

In order to ensure a comprehensive collection of information for registries, it is essential to draw upon different data sources. These sources include archives and hospital statistics, clinics, private practices, public or private analysis laboratories, autopsy reports and death certificates. The use of these diverse sources allows for a comprehensive and detailed view of health events in the population of interest. This increases the accuracy and relevance of established registries.

However, it is important that personnel responsible for data collection and registry creation receive adequate training and follow clear operational procedures. This is to ensure data quality. Meeting this requirement, however, necessitates the mobilization of significant human and financial resources.

To establish robust governance of this data, a national strategy for digital health development (e-health) is being developed. This strategy encompasses various initiatives, including medical records digitization. This modernization of the data management system will facilitate the collection of essential information for establishing registries. In addition, it reduces data loss risk.

Additionally, data protection is essential during registry development. A precise legal framework must govern the registry, ensuring information confidentiality, securing access to data, and regulating their use in other scientific research endeavors. It is also critical to control the distribution, dissemination, and sharing of this data. Certain registries are subject to legal obligations outlined in ministerial orders, with the primary objective of ensuring confidentiality, as is the case with the RCNT (Northern Tunisia Cancer Registry).

To ensure registry reliability, evaluation and certification committees are in place to guide researchers who wish to use the data. The National Health Evaluation and Accreditation Agency accredits several registries, ensuring compliance and reliability of collected information. This process aims to establish trust among users and promote ethical and responsible health data use.

The development of national and regional networks, as well as collaboration between scientific societies, healthcare institutions, the Ministry of Health, and the public and private sectors, plays a key role. On the one hand, this allows for quality and comparability standards for registries. On the other hand, it promotes collaboration among registries and facilitates data flow.

Therefore, institutes, healthcare organizations, and the Ministry of Health must commit to supporting and accrediting these registries. Their engagement is crucial to ensuring the success and sustainability of these initiatives, thus guaranteeing the reliability and value of the collected data.

 

In conclusion, it is highly advantageous to regularly update the national coverage of health registries in Tunisia. This would be done by assessing the range of pathologies they cover, and creating a national directory listing all accredited registries. This would guide researchers toward reliable data sources, facilitating research and analysis.

Moreover, it is essential to define and specify the data to be collected based on the specific missions of each registry. This approach rationalizes the budgetary, human, time, and effort resources invested in data collection. Interoperability between different databases and registries, as well as collaboration between the public and private sectors and national and international stakeholders, would be key factors in promoting registry data dissemination and utilization. This synergy would allow for optimal use of available resources and strengthen Tunisia’s role as a major actor in international research and scientific dissemination.

By implementing these measures, Tunisia could enhance its position as a key player in health data governance. This is while adhering to legislative and scientific quality standards. It would also become an indispensable reference in public health research, improving care quality and making informed decisions regarding national and international health strategies.

 

 

 

 

 

 

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Exactly 10 years on, how should we understand the root causes of the 2011 uprisings in the Middle East and North Africa? At the time, many commentators and policy-makers answered this question with reference to the simple mantra of ‘political and economic freedom’. While much of the world appeared to move away from authoritarian state structures through the 1990s and 2000s, the Middle East had remained largely mired in autocracy and monarchical rule – ‘the world’s most unfree region’ as the introduction to one prominent study of politics in the Arab world put it.^[2] The problem, according to these frameworks, lay in the stifling effect of authoritarianism over capitalist markets, which prevented the emergence of a vibrant private sector and held back the region’s economic potential. The popular rage expressed on the streets of the Middle East in 2011 could thus be understood as a desire for both ‘free’ political systems and ‘free’ economies.

In this vein, then-US President Obama noted in a major policy speech on the Middle East in May 2011 that the region needed ‘a model in which protectionism gives way to openness, the reins of commerce pass from the few to the many, and the economy generates jobs for the young. America’s support for democracy will therefore be based on ensuring financial stability, promoting reform, and integrating competitive markets with each other and the global economy.’ Likewise, the president of the World Bank at the time, Robert Zoellick, argued that the revolts in Tunisia occurred because of too much ‘red tape’, which prevented people from freely engaging in capitalist markets. Western policy-makers have repeated this basic argument incessantly since 2011 – autocratic states smother economic freedom, and ‘free markets’ are essential for any sustained transition away from authoritarianism. As part of this narrative, Western governments and international financial institutions (IFIs) are recast as benign and benevolent actors – ready to support the ‘transition’ to democracy and willing to provide the necessary technocratic expertise to construct open economic markets.

In what follows, it is argued that this standard framing of the Middle East’s political economy is false. It is certainly true that the region’s political structures were (and remain) highly authoritarian, but this kind of political system is directly reflective of how capitalist development occurred in the region over the last few decades. Central to this development trajectory were the far-reaching economic shifts that began in the 1980s under structural adjustment packages (SAPs) supported by the leading IFIs. Locked into these agreements, Arab governments moved through the 1990s and 2000s to reorient their economies in line with market-driven principles. The policies adopted in the region differed little from those found elsewhere around the globe – the prioritization of private sector growth, fiscal austerity, opening up to foreign capital inflows, privatization, and the deregulation of markets (including labour). There was no essential contradiction between these economic policies and political authoritarianism – indeed, the opening up of markets and the steady creep of neoliberal policies throughout the region depended precisely upon authoritarian rulers (as it still does). Crucially, this process was fully supported by Western governments, who applauded the coming to power of autocratic rulers in the region in the 1980s and continued to laud the direction of economic policy-making in the decades preceding 2011.

Postwar politics and the modern Middle East

Any analysis of the contemporary Middle East needs to begin with the region’s centrality to the world economy. Long a strategic crossroads of trade, the area took on special importance following the discovery of large supplies of hydrocarbons during the early twentieth century. Oil and gas were to become essential commodities underpinning modern industrial production and transport following World War 2 and, in this context, control and influence over the region shaped the balance of global rivalries in the postwar period. The United States, which emerged as the dominant power at this time, placed particular emphasis on building privileged relationships with countries across the region.

The 1950s and 1960s saw both a deepening of the region’s importance to the world economy and, at the same time, the coming to power of Arab nationalist movements in Egypt, Yemen, Algeria, Syria and Iraq. These new governments overthrew regimes allied to former colonial powers and attempted to pursue economic models based upon statist forms of development – emphasizing domestic control of industry, support to education and employment for university graduates, subsidies for basic consumer items such as food, and state control of land and other resources. Nonetheless, despite the frequent reference to ‘Arab socialism’ made by these new governments, their economic strategy was still very much capitalist in orientation.[3] These policies led to an improvement in living conditions for much of the region’s population, but they were also characterized by repressive forms of rule aimed at curtailing any independent political action.

Western governments – led by the United States – initially confronted these nationalist struggles through strengthening relations with three key regional allies: Saudi Arabia, Iran and Israel. In the Gulf, the Saudi monarch, King Saud, had long been reliant on US political and military support, and was all too willing to undercut Arab nationalism through the corrupting influence of oil revenues. Saudi funding of pro-Western movements in the region enabled these forces to deny any direct link to Western governments. The Saudi government was also encouraged to deploy Islam as a regional counterweight to nationalist and left-wing ideas, organizing ‘Islamic summits’ that asserted Saudi influence and challenged Egypt’s role as the leading Arab state. A vitriolic propaganda war opened up between the Saudi and Egyptian governments. This proxy conflict with Egypt took its most vivid form during the eight-year North Yemen civil war, where Saudi Arabia was the main supporter of the royalist, pro-British forces that had been overthrown in 1962, while Egypt backed the republican movements arrayed against the ousted monarchy.

In the case of Iran, the United States (and Britain’s M16) engineered a coup against the Iranian Prime Minister Mohammad Mosaddegh in 1953, bringing to power a pro-Western government that was loyal to the Iranian monarchy, headed by Mohammad Reza Shah Pahlavi. The US explicitly conceived of Iran as its principal base of control for the Gulf region, with a 1969 report by the RAND Corporation – a prominent think tank closely connected to Washington policy-makers – noting that Iran could ‘help achieve many of the goals we find desirable without the need to intervene in the region’.[4] This role was convincingly demonstrated in 1973 with the dispatch of the Iranian military to Oman to assist British troops in the repression of the Dhofar rebellion – a powerful struggle that was at the heart of left-wing movements in the Arabian Peninsula. The Iranian troops, supplied with US helicopters and other weaponry, succeeded in crushing the rebellion. US military support to Iran skyrocketed from 1973 onwards, amounting to more than $6 billion annually between 1973 and 1975. This close relationship continued up until 1979, when the Iranian revolution ousted the Pahlavi monarchy and removed Iran from the sphere of US influence in the region.

The other major pivot of US power in the broader region was the state of Israel. As a settler-colonial state, Israel had come into being in 1948 through the expulsion of around three-quarters of the original Palestinian population from their homes and lands. Inextricably tied to external support for its continued viability in a hostile environment, Israel could be counted on as a much more reliable ally than any Arab state. During the 1950s, Israel’s main external support had come from Britain and France. But the 1967 war saw the Israeli military destroy the Egyptian and Syrian air forces and occupy the West Bank, Gaza Strip, (Egyptian) Sinai Peninsula, and (Syrian) Golan Heights. Israel’s defeat of the Arab states encouraged the United States to cement itself as the country’s primary patron, supplying it annually with billions of dollars’ worth of military hardware and financial support.

Israel’s victory in 1967 signalled a decisive turning point in the evolution of Arab nationalism. While pro-Western regimes continued to be challenged from below by various radical movements, and new nationalist governments came to power in Southern Yemen (1967), Iraq (1968) and Libya (1969), Israel’s victory dealt a devastating blow to the notions of Arab unity and resistance that had been crystallized most sharply in Nasser’s Egypt. The military defeat was symbolically reinforced by Nasser’s death in 1970 and the coming to power of Anwar Sadat, who subsequently moved to reverse many of Nasser’s more radical policies. The priority given by the United States to its relationship with Israel was further highlighted in 1973, when another war broke out between Israel and a coalition of Arab states led by Egypt and Syria. Despite initial Egyptian and Syrian advances in the opening salvos of the war, US airlifts of the latest military equipment led to Israel’s eventual victory.

The emergence of authoritarian neoliberalism

Given this regional political context, the global economic downturn of the early 1970s placed severe pressure on the statist development strategies of various Arab governments. The global recession hit the non-oil exports of many Arab countries, while the cost of food and energy imports increased. Moreover, large military expenditures associated with ongoing conflicts in the region (particularly the 1967 and 1973 wars with Israel) placed considerable strain on government budgets. Following the sharp rise in US interest rates that began in 1979 – the so-called Volcker Shock – an acute debt crisis swept through key Arab states, including Egypt, Morocco, Tunisia and Jordan.

As a result of this debt crisis, many Arab governments sought financial support from IFIs, in return for signing SAPs that committed them to a reorientation of economic priorities. Morocco was the first to sign a SAP in 1983, and similar reform programmes were soon adopted in Tunisia (1986), Jordan (1989), Egypt (1991), Algeria (1994) and Yemen (1995). These SAPs sought to strengthen the private sector and achieve closer integration with the world market. The private sector would be, as the World Bank later put it, the ‘engine of strong and sustained growth’ – a necessary requirement of the ‘new global economy’ in which ‘rewards . . . go to the most hospitable environments [for capital investment]’.

