Thursday, November 30, 2017

African refugees bought, sold and murdered in Libya


Migrants arrive at a naval base after they were rescued by Libyan coastal guards in Tripoli, Libya [Ismail Zitouny/Reuters]
Migrants arrive at a naval base after they were rescued by Libyan coastal guards in Tripoli, Libya [Ismail Zitouny/Reuters]
Hundreds of African refugees are being bought and sold in "slave markets" across Libya every week, a human trafficker has told Al Jazeera, with many of them held for ransom or forced into prostitution and sexual exploitation to pay their captors and smugglers.
Many of them ended up being murdered by their smugglers in the open desert or die from thirst or car accidents in the vast Libyan desert, said Salman*, the human trafficker. 
A morgue in the southern city of Sabha - an entry point for many refugees coming from Africa - is overflowing with corpses, with faulty refrigerator making the situation worse, according to a Libyan health official. 
The official in Sabha, 650km south of the capital Tripoli, described horrendous scenes of bodies dumped in threes, fives or more at the gates of the Sebha health facility by smugglers.
The refugees who died are never identified and many ended being buried without names or proper graves, he said.
The health official, who declined to give his name for security reasons, said Sabha's morgue has only one dysfunctional refrigerator that can hold bodies for up to three days but end up keeping them for months and on.
"Bodies end up being decomposed inside the refrigerator and often give off foul stench.
A health offical in Sabha told Al Jazeera the city's morgue is overflowing with corpses [Al Jazeera]
"We appealed to the World Health Organization to help us with a new refrigerator but we have yet to receive a positive response from them," he told Al Jazeera.

Gateway to reach Europe

The refugees and migrants - most of them from Ghana, Nigeria, Cameroon, Zambia, Senegal, Gambia and Sudan - are smuggled into Libya by a network of criminal gangs on the promise of reaching Europe's shores.
Libya is the main gateway for people attempting to reach Europe by sea, with more than 150,000 people making the deadly crossing in each of the past three years.
The International Organization for Migration (IOM) said on Tuesday that it had interviewed migrants from west African countries who recounted being traded in garages and car parks in Sabha.
The IOM said it had spoken to one Senegalese migrant, who was held in a private house in Sabha along with some 100 others. They were beaten up and forced to call their families to arrange money for their release. The unnamed migrant was then bought by another Libyan, who set a new price for his release.
The refugees and migrants are smuggled into Libya by a network of criminal gangs on the promise of reaching Europe's shores [Al Jazeera]
Some of those who cannot pay their captors are reportedly killed or left to starve to death, the IOM said. When migrants die or are released, others are purchased to replace them.
Salman, the human trafficker, explained in detail his routes through Libya, telling Al Jazeera by phone that his "business" had increased several fold since the fall of long-time Libyan leader Muammar Gaddafi.
He said the refugees are first introduced to the traffickers by private labour offices in the cities of Agadez and Zinder in neighbouring Niger.

Forced into prostitution

Salman said once he receives a wire transfer for the refugees from a "commander" in Niger, he starts the transportation process.
He said he charges between 1,000 Libyan dinars ($735) and 1,500 Libyan dinars ($1,100) per person, and once he receives payment, the migrants are loaded up on battered 4x4 vehicles and driven through Libya's sweltering desert, where temperatures exceed 50C during the summer season.
"I pick up migrants from al-Qatron [in Libya] and transport them to Sabha," he told Al Jazeera.
"This is a deal agreed upon with other commanders in Niger and other African countries."
The women in particular are helpless and for the most part are stuck in Libya with nowhere to go
Mohamad Hasan, Libyan national
Al-Qatron, a small town about 300km south of Sabha and close to the Nigerien border, is the starting point for many of the thousands of migrants that enter Libya every year.
Once in Sabha, the refugees are taken under the control of a "commander" who provides them food, shelter and protection, before they are sold as slaves to other smuggling rings or other commanders in various Libyan cities.
The refugees who died are never identified and many are buried without names or proper graves, according to a health official in Sebha [Al Jazeera]
The refugees are forced to live in either open courtyards, or in ramshackle rooms without proper sanitation.
Ahmad*, a resident of Sabha, told al Jazeera that forced prostitution was widespread in the town.