From the 1980s onwards, the economic policies of Arab states followed such prescriptions, much like countries elsewhere around the world. Trapped in a cycle of debt and compelled by the conditionalities of multilateral loan packages, Arab governments embraced the standard policy priorities of market-based development: privatization and the prioritization of private sector growth, deregulation of labour and financial markets, a lowering of corporate tax rates, relaxation of barriers to trade and foreign investment, and cutbacks to public spending, including subsidies on food and energy. These new policies were widely unpopular, and their introduction was met with strikes, demonstrations and violent clashes between citizens and security forces – one survey documented 25 outbreaks of major protests between 1977 and 1992 against structural adjustment in nine countries across the region (Algeria, Lebanon, Jordan, Egypt, Morocco, Iran, Sudan, Tunisia and Turkey).[5]

In the face of this widespread opposition to economic change, Arab states took on increasingly authoritarian characteristics through the 1980s and 1990s. Indeed, several of the regimes that were overthrown in 2011 first came to power in this period and led the turn towards neoliberal development models. The 1987 coup by Ben Ali in Tunisia, for example, was followed by the country’s decisive orientation towards IFI-led structural adjustment. Likewise, Egypt’s Hosni Mubarak, who became president in 1981 following the assassination of his predecessor Anwar Sadat, consolidated a system of repressive rule that included the suspension of the constitution, imposition of an Emergency Law, restrictions on the press, detention without charge, and the introduction of military courts to try political opponents. In 1991 Mubarak agreed to an SAP with the IMF and World Bank, and then turned his security forces against the resulting labour strikes and mass demonstrations that occurred throughout the 1990s. Similarly, governments in Jordan, Morocco and Algeria became much more authoritarian in this period. Western governments and IFIs were nonetheless supportive of these governments, viewing their repressive practices as a necessary means to undercut the widespread social discontent around the new neoliberal measures.

These economic measures reversed many of the previous policies embraced by Arab nationalist governments from the 1950s to the 1970s. One indication of this is the large-scale privatization of state-owned firms during this period. According to World Bank figures, total proceeds from privatization in Egypt, Morocco, Tunisia, Algeria, Jordan, Lebanon and Yemen reached a little over $8 billion between 1988 and 1999, with more than half of this figure coming from sales in Egypt alone ($4.172 billion).[6] Over the subsequent decade, the scale of privatization expanded considerably, with privatization receipts totalling more than $27 billion between 2000 and 2008. This latter period saw many more countries in the region engage in the selling of assets, as well as a shift away from the privatization of industrial and manufacturing industries and towards the privatization of the telecommunications and financial sectors. Despite the increasing number of countries involved in privatization, Egypt continued to register both the highest number of deals and the largest value of assets sold ($15.7 billion from 1988 to 2008).

A further core priority of structural adjustment in the region was the deregulation of labour markets through reducing (or abolishing) minimum wages and severance pay, and easing laws around hiring and firing.^[7] Arab governments were urged by the World Bank and other IFIs to implement ‘more flexible hiring and dismissal procedures’ as a means of reducing ‘the dominant role of government as employer’ – in this manner, the costs of labour across the board could be reduced. In particular, those firms that were earmarked for privatization would not have to compete with better labour conditions in the public sector and would thus become more attractive to potential investors. Throughout the 2000s, Egypt, Jordan, Morocco and Tunisia all passed significant laws deregulating the labour market.

Another important focus of IFI policy in the region during this period was liberalization of the agricultural sector. Here, policies aimed to develop new agribusiness models that would link production more closely to global markets. Alongside laws that commodified land and dismantled collective ownership rights, other measures lifted price caps on agricultural inputs (such as fertilizers, pesticides and water), and sought to integrate farmers into agribusiness commodity chains. The Egyptian case has been particularly well documented. In 1992, the Mubarak government passed Law 96, which allowed landlords to sell land without informing or negotiating with tenants and lifted longstanding caps on rural rents.[8] As a consequence of this law, rents increased by 300 to 400 per cent in some areas and over a third of all tenant families in Egyptian rural areas (around 1 million households) lost their rights to land. Law 96 was enthusiastically backed by the World Bank and IMF as part of a general policy to establish private property rights in agriculture. A USAID-sponsored study applauded the Egyptian government for passing the law, which it saw as doing away with

‘more than 40 years of an imbalanced relationship between landlords and tenants’.

The logic of these and other policies was further reinforced through international trade and financial agreements signed throughout the 1990s and 2000s. Of particular significance here are the Association Agreements signed with the European Union as part of the European Mediterranean Partnership (which later became the European Neighbourhood Policy). Between 1995 and 1997, Jordan, Morocco and Tunisia signed Association Agreements with the EU, while Egypt followed them in 2004. These agreements promised financial aid and greater access to the markets of the EU – the region’s most important trading partner – in return for deepening neoliberal reform. Alongside similar bilateral treaties with the US and accession to the World Trade Organization, these international agreements constituted an important driving force behind the reduction of trade barriers and the opening of new sectors – such as finance, telecommunications, transport, and energy – to foreign ownership.

These economic agreements were also directly tied to the intensification of Western military and political intervention in the region throughout the 1990s and 2000s. Most significantly, this included the decade-long imposition of sanctions on Iraq through the 1990s, culminating in a 2003 US/British-led invasion that overthrew the Iraqi ruler, Saddam Hussein, and that led to a devastating series of social and economic crises from which the country has yet to emerge. At the same time, the United States and European Union sought to normalize Israel’s place in the region – backing the misnamed Oslo Peace Process through the 1990s and advancing a range of regional initiatives aimed at deepening Israel’s ties with Jordan, Egypt and the Gulf states. In relation to both the Iraq War and Israeli–Arab negotiations, US strategic objectives carried an explicit economic dimension (frequently overlooked) that aimed to deepen the region’s integration with global trade and financial flows – war, politics and the region’s economic transformation need to be seen as intimately connected.

Of course, not all states in the Middle East were integrated into the global economy and the Western orbit to the same degree. Throughout the 1980s and 1990s, countries such as Libya and Syria largely stood outside the US-dominated system, seeking instead to build relationships with other powers – notably the Soviet Union (up until the early 1990s), and later Russia and China. These two states were headed by tightly centralized, authoritarian regimes – that of Gaddafi in Libya and the Assad family in Syria – in which state power was based on highly patrimonial structures and, in the case of Syria, the deliberate cultivation of sectarian patterns of rule. Due to the way that state control underpinned the power of these regimes, and their relative isolation from Western markets, both Libya and Syria did not see the adoption of IFI-led structural adjustment throughout the 1980s in the same way as other Arab states. Nonetheless, in the wake of the decline of their traditional international backers in the 1990s and early 2000s, both Syria and Libya began to seek a rapprochement with the West. This move was not solely political: it also included an opening to world markets and initial steps towards economic liberalization. In the case of Libya, Gaddafi gave his strong support to the US attack on Afghanistan in 2001 and was later to participate in CIA rendition flights and torture programmes. In 2003, following the lifting of UN sanctions that had been placed on Libya in 1992, key regime figures began lobbying for economic liberalization, with Gaddafi’s son Saif el-Islam insisting that ‘everything should be privatized’ in a speech at the Libya Youth Forum in 2008.^[9] Only tentative steps in this direction were to be adopted, however, due to the highly centralized concentration of state power in the hands of the Gaddafi family. Despite this fact, the IMF was to note on 15 February 2011 – just two days prior to the beginning of an uprising that was to lead to the overthrow of the regime – that ‘An ambitious program to privatize banks and develop the nascent financial sector is under way. Banks have been partially privatized, interest rates decontrolled, and competition encouraged . . . ongoing efforts to restructure and modernize the Central Bank of Libya are under way with assistance from the Fund.’

For Syria, significant steps towards economic reform began following the accession to power of Bashar al-Assad in 2000, after the death of his father Hafez al-Assad. The younger Assad began to privatize and open up the Syrian economy to foreign direct investment, leading to private control of key industrial sectors such as metallurgy, chemicals and textiles. According to one analyst of the Syrian economy, the size of the private sector had risen to just over 60 per cent of GDP by 2007, up from 52.3 per cent in 2000.^[10] Much like other countries in the Middle East, privatization benefitted a small group of business groups that were closely linked to the Assad regime, and that were enriched through state contracts and joint projects with foreign investors. As these reforms accelerated during the period 2005–10, much of the rest of the Syrian population saw a severe worsening of their living standards.

The cases of Syria and Libya confirm that the core assumptions of market-led development had become widely accepted by state and ruling class elites throughout the region by the end of the first decade of the 2000s. Although Syria and Libya may have sometimes expressed opposition to US policy in the Middle East – an opposition that was, however, typically rhetorical rather than substantive – their ruling regimes sought entry into the world market on the basis of economic programmes that paralleled those found elsewhere in the region. Characterized by a similar intertwining of authoritarian rule and economic power, the embrace of these policies expressed an attempt to strengthen the position of those located at the centre of the political system.

Social inequality and the polarization of wealth

Throughout this period of economic transformation, large and persistent disparities opened up in the ownership and control of wealth, access to resources and markets, and the exercise of political power. Alongside consistently high unemployment, rising poverty, and substantial levels of rural dispossession, a tiny layer of the region’s population benefitted considerably from the new economic policies. Privatization and new market opportunities presented lucrative openings for well-connected business groups involved in areas such as trade, finance and real estate speculation. State elites and militaries also came to wield significant economic power, building a web of highly opaque relationships with private capital groups.^[11] These patterns of inequality were sustained through authoritarian rule and state repression. Indeed, it is impossible to separate the highly autocratic political structures of the region from the policies (and outcomes) of the market-led development models implemented from the 1980s onwards.

One important illustration of these patterns can be seen in jobs and employment statistics. Before the global economic downturn of 2008, the average official unemployment rate across Egypt, Jordan, Lebanon, Morocco, Syria and Tunisia was higher than in any other region in the world. Young people and women were most affected by unemployment – with around one-fifth of all Arab women and one-quarter of youth in the region unemployed. These figures hide large regional disparities: in the Mashreq sub-region (Egypt, Jordan, Iraq, Syria, Lebanon and the West Bank and Gaza Strip), over 45 per cent of all young females were unemployed in 2011, more than double the rate for young men. The Middle East also ranked at the bottom of the world for labour market participation rates, with less than half of the region’s population considered part of the labour force. Only about one-third of young people and 26 per cent of women were in work, or actively seeking employment. This profound marginalization of young people and women carried deep social implications in countries where elderly men monopolized political power.

The region’s labour markets were also marked by a widespread prevalence of informal and precarious work. In 2009, the United Nations Development Programme reported that the growth of informal work in Egypt, Morocco and Tunisia was among the fastest in the world (reaching between 40 and 50 per cent of all non-agricultural employment). In Egypt, three-quarters of new labour market entrants from 2000 to 2005 joined the informal sector, up from only one-fifth in the early 1970s.[12] Not only did these trends affect the character of employment, they also carried important implications for the way urban space was used, and the kinds of social and political movements that emerged in the Middle East – the residents of densely-packed informal settlements across cities such as Cairo, Casablanca, Algiers and Beirut were viewed by governments with deep mistrust and suspicion.

These highly unequal employment and labour market outcomes contributed to worsening overall poverty levels in the region. The proportion of the population without the means to acquire basic nutrition and essential non-food items (the ‘upper poverty line’) averaged close to 40 per cent across Jordan, Morocco, Syria, Tunisia, Mauritania, Lebanon, Egypt and Yemen in the decade prior to the uprisings.[13] Health and educational outcomes also reflected unequal access to state services and social support. Between 2000 and 2006, around one-fifth of all children in Egypt and Morocco exhibited stunted growth as a result of malnutrition. Across the Mashreq countries, undernourishment increased from 6.4 per cent in 1991 to 10.3 per cent in 2011. In 2010, on the eve of the uprisings, a striking 30 per cent of all adults in the region were illiterate (rising to 40 per cent for females aged 15 and above). Educational access was also marked by clear inequalities. In Egypt, for example, UNESCO noted that ‘one in five of the poorest [children] do not make it into primary school at all, while almost all rich children get through to upper secondary’.

It is essential to stress, however, that alongside this widespread deterioration of social conditions throughout the 1990s and 2000s, many of the region’s leading economies were experiencing very high growth rates and were being lauded as successful cases of economic reform, worthy of emulation by other countries in the Global South. Egypt, for example, was ranked by the World Bank as the ‘world’s top reformer’ in its 2008 Doing Business report, and continued to rate within the top 10 global reformers until the overthrow of Mubarak. Likewise, the World Bank’s 2010 Development Policy Review on Tunisia praised the country for its ‘steady structural reforms and good macroeconomic management’ that had earned Tunisia a place ‘among the leading performers in the group of emerging economies’ and led to ‘enviable achievements’ for the country’s poor. This kind of support to authoritarian governments continues to mark IFI policy in much of the Middle East today (such as the Sisi regime in Egypt) – a fact that it is crucial to remember in the light of attempts by these institutions to rewrite their historical record in the region.

The regional order and the global crisis of 2008

The economic policies imposed by IFIs on the Middle East throughout the 1990s and 2000s did not just reconfigure social structures at the national scale, they also precipitated new economic and political hierarchies at the regional level. A key feature of these emergent hierarchies was the growing weight of the six Gulf Arab states (Saudi Arabia, the United Arab Emirates (UAE), Qatar, Kuwait, Bahrain and Oman) in the regional political economy – and the linkage between capital accumulation in the Gulf and processes of class and state formation elsewhere in the area.

Taken as a whole, the Gulf Arab states are marked by features that set them apart from the rest of the region. All these states are monarchies whose rich and relatively cheap hydrocarbon resources (both oil and natural gas) made the Gulf a critical focus of Western strategy in the Middle East throughout the twentieth century. At the same time, the social structures of the Gulf monarchies differ considerably from those found elsewhere in the Middle East. Most significant is the Gulf’s reliance on a large number of temporary migrant workers, mostly drawn from South Asia and to a lesser degree neighbouring Arab countries, who now make up more than one-half of the Gulf’s total population of 56 million. When considered as a percentage of the labour force, non-nationals make up from 59 to 86 per cent of the employed population in Saudi Arabia, Oman, Bahrain and Kuwait, increasing to around 92 to 95 per cent in Qatar and the UAE. Denied labour, political and civil rights, these migrant workers have been fundamental to patterns of urban growth and capital accumulation in the Gulf; they have also underpinned the ‘vertical segmentation’ of Gulf societies, with citizens incorporated into the surveillance and control of migrant populations through the kafala system.^[14]

Over the past several decades, growing international demand for the Gulf’s hydrocarbons – underpinned by a near continuous increase in the price of oil from 2000 to mid-2014 – has massively increased wealth levels in the Gulf.^[15] This has helped nurture the development of large capitalist conglomerates in the Gulf, closely linked to ruling monarchies and the state, whose activities span sectors such as construction and real estate development, industrial processes (particularly steel, aluminium and concrete), retail (including import trade and the ownership of shopping centres and malls) and finance.

While much of the surplus capital held in the Gulf has been invested in North America and Europe, large amounts also flowed into neighbouring Arab countries throughout the 2000s.^[16] Critically, this regional expansion of Gulf capital was predicated upon the SAPs discussed above, and the subsequent liberalization and opening up to foreign direct investment flows throughout many Arab countries in the 1990s and 2000s. As a result, Gulf capital was a prime beneficiary of the neoliberal turn throughout the wider region – becoming intimately involved in the ownership and control of capital across the Middle East as a whole.

These regional hierarchies are crucial to understanding the impact of the 2008–09 global economic crisis on the Middle East. As noted, in the years preceding this crisis the region was already facing very high levels of social and economic inequality. In addition to issues of youth unemployment, social exclusion and poverty, rising costs of food and energy placed considerable pressure on the livelihoods of many families.[17] Growing import bills meant that Arab governments faced enormous difficulties in maintaining already reduced subsidy levels; simultaneously, the cost of living for poorer families also rose. This precipitated a large jump in the number of the region’s poor – one estimate from the African Development Bank calculated that a total of 1.11 million additional people had fallen below the poverty line in Egypt, Jordan, Palestine, Syria and Yemen immediately prior to the 2008 global crisis itself.

As the 2008–09 crisis unfolded, these pre-existing patterns of economic development influenced how different parts of the region experienced the global turmoil. Non-oil exporting states were hard hit by the drop in global demand for goods such as agricultural products, textiles and garments, and other manufactured items. Simultaneously, overseas remittance levels fell as the crisis enveloped agriculture, construction and low-skilled manufacturing sectors in Europe, where many Arab migrants (both documented and undocumented) were located. Finally, financial liberalization throughout the neoliberal period had exposed many countries to potential fluctuations in foreign capital inflows, notably of tourist spending and foreign direct investment.

In the Gulf, however, the crisis was experienced differently. Gulf countries were initially shaken by a short-lived drop in oil prices from July to December 2008 (and the associated fall in global demand), as well as a pull-back in foreign capital inflows that led to a collapse of the Gulf’s real estate bubbles (particularly in Dubai). But, in response, the Gulf utilized accumulated financial surpluses to support the large private and state conglomerates threatened by the crisis, launching massive programmes of spending on real estate and infrastructure projects (concentrated in Saudi Arabia and the UAE). Moreover, the Gulf monarchies were able to make use of their structural dependence on temporary migrant workers to shift the burden of the crisis onto neighbouring countries – the hiring of new workers slowed and existing workers could simply be sent home as projects were cancelled. By 2010, oil prices had begun to move upwards once more, further consolidating the Gulf’s path out of the global crisis.

Taken together, these different regional trajectories of the global crisis meant that the Gulf states were able to emerge in a regionally strengthened position in the years following 2008, whilst neighbouring Arab countries faced growing fiscal and social burdens. It was in this context that mass protests first emerged in Tunisia in December 2010, spreading rapidly throughout the entire region. The first phase of these protests in 2011 saw the overthrow of the Ben Ali regime in Tunisia and the Mubarak regime in Egypt. Governments in Syria, Bahrain, Jordan, Algeria, Oman, Morocco, Yemen and Libya were also faced with uprisings and protests expressing opposition to autocratic patterns of rule and the deteriorating socioeconomic conditions experienced by much of the population. In this sense, the uprisings targeted both the economic policies that had been so heavily promoted by Western financial institutions over the preceding decades, as well as the political structures with which they were twinned. Not all participants in the uprisings thought about the protests in this manner, of course, but the ubiquitous slogan of aish, hurriyah, ‘adalah ijtima’iyah (bread, freedom, social justice) make this fusion of the economic and political spheres quite evident.

Conclusion

Despite the aspirations of those who took part in the extraordinary struggles of 2011, the extreme polarization of wealth and power in the region has not been fundamentally altered. A recent study has shown that the Middle East is now the most unequal region in the world, with the richest 10 per cent of income earners capturing 64 per cent of total income – compared to 37 per cent in Western Europe, 47 per cent in the United States and 55 per cent in Brazil.[18] The figures are even starker for the ultra-rich population of the region: the income share of the top 1 per cent stands at about 30 per cent in the Middle East, compared to 12 per cent in Western Europe, 20 per cent in the US, 28 per cent in Brazil, 18 per cent in South Africa, 14 per cent in China and 21 per cent in India.[19] These unprecedented levels of inequality are present both at the regional level – between the wealthy countries of the Gulf and the rest of the Middle East – as well as within individual countries.

These high levels of inequality are directly attributable to the market-based development models of recent decades, which have remained essentially unchanged following the uprisings and which continue to be promoted by major IFIs. Such continuities were clearly demonstrated by the IFI-led Deauville Partnership, an initiative launched at the May 2011 G8 summit in France that promised up to $40 billion in loans and other assistance towards Arab countries ‘in transition’. The core premise of the Partnership was a redoubled effort towards market opening in five target countries – Egypt, Tunisia, Jordan, Morocco and Libya – with goals such as ‘remov[ing] existing structural impediments’, encouraging a ‘vigorous private sector’ as ‘the main engine for job creation’, and pursuing ‘regional and global economic integration [as the] key to economic development’. In this manner, and strikingly reminiscent of how the political and economic crises of the 1970s and 1980s had opened the path to structural adjustment in the region, the post-2011 crises were viewed as an opportunity to extend the policy trajectories of past regimes. As the European Investment Bank noted not long after the overthrow of Ben Ali and Mubarak, ‘moments of political change can also represent an opportunity to reinforce or improve already existing institutional frameworks’.

Backed by initiatives such as the Deauville Partnership, IFIs have moved since 2011 to expand their position in the region with the offer of new loan agreements and other forms of assistance. Long-established institutions such as the World Bank and IMF have led the way in this process, while working alongside other institutions that have only begun operating in the region during the last decade (such as the European Bank for Reconstruction and Development). The evolving discussions around post-conflict reconstruction in countries such as Syria, Yemen, Libya and Iraq are also marked by the same kind of market-driven logic, and – as history amply illustrates – the aftermath of war, conflict and crisis (including the current global pandemic) is frequently viewed as an opportunity to rework power arrangements and accelerate economic change.

A decade on, the experience of the 2011 uprisings demonstrates that it is not sufficient to focus solely on political demands (such as new elections or governmental corruption) without simultaneously tackling the social and economic power of capital (nationally, regionally and globally). There can be no fundamental break with authoritarian state structures under an economic system that continues to promote unfettered growth and so-called ‘free markets’ at the expense of social justice and equality. One of the major weaknesses of the 2011 revolts was a failure to recognize this strategic lesson. But more recent cycles of political protest – notably the 2018–21 uprisings across Lebanon, Sudan, Algeria, Morocco and Iraq – appear to have learnt from the 2011 experience, explicitly linking the challenge to autocratic political elites with the need to reverse the extreme disparities in the control and distribution of wealth. In this sense – while the aspirations of 2011 remain wholly unfulfilled – the lessons, experiences and hopes of that moment will form an indelible part of struggles to come.