UN considers sanctions to fight Libya slave trade

"The Abdel Kafi neighbourhood is one of the main squares where the prostitution rings exist," Ahmad told Al Jazeera by phone.
He added that people were being auctioned off in the town, with men and women fetching 1,000 Libyan dinars ($735). Others from Ghana and Cameroon might fetch several thousand Libyan dinars.
"Libyans don't have a problem with African migrants," Ahmad said, adding that in recent years Sabha had seen an influx from countries such as Ghana, Cameroon, Nigeria and Zambia, along with Chad and Niger.
Mohamad Hasan, a Libyan national and a resident of Sebha, told Al Jazeera by phone that he witnessed five women being sold by one commander to another who immediately forced them into prostitution.
"I have seen African women being ordered to work in private night clubs that cater to the migrant communities in Libya and are forced into prostitution," he said.
Hasan, who owns a restaurant frequented by migrants, said, the "women in particular are helpless and for the most part are stuck in Libya with nowhere to go".
Al Jazeera could not independently verify the accounts.
*Names have been changed to protect the person's identity
Follow Ali Younes on twitter @ali_reports

 SOURCE: Al Jazeera News

Bosnian Croat Slobodan Praljak dies on drinking poison


Image result for Bosnian Croat Slobodan Praljak dies on drinking poison
A commander of Bosnian Croat forces during the Bosnian War has died from drinking what he claimed to be poison at the war crimes court for the former Yugoslavia in The Hague.
The death on Wednesday was first reported by Croatian state TV and later confirmed by the tribunal's spokesperson.
Upon hearing that his 20-year prison sentence had been upheld, General Slobodan Praljak shouted at the presiding judge: "I, Slobodan Praljak, reject the verdict. I'm not a war criminal."
Then he drank from a small bottle or flask and declared: "What I am drinking now is poison."
The judge suspended the hearing and called for a doctor.
The incident happened when the International Criminal Tribunal for the former Yugoslavia (ICTY) was handing down its last judgment in an appeal by six Bosnian Croat political and military leaders, who were convicted in 2013 of persecuting, expelling and murdering Bosnian Muslims during the 1992-1995 war.
Speaking to Al Jazeera from Sarajevo in Bosnia, Denis Dzidic, deputy editor for the Detecor project, said policemen and an ambulance were ordered to the tribunal building.
WATCH: Omarska's survivors - Bosnia 1992
"Slobodan Praljak had his first instance verdict confirmed, in which he was sentenced to 20 years in prison," Dzidic said.
"He said that he did not accept the verdict, that he was not a war criminal and then drank the substance.

The Bosnian Croats sentenced

  • Jadranko Prlic, prime minister of the Croat statelet Herzeg-Bosnia: 25 years
  • Bruno Stojic, defence minister of Herzeg-Bosnia: 20 years
  • Slobodan Praljak, HVO chief: 20 years
  • Milivoje Petkovic, deputy commander of HVO: 20 years
  • Valentin Coric, commander of HVO's military police: 16 years
  • Berislav Pusic, president of Herzeg-Bosnia's Commission for the Exchange of Prisoners: 10 years
"The judge then paused the proceedings and ordered the glass [from which Praljak drank] not be taken from court.
"The verdict was mid-way and the first three defendants had their sentences confirmed."
Later on Wednesday, the judges continued reading out the final verdict, also upholding the jail terms against the other three defendants.
All six - including Jadranko Prlic, the former prime minister of the the breakaway Bosnian Croat statelet, known as Herzeg-Bosnia - had been sentenced in 2013 to a total of 111 years in prison.
The tribunal on Wednesday confirmed that there was an internationally armed conflict in Bosnia and Herzegovina and that Croatia - by controlling the Bosnian Croat armed forces, the "Croatian Defence Council" (HVO) - had held Herzeg-Bosnia's eight municipalities "under occupation".
"There are numerous indications that, acting through the Croatian Defence Council, Croatia had real authority," said presiding Judge Carmel Agius.
The original conviction had also said that Franjo Tudjman, the late Croatian president, was a key member of a plan to create a Croat mini-state in Bosnia.
The ICTY upheld the 2013 ruling that the six officials, along with Tudjman, were part of the Croatian "joint criminal enterprise", which aimed for a "unification of the Croatian people" and persecuted Bosnian Muslims from areas in Bosnia and Herzegovina in order to create a "Greater Croatia".
WATCH: Al Jazeera World - Women Who Refuse to Die
Edin Batlak, of the Association of Concentration Camp Survivors of Mostar, said the verdict had "met his expectations".
"I'm satisfied," he said. "I believe these kind of verdicts will help in relations between Bosnia and Herzegovina and Croatia," added Batlak.
"Bad politics received its verdict. Croatia needs to be completely honest towards Bosnia and Herzegovina … and to protect and respect its sovereignty and integrity.
"This isn't, can't be and will never, be a verdict against the Croatian people; it is only for people who were at the top [of command] of Herzeg-Bosnia, who implemented their policies. It's a verdict for the executors, creators of bad politics in evil times."
Wednesday's hearing was the final case to be completed at the ICTY before it closes its doors next month.
The tribunal, which last week convicted former Bosnian Serb military chief General Ratko Mladic of genocide and other crimes, was set up in 1993 while fighting still raged in the former Yugoslavia.
It indicted 161 suspects and convicted 90 of them.
With reporting by Mersiha Gadzo in Sarajevo, Bosnia.
Chasing Mladic: The Hunt for the 'Butcher of Bosnia' 