Adam Hanieh is a Professor of Political Economy and Global Development at the Institute of Arab and Islamic Studies, University of Exeter.  His current research focuses on global political economy, development in the Middle East, oil and capitalism. He is the author of three books, most recently Money, Markets, and Monarchies:The Gulf Cooperation Council and Political Economy of the Contemporary Middle East (Cambridge University Press, 2018), which was awarded the 2019 International Political Economy Group (IPEG) Book Prize of the British International Studies Association.

Copy-edited by Ashely Inglis

A partnership with Rosa Luxembourg – North Africa & TNI

[1] This article draws on Hanieh, A. (2013) Lineages of Revolt: Issues of contemporary capitalism in the Middle East. Chicago: Haymarket Books.

[2] Schlumberger, O. (2007) Debating Arab Authoritarianism: Dynamics and durability in nondemocratic regimes. Palo Alto, CA: Stanford University Press. p. 5.

[3] Hanieh, A. (2021) ‘Class, nation, and socialism’, International Politics Reviews 9: 50–6-0. Available at: https://link.springer.com/article/10.1057/s41312-021-00104-2 [Accessed 26 July 2021].

[4] Cited in Stork, J. (1975) ‘US Strategy in the Gulf’, MERIP Reports 36: 19.

[5] Walton, J.K. and Seddon, D. (1994) Free Markets and Food Riots: The politics of global adjustment. Wiley-Blackwell. p. 171.

[6] See Hanieh, A. (2013) Lineages of Revolt, pp. 76–80, for further discussion of the figures in this paragraph.

[7] Ibid.

[8] See Bush, R. (ed.) (2002) Counter-Revolution in Egypt’s Countryside: Land and farmers in the era of economic reform. London: Zed Books.

[9] Prashad, V. Arab Spring, Libyan Winter. Oakland, Baltimore, Edinburgh: AK Press Publishing and Distribution. p. 111.

[10] Haddad, B. (2011) ‘The Political Economy of Syria: Realities and challenges’, Middle East Policy 18(2): 53.

[11] For Egypt’s military–economic links see Marshall, S. and Stacher, J. (2012) ‘Egypt’s generals and transnational capital’, Middle East Report 262(Spring); and Abul-Magd, Z. (2011) ‘The army and the economy in Egypt’, Jadaliyya, 23 December 2011.

[12] Wahba, J. (2010) ‘Labour markets performance and migration flows in Egypt’, in Labour Markets Performance and Migration Flows in Arab Mediterranean Countries: Determinants and Effects, European Commission Occasional Paper 60, Vol. 3. Brussels: European Commission. p. 34.

[13] Achcar, G. (2013). The People Want. London: Saqi Books. p. 31.

[14] Khalaf, A. (2014) ‘The Politics of Migration’, in A. Khalaf et al. (eds.) Transit States: Labour, migration and citizenship in the Gulf. London: Pluto Press. pp. 39–56.

[15] Hanieh, A. (2018) Money, Markets, and Monarchies: The Gulf Cooperation Council and the political economy of the contemporary Middle East. Cambridge: Cambridge University Press. p. 31.

[16] A commonly cited figure throughout the 2000s was that around 50 to 55 per cent of all Gulf Cooperation Council investments went to US markets, 20 per cent went to Europe, 10 to 15 per cent went to Asia and 10 to 15 per cent went to the Middle East and North Africa.

[17] From July 2007 to July 2009, the food consumer price index rose 53 per cent in Tunisia, 47 per cent in Egypt, 42 per cent in Syria, 22 per cent in Morocco, and 20 per cent in Jordan.

[18] Alvaredo, F., Assouad, L. and Picketty, T. (2018) ‘Measuring inequality in the Middle East 1990–2016: The world’s most unequal region?’, The Review of Income and Wealth (online). Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/roiw.12385 [Accessed 26 July 2021]

[19] Ibid.

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Around a year ago we were reminiscing about how a decade had passed since the mass protests in Alexandria (Egypt) in June 2010 against the police murder of a young Egyptian, Khaled Mohamed Saeed,[1] and since the start of the third Saharawi intifada in Gdeim Izik[2] (Occupied Western Sahara) in October 2010. We talked about how for us that marked the beginning of a life-changing epoch.

In the year that followed (2011) a wave of revolt spread throughout the whole Middle East and North Africa region, in what came to be called the ‘Arab Spring’.[3] These uprisings were acknowledged as world-shaking events. The Tunisian and Egyptian revolutions ignited historic upheavals in North Africa and beyond. People there celebrated the toppling of the dictators, Ben Ali and Mubarak, and looked ahead towards meaningful change in their lives. These uprisings, like most revolutionary situations, released enormous energy – a collective effervescence, an unparalleled sense of renewal and a shift in political consciousness.

The peoples of the region are all too familiar with the racist stereotype and contemptuous cliché embodied in the facile falsehood that ‘Arabs and Muslims are not fit for democracy and they are incapable of governing themselves’. The imperial and colonial dominance over the region has led to it being seen in some quarters as a homogeneous entity that can be systematically reduced through negative tropes. Seen through this distorting lens, the region evokes images of conflict and wars, ruthless dictators and passive populations, terrorism and extremism, as well as rich oil reserves and expansive deserts. This orientalist imaginary and the rigid representation of ‘the other’, as well as having the power to ‘block narratives’, are hallmarks of a political and geographic violence that is produced by imperialism.[4]

The uprisings shattered many of these stereotypes and debunked many myths. The wind of revolution that began to blow in 2011 spread from Tunisia to Egypt, Libya, Syria, Yemen, Bahrain, Jordan, Morocco and Oman. The emancipatory experience was contagious, inspiring people all over the world: activists in Madrid, London and New York, whether calling themselves the Occupy Movement or the Indignados, were all proud to ‘Walk like an Egyptian’. Although the last three to four decades have seen attempts to delegitimize meaningful and radical change through revolution, following the shortcomings and defeat of decolonization efforts in various parts of the global South, and although counter-revolutionary onslaughts will always seek to crush the will of the people – revolutions and uprisings for emancipation continue (and will continue).

For both of us, as for many activists, the pride and hope that these events generated remains deeply personal and political. Our career paths, activism and world-views were shaped by this formative political experience. We participated in conferences/round-tables celebrating and analysing these historical events, we marched with our peoples in protests, and we were involved in various solidarity initiatives. We discussed, debated and disagreed with friends and comrades. Sometimes we felt hopeful, at others sad and dispirited. Above all, we learnt a great deal: engaging with revolutionary praxis offers a unique source of knowledge.

Nevertheless, we cannot deny that what started as inspiring uprisings against authoritarianism and oppressive socio-economic conditions, demanding bread, justice and dignity, morphed into violence and chaos, profound polarizations, counter-revolution and foreign intervention. The various people’s movements in the region found themselves pitted against entrenched authoritarian and counter-revolutionary forces bent on suppressing them. All were met with resistance from the state, often in conjunction with global capital and foreign interference. The military coup in Egypt ended up restoring a much more ruthless and repressive form of dictatorship. The brutal descent into civil wars in Syria, Libya and Yemen, and the series of crackdowns in Gulf countries like Bahrain, provide examples of the cruel logic of proxy war so reminiscent of the colonial schemes with which the region and its people are all too familiar. Tunisia, which had seemed to be the exception in this gloom and doom, is now in a very fragile position. Moreover, the deep polarizations (e.g. Islamists versus secularists) imposed on the masses have distracted them from the key socio-economic issues that were at the heart of the uprisings in the first place.

Some mainstream commentators have argued that the ‘Arab Spring’ gave way to an ‘Islamist winter’ (with Islamist forces coming to power in some countries). Some progressive voices have been less pessimistic and have presented a more historically nuanced perspective, arguing that these events should be seen as part of a long-term revolutionary process, with ups and downs, periods of radicalization and periods of setback and counter-revolution. This latter view received some vindication when, eight years after the 2010/11 events, an escalation of the revolutionary process took place, in the form of a second wave of uprisings in Sudan, Algeria, Iraq and Lebanon (2018–21), alongside the return to the spotlight in 2021 of the unending and heroic struggle of the Palestinians – all of which reveals people’s determination to continue fighting for their rights and sovereignty.

All of these momentous events between 2010 and 2021 have opened new horizons for people to express their discontent and demand radical change and reforms, forcing almost every government in the region to concede on issues – both political and economic.

Why a project to commemorate this decade of struggle in the region?

When we embarked on this project our guiding compass was the important role of memory in our movements for justice and freedom, and the crucial task of maintaining an archive. Our political memory is not an automatic process, like muscle memory; rather, it is shaped by the political and economic conditions in which we exist. The nurturing of political affinity and the maintenance of radical kinship does not occur in a vacuum – it must be fed, to be kept alive. To be archived and reflected upon. Anniversaries provide one occasion for such activities, and that is what this project represents. The project includes webinars [hyperlinks] and podcasts [links], together with the articles collected here, all of which can help us to look at the concrete within what are sometimes too-abstract debates, and to engage with some less visible cases.

One of our aims in this project has been to challenge a number of misconceptions about the region, its people and their revolts and uprisings. One such misconception was the attempt by the global and mainstream media, Western governments, as well as international financial institutions, like the World Bank, to portray the uprisings as merely revolts against authoritarianism and as demanding only political freedoms and democracy of the stunted kinds that exist in Western industrial countries. This framing steers away from any class analysis and tends to dissociate the political from the economic, ignoring the fundamental socio-economic demands of bread, social justice, dignity and popular sovereignty. But the misreading – or more accurately distortion – did not stop there. The Tunisian and Egyptian uprisings were dubbed by Western mainstream commentators ‘Facebook and Twitter revolutions’, exaggerating the role of social media in fomenting them. Another dominant – but no less superficial – framing was the demographic one, which interpreted the revolts as primarily youth uprisings against the older generation – the product of a ‘youth bulge’ in the affected countries.

A decade later, mainstream interpretations commemorating the tenth anniversary of the events have gained little by way of insight. Several media reports and articles talk of failed and lost revolutions and broken promises. But the dominant tone is captured by a title of one Guardian article published in December 2020, referring to Mohamed Bouazizi, the street fruit vendor who set himself on fire, catalysing the Arab uprisings: ‘He ruined us: 10 years on, Tunisians curse man who sparked Arab Spring’. The narrative advanced is one of despair and hopelessness: the uprising was not worthwhile, better to have remained in poverty and in chains. Such an interpretation needs to be strongly challenged and deconstructed in order to offer a more nuanced and less idealist (more materialist) reading of revolution and what it entails. Various critical progressive activists and researchers have emphasized the importance of acknowledging the complexities of revolutionary dynamics and their inevitable crises, shortcomings and even failings.[5] This necessitates seeing revolutions as being imbued with counter-revolutionary tendencies and encroached upon by reactionary forces. The fact that people in the region are continuing to revolt is testimony to this complexity. Ultimately, the ideas people hold about revolutions have a critical impact on the outcomes of such events when they actually occur; hence the necessity of reflecting and learning from past revolutions.