People & Power
Chasing Mladic: The Hunt for the 'Butcher of Bosnia'
SOURCE: Al Jazeera News

Is religion good or evil?

Scientist and atheist Richard Dawkins is challenged on whether religion is a force for good or evil in the world.

With the headlines covering fanaticism, fundamentalism, superstition and ignorance, religion is getting a bad press these days. And much of the conflict in the world, from the Middle East to Nigeria and Myanmar, is often blamed on religion.
But how are things from a different perspective? Some defenders of religion claim Adolf Hitler was an atheist. Communism under Joseph Stalin, Pol Pot or Mao Zedong banned religion, but also massacred millions. And science brought incredible and amazing advances, but also pollution and the atomic bomb.
A critic of religious dogmatism, Professor Richard Dawkins revolutionised genetics in 1976 with the publication of The Selfish Gene. He has since written 12 more bestsellers, including The God Delusion which sold millions of copies, was translated into more than 30 languages, and catapulted him to the position of the world's foremost atheist.
Mehdi Hasan challenges evolutionary biologist Richard Dawkins at the Oxford Union in front of a varied and lively audience.
In a frank and at times heated exchange, they discuss: Is religion a force for good or evil? Can it co-exist with science? Is science the new religion? And why if god does not exist, is religion so persistent?

Religion and the brain

TechKnow meets the scientists trying to uncover how religious and spiritual experiences impact the brain.

Science & Technology, Religion, Health
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Story highlights

  • It's estimated that 84 percent of the world population follow a religion 
  • 2.2 billion are Christians, and 1.6 billion are Muslims 
  • 1 billion are Hindus, and 500 million are Buddhists 
  • 400 million people practise various folk or traditional religions
  • One-in-six people around the globe have no religious affiliation
Source: The Global Religion Landscape
Religion was long seen as spiritual nourishment of the soul, but now, groundbreaking research looks at how it impacts the brain. Can "feeling the spirit" be measured scientifically?
Of the seven billion of people on the planet, it's estimated that 84 percent are members of one of hundreds of religions. Despite the different gods, philosophies and rituals, most religions share a promise for a physical sense of spirituality.
"In our faith, we do believe that you have the spirit constantly with you," Auriel Peterson, a Mormon believer, says. "It's a very much peaceful feeling. I have clarity, and I have a burning sensation throughout my chest."
Her devotion to God and science have made her a perfect subject for a University of Utah's Religious Brain Project.
Researchers Julie Korenberg and Jeffrey Anderson conducted a study that combined brain scans (MRI) and blood tests on 20 devout Mormons to track their neurological reactions to biologically explained spiritual sensations. 
"When a young boy goes off to join ISIL, or a Mormon in Salt Lake has some sense of connectedness with the divine in their view, we don't know if that's the same thing. What do people experience in their brains, when they feel religious and spiritual experience?" Anderson says.
Perhaps it's possible to recognise that our brains work the same way. Our feelings are the same, regardless of what doctrines they are associated with.
Dr Jeffrey Anderson
By analysing the scans and self-reported feeling of spirituality, along with blood work (taken before and after to track hormones connected to positive feelings) the researchers believe that they've found the areas in the brain that are connected to the religious feelings of euphoria.
Their goal is to prove that the experience of faithful bliss could be tracked - and they want to widen their study to a variety of religions.
The researchers suggest that the brain's reaction to religious stimuli in Mother Teresa might very well be the same as a "terrorist's" reaction.
"Perhaps it's possible to recognise that our brains work the same way. Our feelings are the same, regardless of what doctrines they are associated with, and I think that's provable," Anderson explains.
TechKnow also goes to Los Angeles and visits an unique community project. The BioScan project uses 30 volunteers with large malaise traps to find new species of insects.
This year's BioScan project focused on flies. And at each of the sites, a new fly was discovered. This means a total of 30 new species were found, and it only took the first three months of the project to obtain these results.

Read more: 

The business of human trafficking


We look at modern day slavery and what can be done to tackle the growing problem of human trafficking.

In 2003, the United Nations ruled that human trafficking was a crime. More than 100 countries signed the protocol and many introduced anti-trafficking legislation. However, human traffickers continue to operate, and this continues to be a big problem.
 Beate Andrees and Nick Grono on human trafficking
In 2005, according to the International Labour Organisation, there were at least 2.4 million trafficked people at any given time in the world. Today, 21 million is the latest estimate.
In 2005, the profit was about $32bn a year, today it is at $150bn profit a year.
The problem is particularly bad in the Asia Pacific, where there are around 3.5 million vulnerable refugees. Four years ago, 32 countries in the region signed a framework agreement to try to curb the problem.

But in southern Thailand, they are not waiting around for results. Some locals have taken matters into their own hands, arming themselves to stop their communities from descending into lawlessness. Al Jazeera's Marga Ortigas reports from Thailand.
To discuss the issues behind forced labour and human trafficking, Counting the Cost is joined by Beate Andrees from the ILO in Geneva; and Nick Grono, the CEO of The Freedom Fund.

Migrants for sale: Slave trade in Libya


African refugees have long used Libya as gateway to Europe, but many are now facing abuse, exploitation and trafficking.

Libya's UN-backed government says it is investigating allegations that hundreds of African refugees and migrants passing through Libya are being bought and sold in modern-day slave markets.
According to reports, the trade works by preying on the tens of thousands of vulnerable people who risk everything to get to Libya's coast and then across the Mediterranean into Europe - a route that's been described as the deadliest route on earth.
Libya is the main gateway for people attempting to reach Europe by sea, with more than 150,000 people making the crossing in each of the past three years.
"They [the refugees] are from several African countries and they say they have fled war, poverty and unemployment in their countries ... They have taken a tough journey through the desert and they have paid people smugglers to get to Libya to try to cross the Mediterranean to Europe. With the security and financial collapse in Libya, human trafficking and smuggling have become a booming trade," says Mahmoud Abdelwahed, reporting from a detention centre in the Libyan capital Tripoli.
Modern-day slavery is widespread around the world and Libya is by no means unique ... But what's particularly shocking is that this is happening effectively in the open, where people can go to a farmhouse, place a bid and end up 'owning' a human being.
Leonard Doyle, International Organization for Migration
There is no proper registration process for the tens of thousands of refugees arriving in Libya.
According to reports, the business of detention centres is unsupervised in some parts of Libya and stories of torture, rape and forced labour have emerged.
When the centres get too crowded, people are then allegedly sold off like goods in an open market. Survivors have told the UN's migration agency that they use smartphones to connect with people smugglers to get them to Libya's coast, and that they were then sold, being held for ransom, used as forced labour or for sexual exploitation.
The International Organization for Migration says trade in humans has become so normalised that people are being bought and sold in public for as little as $400.
"As shocking as it seems, it's indeed true," Leonard Doyle from the International Organization for Migration tells Counting the Cost. "The reason it [slave trade] can happen is because there is really no rule of law across much of Libya. Libya is a country as big as France, with a lot of space there. Migrants are coming there ... they see the promise of a new life when they go to their Facebook feed and they think something wonderful is waiting for them in Europe, because a smuggler has abused the system and has sold them that lie."
He explains that when they arrive in Libya, "they get off the bus and they are quickly put into a kind of murder machine, an extortion machine. They are robbed of their possessions, their families are called. They are forced, they are tortured, they give them money. And then they are sold. Unbelievable, but they are sold in open, public auctions: $400 for a labouring man, maybe a bit more for a woman who can be put in the sex trade. And this is what's happening across the country."
Doyle stresses that this issue shows that the international community should pay more attention to post-Gaddafi Libya.
"There is an international responsibility to help ... What is particularly important now is that this issue is reaching global attention," says Doyle.
"Modern-day slavery is widespread around the world and Libya is by no means unique. It's happening in the developed countries of the world as well as the undeveloped countries. But what's particularly shocking is that this is happening effectively in the open, where people can go to a farmhouse, place a bid and end up 'owning' a human being."
Source: Al Jazeera News