Throughout this project we have sought to make space for critical reflection: we prioritized an inclusive approach regarding different disciplinary views and political emphases, and in the process gave a platform to younger, female and local voices from the region – the least we can do. We hope we have eschewed rigid dichotomies, as well as self-righteousness as regards possession of ‘the truth’ – a desire that stems from our rejection of sectarian and polemical styles and behaviours, which can too easily morph into personal attacks. One outcome of this collaboration has been to learn to disagree and to work respectfully in a comradely fashion, and to continue the discussion in a constructive way. Anyone who is engaged in the issues presented in this project will be all too aware of how the nefarious effects of trench positions (campism) have weakened progressive possibilities for meaningful engagement over the years. So often we have seen debates about Syria or Libya, for example, turn into deeply polarizing (and often false) binaries – alienating participants and choking off productive debates regarding revolutionary strategies and international solidarity. Ultimately, how exactly we can reconcile certain positions (e.g. anti-authoritarian versus anti-imperialist) will be put to the test in our movements, but we should never absolve ourselves of our duty to argue against selective political positions. One case of freedom should be in the service of – not expendable in pursuit of – another. This was powerfully captured during one of our webinars between our Moroccan and Saharawi participants.

Summary of the articles

The contributors to this dossier are outstanding scholars and activists from, or having their roots in, the region.[6] They were given the choice to write either in Arabic or English. All pieces are offered to our readers in both languages.

In his piece, Adam Hanieh delves into the root causes of the regional uprisings through a historical and political economy approach. By describing in detail some of the lineages of the revolt that broke out in 2011, he deconstructs the mainstream liberal framing of the region and its uprisings. He argues that we must pay attention to the region’s centrality to the world economy, and how its political structures are directly reflective of the capitalist development that has taken place in the region over the last few decades.

Ghassen Ben Khelifa takes us back to 2010–2011, when Tunisian people who desired to live in dignity rose up to claim their rights. He takes a very critical look at the initial events that constituted Tunisia’s intifada and shows how it has now been contained, if not aborted. He cogently challenges the ‘exceptionalist’ framework around the Tunisian experience by showcasing a series of counter-revolutionary imperial and neoliberal measures designed to strangle the revolution and its economic demands.

Mostafa Bassiouny and Anne Alexander argue in their piece that any attempt to understand the course of the 2011 Egyptian revolution must necessarily grapple with the role of the workers’ movement. They show how workers’ struggles were an independent factor in the revolutionary process. They also underline the importance of ‘reciprocal action’ between the economic and the political aspects of the class struggle, and how this process played a pivotal role in the revolutionary developments in Egypt.

Fourate Chahal delivers beautiful and evocative illustrations for all the articles in this dossier. She also offers us some exquisite and powerful artistic collage, capturing the beauty, creativity and the energy released by various uprisings through graffiti, art, slogans and the recapturing of public spaces by people in revolt.

In his contribution, Ali Amouzai critically reflects on the historic February 20 Movement in Morocco, which arose in 2011, and details the balance of political and social forces that preceded it. Then, he describes and analyses the reaction of the monarchy to this threat to its rule, which took the form of repression, cooptation and containment. He also shines a light on Morocco’s role as an outpost of imperialist designs in the African continent, while continuing to resist the right to self-determination of the Saharawis.

Rafeef Ziadah argues that one of the major outcomes of the uprisings has been the increased role of regional players in multiple states, working to stabilize the political system to their advantage. With a focus on Libya and Yemen, she examines the various modes of intervention applied by the United Arab Emirates and Saudi Arabia, including direct military campaigns, the use of proxies, financial aid and humanitarian packages – all working in tandem to shape a regional outcome that has buttressed the status quo against the initial hopes of change offered by the uprisings.

Yasser Munif starts his article by examining bread as a central commodity in times of war and peace, offering an overview of the agrarian reform implemented by successive regimes in Syria from 1963 to 2000. He then focuses on the weaponization of bread as an important military strategy of the Assad regime during the revolt in Syria, while giving us a glimpse of the rebels’ grassroots resistance, using the city of Manbij in northern Syria as a case study.

Muzan Al Neel’s contribution focuses on the 2018–2019 Sudanese revolution and explains why the Sudanese rose up, and what it was they wanted to overthrow when they chanted ‘Just fall’. She analyses the current moment and the role of the transitional government, and its evolution vis à vis the uprising’s objectives. She ends by exploring the ways the Sudanese uprising could and should continue to achieve its goals in the face of the counter-revolution.

Zahra Ali puts forward a feminist analysis of the Iraqi uprising of 2019. Based on her in-depth fieldwork conducted with women and youth networks and social movements in Iraq, she takes the 2019 uprising as a framework for thinking about how massive protests allow for an understanding of emancipation that broadens our feminist imagination, paying particular attention to the spaces the uprising produced.

Hamza Hamouchene adopts a Fanonian lens to analyse the 2019–2021 Algerian uprising,  and argues for the rationality of rebellion in the context of the new popular movement (Hirak) in Algeria – a movement that he argues represents a continuation of the decolonization process. He also connects the uprising in Algeria with the Black Lives Matter movement in the United States and considers what Fanon’s thought has to offer to these and other struggles for economic and political justice.

And last, but not least, Rima Majed applies a comparative approach and asks what the Iraqi and Lebanese  uprisings of 2019 have in common beyond a regional/cultural proximity. She first discusses whether these uprisings can be termed ‘revolutions’ or ‘revolutionary’ in the first place. She then focuses on the internal contradictions of these revolutions, looking at the rhetoric of corruption, national unity, technocratic politics and individualism.

Looking back – looking forward

Anniversaries have a symbolic power and can be good opportunities for taking stock of what happened, and for reflecting on the positives and negatives. They can also be dynamic moments where we think about how to move forward. Our aim is not to reminisce about the beautiful times that are long gone, or to romanticize these great historical events. Instead, in this project we hope to get closer to the spirit of the revolutions, their creative energy, as well as their contradictions and shortcomings – and their enemies.

Obviously, this project has some lacunas – things that are not addressed. This is partly due to our own limits, in terms of our labour and time, and partly due to the limits of a project whose raison d’être is bound to a certain moment in time. In truth, revolutionary processes are always unfinished. The same goes for political praxis, which includes writing about revolutions. And although we would not pretend, or seek, to be fully comprehensive when discussing such a vast region, we hope we offer here an important glimpse, in the voice and the language of its people. What we have sought to present is a progressive analysis that can contribute to deepening our knowledge about the region – with the hope that this will allow us to learn from past mistakes and continue to push for long-sought change in the prevailing oppressive political and socio-economic conditions.

Our memories of the incredible events over the last decade have been foundational. We feel privileged to have witnessed people acting with a political stamina and bravery that can only be termed ‘historic’. Our minds have been enlightened and our spirits elevated by the countless ordinary men and women who dared to say ‘the people want’ [al sha’b yourid], and who rose up in unprecedented circumstances. We inherit their legacy, and the enormous price paid to arrive at a tipping point from which neither the friends nor the enemies of revolution can return. There are few things as powerful as ordinary working class people overcoming all the odds and shaking the very foundation of the status quo.

‘The personal is political’ proclaims the feminist maxim. ‘Nothing about us goes without us’ runs the motto of the disability struggle. In the spirit of these two messages we wholeheartedly thank all of the contributors to this project, who bring their perspectives as scholars and activists in and from the region. And we pay tribute to the fallen, the injured, the political prisoners and the ones who continue to struggle. We dedicate this work to them, and to all those who have sacrificed their lives for bread, justice and dignity.

Miriyam Aouragh is a Dutch-Moroccan anthropologist. She is a Reader at the Communication and Media Research Institute, University of Westminster. She is the author of the book Palestine Online and the forthcoming Mediating the Makhzan.  Her research and writings focus on cyber warfare, grassroots digital politics and (counter-) revolutions.

Hamza Hamouchene is a London-based Algerian researcher-activist, commentator and a founding member of Algeria Solidarity Campaign (ASC), Environmental Justice North Africa (EJNA) and the North African Food Sovereignty Network (NAFSN). He is currently the North Africa Programme Coordinator at the Transnational Institute (TNI).

Copy-edited by Ashley Inglis

References

[1] The murder by Egyptian police of Khaled Mohamed Saeed, and the outrage it provoked, contributed to the growing discontent in the weeks leading up to the Egyptian Revolution of 2011.

[2] Gdeim Izik was a protest camp in Western Sahara, established on 9 October 2010 and maintained till November that year. While protests were initially peaceful, they were later marked by clashes between Saharawi civilians and Moroccan security forces. Some have referred to the protests as the Third Saharawi Intifada, following the First (1999–2004) and Second (2005). Scholar and political activist Noam Chomsky has suggested that the month-long protest encampment at Gdeim Izik constituted the start of the Arab Spring.

[3] The term Arab Spring is an allusion to the Revolutions of 1848, which are sometimes referred to as the ‘Springtime of Nations’, and to the Prague Spring in 1968 , as well as later uprisings in Central and Eastern Europe in 1989. This term was been coined, and has been promoted by, Western media and pundits, and has been criticized by some scholars as part of a US strategy of controlling the movement’s aims and goals and directing it towards Western-style liberal democracy. However, it is important to acknowledge some positive uses of the term Arab Spring, and how it makes a link with earlier historic uprisings in the region, such as the Berber Spring of 1980 in Algeria and the Damascus spring of 2000.

[4] Said, E. (1984) ‘Permission to narrate’, Journal of Palestine Studies 13(3): 27–48.

[5] Bayat, A (2017) Revolution without Revolutionaries: Making sense of the Arab Spring. Stanford: Stanford University Press. See also Traboulsi, F (2014) Revolutions without Revolutionaries. Beirut: Reyad El-Rayyes Books.

[6] We note briefly here the various ways the authors in this dossier refer to the region that is the focus of this project. Some use ‘Middle East’ or ‘Middle East and North Africa (MENA)’. Others refer to the ‘Arab region’ or ‘Arab world’, while others go for the less-used coinages ‘North Africa and West Asia (NAWA)’ or ‘West Asia and North Africa (WANA)’. Our own view is that if we are committed to advancing counter-hegemonic narratives that challenge structures of power, and to decolonizing concepts and names, it is only fitting to call into question the colonial designation ‘Middle East’ – a construct of, and designed to sit in opposition to, the West; part of the legacy of Orientalism, of creating an ‘other’. We are sympathetic to the use of ‘Arabic region’, but without its ethnic connotations. We acknowledge that this naming can arouse feelings of exclusion and oppression among some. No naming is perfect, and each has its own limits. In our view, without trying to efface the rich shared cultural and political legacies in our region, a reference rooted in a geographic identification, such as North Africa and West Asia (NAWA), is a more apt description.

This dossier of articles is published in collaboration with the Transnational Institute (TNI) and Rosa Luxemburg Foundation – North Africa.

EDITOR’S NOTE: We remain at the disposal of fellow journalists to explain our approach and its limitations. However, the editorial staff of Barr al Aman Research Media specifies that it does not accuse any moral or physical person. This article gives the floor to the main person quoted. It is  based solely on public data. We call on colleagues not to headline their articles “Barr al Aman accuses” but rather, “traceback”. The editors call on the Middle East Eye media to respond to the elements we present here.

Where did “the document” come from?

This document was placed on the drive in “reading” mode and displayed to anyone with the link. The name of the file is “article_80.pdf”. The owner of the drive account is Mr. Mahmoud Bondok [1], a journalist of Middle East Eye. After downloading the document and analyzing the metadata, we see that this document was written in Word and that the author is Beta methods B(m). It is important to mention here that our article that follows assumes that the metadata of the document has not been modified.

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This company presents itself as follows: “Beta methods B(m). Beta methods is a Financial engineering and consulting firm, which was founded by experienced and internationally trained professionals.”[2]

Where is this company located?

The address of creation is in Borj Baccouche, Ariana as it can be seen on the extract of the “Registre de commerce” that we downloaded from the Registre national des entreprises (RNE).

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However, on google research, it is this address in “Lac 1” that we found: office D 3 2, Dar Maghrebia – Les Berges du Lac – 1053 – Tunis

Who is the representative of this company?

After identifying the company’s page on facebook[3], we were able to find its domain name. This domain is registered to Walid Balti[4]. A name that we also found in the RNE identity sheet available above.

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We are not saying that this person wrote the letter and this is not an accusation against the legal person he represents or his physical person. However, we say that the PDF document posted by Middle East Eye was exported from a Microsoft word program whose author is “Beta methods (m)”.

What is Walid Balti’s background?

A priori, there is no profile of Walid Balti on facebook (with his real name, Editor’s note). However, on linkedin, we find him with a profile picture that reminds us of the press conference room of the Kasbah, the seat of the Tunisian government.

Going back in his professional career, we notice that Walid Balti was an adviser to the Minister of Sports:

“Adviser of Minister of Youth and Sports

Ministry of youth and sports of Tunisia

Dates Employed Mar 2012 – Mar 2014

Employment Duration 2 yrs 1 mo”

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It was therefore under the government of the troika that he was appointed[5] and precisely by Tarak Dhiab. He was dismissed from the board of the public company Promosport on May 13, 2015 by order of the Minister of Sports Maher Ben Dhia.

Balti, the “spokesman” of a sports betting company

We find little about Walid Balti on facebook, except for this video interview on Cap FM[6]. He is there as a representative of the sports betting website www.bountou1x2.com. In the legal notice of this company, we find Beta Methods as one of the “two firms specialized in accounting, auditing, consulting and financial engineering. ” [7].

Although no mention is made of the role of spokesperson, there is an additional link between “bountou1x2” and “Beta Methods”. Indeed, the address of the “commercial department” of “bountou1x2” is office 2, 3rd floor block D dar Maghrebia – Les Berges du Lac – 1053 – Tunis, which is the headquarters of Beta Methods.

On the other hand, Walid Balti’s media outings are relatively rare. One of the most remarkable is undoubtedly this publication in 2018, which resembles a right of reply, published on the site of mtunisia[8] (previously Al Mutawassit, reputedly a conservative channel and close to the Ennahda party). He defended the activity of the company bountou1x2, as a promoter of sports and sports clubs, contrary to the statements of the CEO of the company Promosport where he sat a few years earlier.

Walid Balti, the activist for transparency and against corruption

What caught our attention in this open letter addressed to the CEO of the public company Promosport in 2018, is that Mr. Balti presents himself with his quality of former member of the board of directors of the company but also as a former adviser to the Minister of Sports. However, the speech he holds corresponds much more to his role as spokesman for Bountou1x2.

Although legally, there is no opposition to an individual working in the environment or sector of activity in which he or she was an advisor to the state, the risk of “revolving doors” is quite tangible. Indeed, by advising and amending legislation between 2012 and 2014 as an advisor to the Minister, Mr. Balti was in a privileged position a few years later as a consultant in the same field.

Mr. Balti’s response, reached by Barr al Aman Research Media:

We called the landline number of the company Beta Methods, Mr. Balti identified himself as the manager of the company, he said:

“I have no idea why my company’s name was mentioned in the metadata of this document. I have no relationship with Mr. Bondok. I thank you for warning us, especially since these are very serious matters. The fact that I was an advisor to the Ministry of Sports has nothing to do with it. I will ask our IT people to check, it could be any other company with the same name.”

What we don’t know until publication:

We found no public affiliation of Mr. Balti with any particular political party. He stated that he ‘has no connection with any particular party’.

Some publications about Mr. Balti have come from media outlets not known for their probity, such as Etthawra news, which accuses Mr. Balti of falsifying documents in connection with the president of the Tunis Tennis Club and his former superior Tarak Dhiab. 9

Our article does not incriminate Mr. Balti, nor the company Beta Methods. It questions them. Indeed, Mr. Balti is not alone in this enterprise. We have managed to identify two employees of Beta Methods. First, Mrs. Salhi[10] or Mr. Abdeladhim[11].

A Beta Systemes, behind Beta Methods

Our research through the employees allowed us to identify the latter (Mr. Abdelhadhim) as a “relay” person between Mr. Balti’s first company and the second, whose name resembles the first and which is domiciled at the same address: “Beta-systemes”[12][13] which has a dozen employees/collaborators, some of whom are foreigners.

The latter has several points in common with the former beyond the address. Bountou1x2 is a common customer. One of the employees works for both companies according to his linkedin profile. Another common point is the radio Cap FM which is a client of the second company but which invited the founder of the first to speak. Another element is that the employee who works for the “two betas” also worked for Cap FM and published articles as a journalist under that name[14]. However, the company that we found under this name in the RNE does not a priori correspond to the same company.

When questioned, Mr. Balti indicated that it was a company “domiciled” at this address.

The trade register of the Beta Systemes company that we found

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Références:

[1] Original link to the drive: https://drive.google.com/file/d/1o3e9B-0QeHxduPJvIG-cwOZYr5MALZ1u/ Click on the three dots at the top right of the screen to display the menu and then click on “Details” to see the owner.

[2] https://tn.linkedin.com/company/betamethods

[3] https://www.facebook.com/pg/Beta.methods/

[4] https://who.is/whois/beta-methods.com

[5] الجمهورية التونسية  —  قرار وزير الشباب والرياضة  رقــم 611  لسنة  2012  —   بتاريخ 12 / 6 / 2012

[6] https://www.facebook.com/CapFm.PageOfficielle/videos/1615192038561739

[7] https://www.bountou1x2.com/mentions-legales?system_code=CASUAL-B&language=fr&token=

[8] https://mtunisiatv.com/2018/02/28/%D8%B9%D8%B6%D9%88-%D9%85%D8%AC%D9%84%D8%B3-%D8%A7%D8%AF%D8%A7%D8%B1%D8%A9-%D8%B3%D8%A7%D8%A8%D9%82-%D9%8A%D8%B1%D8%AF-%D8%B9%D9%84%D9%89-%D9%85%D8%BA%D8%A7%D9%84%D8%B7%D8%A7%D8%AA-%D8%B1-%D9%85/

[9] http://athawra-news-tunisie.blogspot.com/2014/05/blog-post_30.html

[10] https://www.linkedin.com/in/amna-salhi-7886ba180/

[11] https://www.linkedin.com/in/elyes-abdeladhim-838033200/

[12] https://www.beta-systemes.com/

[13] https://tn.linkedin.com/company/beta-systems?trk=public_profile_experience-item_result-card_subtitle-click

[14] https://www.cap-fm.tn/ar/%D8%A7%D9%84%D8%B3%D9%8A%D8%B1%D8%A9-%D8%A7%D9%84%D8%B0%D8%A7%D8%AA%D9%8A%D8%A9-%D9%84%D9%88%D8%B2%D9%8A%D8%B1-%D8%A7%D9%84%D8%AE%D8%A7%D8%B1%D8%AC%D9%8A%D8%A9-%D8%A7%D9%84%D9%85%D9%82%D8%AA%D8%B1/

The Fakhfakh government announced a fundraising hotline to collect donations for the national health system and revealed the reorganizing of budget spending priorities in order to reallocate an overall amount of 2,500 billion TND ($860 million) to support small and medium enterprises (SME) and companies suffering from the economic shutdown. The government also agreed to transfer 200 TND ($68) as a social safety net to the 600,000 poorest families for the month of April. So far, an additional 1.4 million Tunisians requested this aid, and the number of applications for emergency cash assistance is expected to rise. The government extended this monthly allocation to May as the targeted lockdown was extended. Other emergency policies include mortgage and loan freeze for middle-income households, a freeze of social contributions from the private sector from three to six months, and a reduction by the central bank of the interest rate by 100 basis points in order to preserve the demand side. However, these measures were generally perceived as insufficient especially with attempts of banks and companies to violate the imposed measures and the agreement with the government to maintain salary payments for workers forced into confinement. Therefore, a great discontent emerged between different classes (workers and business owners), between the private and public sector, and between different unions due to the general belief that some will pay more for the others^[2].

This feeling of injustice is not unfounded as social and fiscal injustice have persisted during decades of economic and fiscal policies guided by austerity measures imposed by international financial institutions (IFIs) and donor countries, and even more so after the 2011 revolution. As a result, workers’ rights have been undermined and their struggles criminalized^[3].

This situation is exacerbated by the government officials’ belief that guaranteeing salary payments in Tunisian Dinar, social transfers to the poorest, and doing “Whatever it takes” to preserve jobs and income for workers and households, can only be done through taxation, or new debts or by collecting donations, or through threatening the rentiers capitalist class by a hypothetical wealth tax measure.

While Tunisia is a currency issuer state and is not fiscally constrained, the Central Bank of Tunisia (CBT) could have accommodated the government’s plan to stabilize the income of the most vulnerable people without fearing inflation, especially in this context of international trade contraction, instead of allowing banks and the financial sector to take advantage of this crisis by seeking more profits, from high-interest rate lending to the state, and by investing public money in non-productive sectors.

This is a political decision that could have been made by the Chief of Government when legislative power was delegated to him at the end of March, but unfortunately such a proposal –of allowing the CBT to accommodate government deficit limited to 5% of GDP- was strangely deleted from the last version of the delegation law.

A new loan with new conditions

Regrettably, the government made another political decision to prioritize external debt servicing and to acquire even more external debt.  Indeed, on the 14th of April, Tunisia and the IMF announced an agreement for the disbursement of a new loan: The Rapid Financing Instrument (RFI) worth $745 million – the second-biggest disbursement by an African country after Côte d’Ivoire – to support “the government’s efforts to contain the pandemic.”

Taking a closer look at the letter of intent^[4] jointly signed and sent by the finance minister and the central bank governor, we find that the loan is conditional, despite the government claiming otherwise. In fact, there are immediate and future commitments that predicate the continuation of the same dependency policies that may jeopardize any attempt by Tunisia to create a more resilient and sovereign economic model.

Indeed, the immediate commitment consists of a reduction of investment in non-priority projects without any clear definition of such projects. The announced budget cuts included the canceling the procurement of cars for government officials, flours and roses for the presidential palace, but most impactful, the reduction of fuel subsidies^[5], the increase in the price of tobacco, the increase in water distribution cost, and the freezing of subsidized fuel and food vouchers for public servants. Already one day of work was cut from workers’ payroll in the private and public sector as a compulsory contribution to the government’s efforts to “collect” funds, this one-day salary cut included healthcare workers and workers in essential and strategic sectors who continued to serve during the pandemic. Farmers also contributed with 1% of their turnover on the wholesale markets, while banks, financial institutions, and large profitable corporations were left free to contribute to the donations fund voluntarily based on their goodwill.