Would we be better off without religion?


Reza Aslan and Lawrence Krauss debate whether religion is inherently violent, and if science and faith can coexist.


Is religion a force of good or evil? A controversial question at times, but one that can't be avoided in the modern world. From violence and terror, to gender equality, to science, reason, and education - the faithful and the faithless tend to repeatedly clash over whether religion is a net positive or negative, whether it helps humanity more than it hurts it.
"Religion is both a force of good and evil because religion is a man-made institution, and human beings are both good and evil," says Reza Aslan, a scholar of religion and best-selling author.
"I don't know why it would come as a surprise to learn that the religious institutions that we create can also be responsible for profound acts of good and compassion and positivity, and for equally profound acts of violence and bigotry and hatred."
Lawrence Krauss, a theoretical physicist and atheist, says religious institutions tend to be harmful to people.
"Religious institutions have not only usurped the notion of morality, but on the whole promulgate ideas that are not useful, and often harmful for people, and take many people … many, many, many people who simply want to ask questions about the universe and make them feel bad," says Krauss.
When asked whether people will outgrow religion, Aslan, who just released his latest book, God: A Human History, says we are not going to outgrow faith.
"The fact of the matter is that religion has always been in a state of evolution," says Aslan. "Scientific knowledge is going to change religion. It's going to alter religious people, but it won't make it go away."
Krauss, who is also a best-selling author of numerous books on science, including his latest, The Greatest Story Ever Told - So Far, doesn't believe religion will disappear, but says more will turn to science.
"When I was a young person, I thought by now we would have outgrown religion because, let's face it, the evidence of science is that there's no evidence for anything, for any purpose to the universe, any divine inspiration," says Krauss.
"The more scientific literacy there is, the less of the intellectual basis will be there to support religion and we'll see more and more people finding other ways to add meaning and purpose to their lives."
In this week's UpFront special, Reza Aslan and Lawrence Krauss debate religion's place in society, whether religion is inherently violent, and if religion will continue to exist in years to come.
Follow UpFront on Twitter @AJUpFront and Facebook.

Wednesday, November 29, 2017

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Tuesday, November 28, 2017

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Monday, November 27, 2017


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Sunday, November 26, 2017

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Saturday, November 25, 2017

Nigeria’s kleptocrats have a toxic love affair with London’s expensive real estate

Quarts African

November 24, 2017quartz africa
The prevailing narratives about corruption in Nigeria rarely mention its international dimension. They tend to gloss over how the United Kingdom, United States, and other financial centers welcome the steady stream of illicit cash flowing out Africa’s largest economy.
Yet the country’s kleptocrats are increasingly exploiting weaknesses in the international financial system to launder and conceal their ill-gotten gains, often via high-end real estate in London, New York, and Dubai.This month’s release of the Paradise Papersa juicy sequel to last year’s Panama Papers leak—is a glaring reminder of how offshore tax havens and secrecy jurisdictions facilitate corruption in developing countries like Nigeria. According to Global Witness, the top five jurisdictions implicated in the Papers, are all UK Overseas Territories or Crown Dependencies like the British Virgin Islands, Jersey, and the Isle of Man.
Nigeria has lost an estimated $230 billion or more in illegal financial outflows since 2004: equal to $1,280 for every Nigerian citizen. Expatriating stolen funds to offshore tax havens and secrecy jurisdictions not only sucks value out Nigeria’s economy, it makes stolen funds harder to find and puts pressure on the value of the naira—Nigeria’s flagging currency.