All of these measures will have a negative impact on the income of the vast majority of the marginalized people, unemployed, low wage workers, but also the middle class, which is mostly composed of public employees, while the capitalist class continues to enjoy the special fiscal status that provides them with tax cuts, especially for companies whose activity is 100% export-oriented.

The government also committed to increasing natural gas prices after the Covid-19 crisis eases. Authorities will put a strain on its workforce by freezing promotions and limiting overtime hours in the public sector to prevent any new wage bill surge for 2020. The government is also negotiating with the Tunisian General Labor Union (UGTT) so that any planned salary increases for 2021 will not exceed the inflation rate. In addition, an audit of the public sector will be performed to reduce absenteeism and ‘ghost’ workers. This may announce hard bargaining times between the government and the national union as the weight of the crisis will mainly be borne by labor, not capital. The UGTT played a major role during the last round of IMF negotiations to push back against reforms that were mainly targeting public sector privatization, wage cuts and a reduction in the number of public sector employees working in local administrations, and strategic sectors like water, energy, transport, education, and health.

As for the limited participation of private banks and financial institutions in the national effort to support SMEs and households, and the non-compliance of some banks to the CBT’s decisions to freezing loan payments, the Ministry of Finance, Nizar Yaïche, reiterated the holy principle of CBT independence. This principle, included in the new statute of the CBT, was also imposed by the 2016 loan agreement with the IMF whose main objective was to prohibit the CBT from directly financing government deficits via treasury bond purchases and to maintain legal independence in policymaking from the central government, even though most of CBT policies are guided by the IMF staff priorities and in agreement with their recommendations.

Although central banks of advanced economies have undertaken massive if not unlimited liquidity injections, to support their economies and support workers whose livelihoods have been adversely affected, this option has been denied for Tunisia. The IMF had the Central Bank of Tunisia commit to not interfering in the foreign exchange market, or limiting foreign transfers (dividends, debt repayments), trade transactions, or entering into bilateral payment arrangements with other countries. Moreover, the IMF imposed that any loan guarantees or subsidies to companies should be borne by the government rather than the Central Bank. With these prescriptions, the IMF clearly plays the role of a self-appointed watchdog of global capitalism. What worries the IMF is the leeway that countries like Tunisia could leverage with their sovereign currency, should their central bank unleash more robust counter-inflationist policies and national rights-based economic stimulus targeting full employment and rebuilding local productive capacity. That is why policing central banks have always been central to the IMF conditionalities.

As for future commitments, the government is planning to permanently reduce subsidies for electricity and natural gas, and to make social safety nets are offered on a temporary rather than permanent basis. This is part of the general neoliberal orientation maintained by the IMF to cancel governmental subsidies as they are considered distortions to market equilibrium. These reforms may certainly apply later to the few products that are still subsidized in Tunisia, namely wheat and semolina flour, sugar, vegetal oils, milk, and tomato paste (the latter are price-settled), all of which are really important food staples for Tunisian consumers, as shown during the COVID-19 crisis. Price-subsidized basic products are a sensitive issue for most Tunisians since the monthly minimum wage for a Tunisian worker is only 403 TND ($140 per month) for 48 hours/week. For a long time, subsidizing basic commodities was a necessary strategic decision for governments to maintain social peace in an economic environment of a race to the bottom wage policies.

Last but not least, to obtain this RFI disbursement, the Tunisian government committed to starting a new IMF program (Extended Fund Facility) in the third quarter of 2020, which will also include a number of painful reforms, as Nizar Yaïche, the Finance Minister stated in his recent interview with Bloomberg News.

While this Covid-19 pandemic allowed debt servicing relief for 25 African countries, Tunisia was excluded from this debt relief program announced by the G20. On the contrary, the new IMF loan is expected to be a lever to other loans from the G7 and international financial markets. The European Commission also announced a new Macro-Financial Assistance (MFA) of €600 million that will help fill the gap of debt servicing tranches which will be due in 2020 and 2021. These MFAs, like former ones that “benefited” Tunisia, were also a European Commission tool to secure its trade-related interests.

It must be noted that the amount allocated to debt servicing in the government’s budget exceeds 11 billion TND ($3,78 billion) for 2020, which is one-quarter of the government’s budget, more than six times the budget allocated for the ministry of higher education and scientific research, 35 times the investment allocation for education, and five times the budget of the ministry of health^[6]. In 2019, more than 4,000 health workers left public health services and were not replaced.

Can Modern Monetary Theory solve Africa’s debt crisis ?

This deal with the IMF is, in reality, imposing an unwarranted burden on government spending, and as a consequence, will tighten the government’s fiscal policy space which would hinder the prioritizing of health, education, universal public services for its population. However, more deceivingly, this deal is making it less likely for Tunisia to launch any new green infrastructure and a job guarantee program^[7] that may act as a stimulus and a stabilizer of economic activity; which could, in turn, protect people’s lives and dignity, especially if the central bank continues its high-interest rate policy focus, and ignores its role in financing the budget deficit or supporting any national rights-based recovery program.

The recent decision of the G20 to relieve some financial constraints on the poorest countries that are liable to find themselves in default is only aiming to avoid an imminent ‘sovereign debt default domino effect’ without addressing the structural deficiencies of developing countries or addressing the root causes of their balance of payment (BoP) deficits^[8].  At the same time, they would approve new concessional loans to countries with fewer financial difficulties, well-controlled markets (like Tunisia), and continue making these loans conditional based upon limiting government spending and deficits, excluding the central bank as an important policy tool, and making sure there are no capital controls or constraints on trade.  This strategy maintains the dependency relationship with creditor countries who need market access in developing countries where they can sell high value-added products, and where they can buy cheap factors of production and resources at stable and affordable prices.

Is this strategy sustainable?

One might, however, wonder to what extent and under which circumstances can this strategy be sustainable. The answer may be found in the blog post[9] of the IMF managing director Kristalina Georgieva who stated “But more lending may not always be the best solution for every country. The crisis is adding to high debt burdens and many could find themselves on an unsustainable path. We, therefore, need to contemplate new approaches, working closely with other international institutions, as well as the private sector, to help countries steer through this crisis and emerge more resilient.”

In reality, “supporting the government’s efforts to contain the pandemic”, could be understood in IMF’s terms as directing the government’s efforts to secure private and multilateral debt servicing, international trade, capital transfers for international investors and opening the door to more lucrative, speculative, rentier profit-making private investments, through private-public partnerships in strategic sectors, further commodification of public goods, and greenwashing that will ultimately lead to more capital accumulation.

To make it clear, the imperialist countries controlling these multilateral institutions (like the IMF, the World Bank, the WTO, ..) are desperately trying to maintain their dominance and the privileged status of their currencies in an increasingly multi polarized world for the benefit of the financialized transnational capitalist classes.[10]

Nevertheless, one hope still persists for most Tunisians: that the revolution of dignity achieves two out of three objectives for which people died, jobs and dignity.

If there is something to learn from this pandemic, it is that today more than ever, a job guarantee program is needed: namely, a green economic program supported by the government, the central bank, and public banks, and in cooperation with the private sector (subject to workers’ rights and environmental protection), managed locally, relying on the real resources and productive capacity of the country, and addressing the real needs of its population, respectful of its climate specificities and water scarcity. Guaranteeing jobs in sustainable agriculture – aiming at ensuring food sovereignty, safe and affordable food – jobs in green infrastructure, using solar, wind and hydroelectric energy to end the fossil fuel economy, and investing in the high value-added industry, in healthcare, childcare, eldercare, education, culture, community building, R&D, and in the local pharmaceutical industry to delink the dependence on big pharma’s speculation on people’s health.

Jobs, decent wages, and bold social rights to restore economic sovereignty and a healthy environment are now necessary for Tunisia’s post-covid-19 recovery. This is the only way for the government to address the root causes of the balance of payment structural deficiencies and the only political ground for the progressive movements’ struggle to end decades of economic dependency. Recent initiatives from Tunisian women and men, engineers, unemployed, students, researchers, practitioners, textile workers, farmers, and civil society during the Covid-19 pandemic to develop solidary local, innovative and autonomous solutions to save our lives are proof that a sovereign, prosperous, and sustainable Tunisia is not an impossible reality, but is rather within reach.

^[1] By End of May the number of total cases counted to 1,084 cases, and 48 deaths, which makes Tunisia one of the few successful countries in managing the pandemic.

^[2] https://orientxxi.info/magazine/tunisie-qui-paie-le-prix-du-coronavirus,3784?fbclid=IwAR0bx85c0zHiY0Hf1NnTsw_ALPXmFnR4N1dKxHNaljiQNyN5mRyQ3Rj8Uq0

^[3] See https://rosaluxna.org/wp-content/uploads/2020/02/What-Democracy-for-Tunisian-Workers.pdf

^[4] https://www.imf.org/~/media/Files/Publications/CR/2020/English/1TUNEA2020001.ashx

^[5] While international fuel prices were collapsing, the internal market prices were very slightly declining, in reality, the consumer is paying an internal price per liter higher than the international price, which makes the consumer subsidizing the government’s loss from falling quantities and not the way around.

^[6] http://www.finances.gov.tn/sites/default/files/2020-02/Loi_finances_2020_fr.pdf

^[7] To learn more about Job Guarantee program for developing countries, African economic and monetary sovereignty, colonialism and independence see the work of Fadhel Kaboub and Ndongo Samba Sylla

http://macroncheese.com/the-spectrum-of-monetary-sovereignty-in-developing-nations-with-ndongo-samba-sylla-and-fadhel-kaboub

https://www.youtube.com/watch?v=HctT4HjgChY

https://urpe.wordpress.com/2019/02/07/fadhel-kaboub-on-monetary-sovereignty-colonialism-and-independence/

https://www.youtube.com/watch?v=xD6mUDRwZ7k

https://www.rosalux.de/en/news/id/41681/modern-monetary-theory-in-the-periphery?cHash=1400f4d40c2caba146cfcd7cd8d19bcc

^[8] Ndongo Samba Sylla explains here how Senegal and other non-monetarily sovereign African countries are trapped in a permanent external debt cycle https://www.rosalux.de/en/news/id/42302/how-foreign-debt-undermines-sovereignty?cHash=71f2e5caaec2a503268898ea98b7db2a

[9] https://blogs.imf.org/2020/04/20/a-global-crisis-like-no-other-needs-a-global-response-like-no-other/

[10] For more information on the Bretton Woods institutions’ response to covid-19 crisis, see the biannual analysis of the World Bank and IMF Spring and Annual Meetings of the Bretton Woods project : https://www.brettonwoodsproject.org/2020/04/spring-meetings-amid-covid-19/

See also the works of Radhika Desai on Geopolitical Economy, and multipolarity and her more recent commentaries on WHAT IS TO BE DONE? A MANIFESTO FOR POLITICS AMID THE PANDEMIC AND BEYOND https://canadiandimension.com/articles/view/political-hope-rises

Why democratize? Every morning, men and women rise to serve those among us who are able to remain under quarantine. They keep watch through the night. The dignity of their jobs needs no other explanation than that eloquently simple term, ‘essential worker.’ That term also reveals a key fact that capitalism has always sought to render invisible with another term, ‘human resource.’ Human beings are not one resource among many. Without labor investors, there would be no production, no services, no businesses at all.

Every morning, quarantined men and women rise in their homes to fulfil from afar the missions of the organizations for which they work. They work into the night. To those who believe that employees cannot be trusted to do their jobs without supervision, that workers require surveillance and external discipline, these men and women are proving the contrary. They are demonstrating, day and night, that workers are not one type of stakeholder among many: they hold the keys to their employers’ success. They are the core constituency of the firm, but are, nonetheless, mostly excluded from participating in the government of their workplaces – a right monopolized by capital investors.

To the question of how firms and how society as a whole might recognize the contributions of their employees in times of crisis, democracy is the answer. Certainly, we must close the yawning chasm of income inequality and raise the income floor – but that alone is not enough. After the two World Wars, women’s undeniable contribution to society helped win them the right to vote. By the same token, it is time to enfranchise workers.

Representation of labor investors in the workplace has existed in Europe since the close of WWII, through institutions known as Work Councils. Yet, these representative bodies have a weak voice at best in the government of firms, and are subordinate to the choices of the executive management teams appointed by shareholders. They have been unable to stop or even slow the relentless momentum of self-serving capital accumulation, ever more powerful in its destruction of our environment. These bodies should now be granted similar rights to those exercised by boards. To do so, firm governments (that is, top management) could be required to obtain double majority approval, from chambers representing workers as well as shareholders. In Germany, the Netherlands, and Scandinavia, different forms of codetermination (mitbestimmung) put in place progressively after WWII were a crucial step toward giving a voice to workers – but they are still insufficient to create actual citizenship in firms. Even in the United States, where worker organizing and union rights have been considerably suppressed, there is now a growing call to give labor investors the right to elect representatives with a supermajority within boards. Issues such as the choice of a CEO, setting major strategies, and profit distribution are too important to be left to shareholders alone. A personal investment of labor; that is, of one’s mind and body, one’s health – one’s very life – ought to come with the collective right to validate or veto these decisions.

Why decommodify? This crisis also shows that work must not be treated as a commodity, that market mechanisms alone cannot be left in charge of the choices that affect our communities most deeply. For years now, jobs and supplies in the health sector have been subject to the guiding principle of profitability; today, the pandemic is revealing the extent to which this principle has led us blind. Certain strategic and collective needs must simply be made immune to such considerations. The rising body count across the globe is a terrible reminder that some things must never be treated as commodities. Those who continue arguing to the contrary are imperilling us with their dangerous ideology. Profitability is an intolerable yardstick when it comes to our health and our life on this planet.

Decommodifying work means preserving certain sectors from the laws of the so-called “free market;” it also means ensuring that all people have access to work and the dignity it brings. One way to do this is with the creation of a Job Guarantee. Article 23 of the Universal Declaration of Human Rights reminds us that everyone has the right to work. A Job Guarantee would not only offer each citizen access to work that allows them to live with dignity, it would also provide a crucial boost to our collective capability to meet the many pressing social and environmental challenges we currently face. Guaranteed employment would allow governments, working through local communities, to provide dignified work while contributing to the immense effort of fighting environmental collapse. Across the globe, as unemployment skyrockets, job guarantee programs can play a crucial role in assuring the social, economic, and environmental stability of our democratic societies.

Environmental remediation. We should not react now with the same innocence as in 2008, when we responded to the economic crisis with an unconditional bailout that swelled public debt while demanding nothing in return. If our governments step in to save businesses in the current crisis, then businesses must step in as well, and meet the general basic conditions of democracy. In the name of the democratic societies they serve, and which constitute them, in the name of their responsibility to ensure our survival on this planet, our governments must make their aid to firms conditional on certain changes to their behaviors. In addition to hewing to strict environmental standards, firms must be required to fulfil certain conditions of democratic internal government. A successful transition from environmental destruction to environmental recovery and regeneration will be best led by democratically governed firms, in which the voices of those who invest their labor carry the same weight as those who invest their capital when it comes to strategic decisions. We have had more than enough time to see what happens when labor, the planet, and capital gains are placed in the balance under the current system: labor and the planet always lose. Thanks to research from the University of Cambridge Department of Engineering (Cullen, Allwood, and Borgstein, Envir. Sci. & Tech. 2011 45, 1711–1718), we know that “achievable design changes” could reduce global energy consumption by 73%. But… those changes are labor intensive, and require choices that are often costlier over the short term. So long as firms are run in ways that seek to maximize profit for their capital investors, and in a world where energy is cheap, why make these changes? Despite the challenges of this transition, certain socially-minded or cooperatively run businesses — pursuing hybrid goals that take financial, social, and environmental considerations into account, and developing democratic internal governments– have already shown the potential of such positive impact.

Let us fool ourselves no longer:  left to their own devices, most capital investors will not care for the dignity of labor investors; nor will they lead the fight against environmental catastrophe. Another option is available. Democratize firms; decommodify work; stop treating human beings as resources so that we can focus together on sustaining life on this planet.

The 258 civil society organizations (CSOs) that sent an open letter to the World Trade Organization (WTO) and its members could not be more concerned. On April 17, 2020, when they asked the WTO to stop all trade and investment treaty negotiations during the COVID-19 outbreak and refocus on access to medical supplies and saving lives, the virus death toll surged past the 150,000 mark.

Trade and health: a prisoner’s dilemma

On the same day, the WTO organized a virtual meeting, in which its director general stressed the importance of “maintaining open markets for trade in laying the groundwork for a strong recovery.” The virtual meeting also discussed if the WTO members “would be open to formal decision-making through virtual meetings or written procedures until traditional in-person gatherings can resume.”

The letter’s endorsers that represent social movements in 150 countries, such as the United States, Brazil, India, Australia, many European countries and Tunisia, said they were shocked by “the business as usual” attitude of the WTO. For them, not only does the institution’s agenda ignore technological deficiencies of some developing countries, but it also diverts the efforts and resources from the most important purpose of combating the virus.

Many of these CSOs, such as the Third World Network, Oxfam, Greenpeace, Arab NGO Network for Development and the Tunisian Observatory of Economy, have been advocating for a fair distribution of world resources and fighting against the adverse impact of free trade on social welfare, especially in the Global South.

The Covid-19 pandemic just seems to revive these concerns. Indeed, access to affordable medicine often stumbles on the binding rules of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs). Adopted in 1994, the latter expanded the scope of intellectual property rights, especially in terms of patent protection and conferred more powers to patent holders.

Despite its binding effect, TRIPs offers flexibilities such as compulsory licensing for public health purposes. Barr al Aman has recently stressed the importance of this flexibility and urged the Tunisian government to use compulsory licenses if the prices of health products are excessively expensive and / or if the quantities made available to Tunisia are not sufficient to cover the urgent national need.

Soigner le COVID-19, l’urgence d’une licence obligatoire

However, for many countries the use of the flexibilities is not that easy. According to a study conducted by the WHO and the South Center in 2005, “a number of provisions in recently concluded FTAs between developed countries (essentially the US) and developing countries, pose a real risk of undermining an effective use of TRIPs flexibilities in developing countries for public health purposes.”

Therefore, besides the discrepancy in the priorities scale of both its issuers and its receivers, the open letter brings back governments, drug companies and the public opinion back to an essential question: will intellectual property hinder the access to the potential COVID-19 medicines and other vital medical supplies?

“From the point of view of intellectual property, of course, a tension exists – and it is a tension that exists around access,” Francis Curry, the director general of the World Intellectual Property Organization (WIPO) said back in 2015, at a symposium on innovation and access to medicine held jointly with the WTO and the World Health Organization (WHO) in Geneva.

Curry then added: “on the one hand, what intellectual property does economically is making access a salable commodity, and that is the basis of markets in technology and creative works. But on the other hand, access as a salable commodity… raises questions about the cost and possibility of access.”

A deep-rooted paradox

The roots of this paradox are deep and old. Since the enactment of the first modern patent law in Venice in 1447, there has been a heated debate over the moral and philosophical foundation of patents and other forms of intellectual property such as copyright, trademarks and trade secrets.

As explained by the Stanford Encyclopedia of Philosophy “patent protection is the strongest form of intellectual property protection, in that a twenty-year exclusive monopoly is granted to the owner over any expression or implementation of the protected work.”

The idea of monopoly over ideas was endorsed by philosophers like John Locke (1632 – 1704) and G.W.F. Hegel (1770 – 1831).

The English theorist claims that individuals are entitled to control the fruits of their labor (including their intellectual labor).

The German thinker has rather a personality-based justification as he argues “that individuals have moral claims to their own talents, feelings, character traits, and experiences.”

Another philosophical justification for intellectual property is to be sought in utilitarianism. The utilitarian point of view was explained in the Virginia law review, by Jeanne C. Fromer Associate Professor at Fordham Law School. “Copyright and patent laws are premised on providing creators with just enough incentive to create artistic, scientific, and technological works of value to society at large by preventing certain would-be copiers‘ free-riding behavior,” she wrote.

Do these arguments hold up when the patented intangible work is the formula of a saving-life drug?

Dr. Yusuf Hamied’s answer would be no. When Harvard Business School (HBS) interviewed the founder of the Indian pharmaceutical company Cipla in 2013, he said:

There should be no monopoly… [we are] willing to pay the originator [of drugs] a suitable compensation and India should not be deprived of newer drugs and be at the mercy of the innovators.”

If the HBS featured Dr. Hamied for its Creating Emerging Markets Project, it is because of the man’s exceptional battle against the human immunodeficiency viruses (HIV) that causes acquired immunodeficiency syndrome (AIDS).

Back in 2001, Cipla mixed three molecules– Nevirapine, Didanosine and Zidovudine and came up with a new anti-HIV drug. Dr. Hamied then gave his antiretroviral therapy (ART) to humanitarian organizations and poor Asian and African governments for $350 a year.

That price was thirty times lower than market prices. Suddenly, big multinational pharmaceutical groups were left with their useless patents and with financial shortfalls of billions of dollars. Full of wrath at seeing their monopolies collapse, western multinationals had to lower their AIDS treatment prices by 80%.

While western business groups and media accused Dr. Hamied of piracy, the United Nations organizations described him as India’s Robin Hood of drugs.

When Dr. Hamied gave that interview, the world was still dazed by the 2009 swine flu pandemic and its estimated death toll of 284,000 victims. So, he intuitively evoked the example of the Oseltamivir; the antiviral drug used to prevent and treat swine flu, other subtypes of influenza A and influenza B.

The patent on the Oseltamivir in the US was then held by the Swiss multinational Roche. An epidemic before the patent’s expiry date (2016) would have meant, according to Dr. Hamied, that the destiny of the world would have been in the hands of one company.

In a concluding remark that encapsulated his business philosophy, the Indian scientist said:  “I am a firm believer that if you are in the health care business like supplies, it is not a business per se; it is a business plus you are saving lives. So it has to have a humanitarian angle to it.”

Santé: la bataille autour de la transparence sur le prix des médicaments