“That’s no moon…”

Recently dubbed “The Death Star of Global Kleptocracy”, London is not just the world’s banking capital, it is also a global focal point for corruptly-acquired wealth. Corrupt officials from around the world find the UK attractive because of its lax corporate and property laws, anemic anti-money laundering safeguards, and the variety of posh neighborhoods.
 Nigeria has lost an estimated $230 billion or more in illegal financial outflows since 2004: equal to $1,280 for every citizen.  At least £4.2 billion ($5.6 billion) worth of UK properties have been bought with suspicious wealth from around the world—likely just a tiny fraction of the total, estimates Transparency International. Decades of such property acquisitions by absentee foreign owners have had a profound impact on London, creating “ghost neighborhoods” where many high-end homes sit empty.
Although it is difficult to gauge what percentage of suspicious properties are owned by Nigerian kleptocrats.The examples below have been derived from corporate, property, and other public records in the UK and Nigeria. Since these property holdings may be of interest to international law enforcement, the names are being withheld.:
  • Three swanky apartments collectively worth over $10 million linked to Nigeria’s former oil minister, Diezani Alison-Madueke. Two of the flats were bought by anonymous briefcase companies registered in The Seychelles and paid for with loan from a Nigerian bank known to facilitate such deals.
  • Three UK properties worth about $7 million in total associated with a senior legislator. One of these residences is owned by his personal foundation, another in his wife, and the most expensive is held by an anonymous shell company.
  • A multi-million pound jet hangar at a major UK airport and London flat owned by one of Nigeria’s most notorious political godfathers. Implicated in contract fraud, election rigging, corrupting judges, and bribing foreign officials, this individual has a wide financial footprint in the UK.
  • A high-end flat in West London held under a fake name used by the son of a former Nigerian head of state. Several UK criminal money laundering and bank fraud cases identify this individual and his pseudonym.

The London laundromat

Why do corrupt Nigeria elites looking to stash their loot find London so attractive?
Home to the world’s snazziest neighborhoods, London has a massive luxury property markets through which large sums of money can be laundered in a single transaction. London’s expensive housing market does not discourage kleptocrats from investing, finds Transparency International. On the contrary, it offers opportunities to launder huge sums of money at a time.
Buying an opulent home in London is a relatively low-risk investment. These properties not only symbolize wealth and respectability, their value often appreciates significantly over time. Such properties can also be used to generate rental income or launder additional money via bogus leases.
UK law allows anyone to purchase property using anonymous offshore companies or complex multi-layered corporate structures. According to the country’s former top anti-corruption cop, this permissive system frustrates law enforcement: “the lack of access to beneficial ownership information about offshore companies…is a major barrier for our investigations. Investigators may spend months and years attempting to peel back layers of secrecy in order to uncover how the proceeds of corruption are being laundered…”

Stemming the tide

What can the UK, United States, and other global financial centers do to wean themselves off of corrupt cash? Because their financial systems are such permissive operating environments, even beefed-up law enforcement and financial intelligence efforts almost certainly won’t stop kleptocrats from trying to exploit them.
To disrupt the flow of corrupt cash from Nigeria and beyond, British and American lawmakers need to issue directives or enact legislation that eliminates home-grown secrecy jurisdictions like the British Virgin Islands and Delaware. They also should create public beneficial ownership registries and expand the range of legal and administrative tools available to identify and investigate suspicious financial and property transactions.
UK lawmakers took a step in the right direction last year when they created a potent new legal tool–the Unexplained Wealth Order (UWO). This mechanism empowers UK prosecutors to force–for example–a Nigerian politician who owns a multi-million pound London flat to explain how he acquired wealth far in excess of his official salary. If he refuses or inadequately responds then the UWO could be used in a separate legal process to seize the official’s suspect assets under the Proceeds of Crime Act.

First line of defense

Although law enforcement efforts have room to expand, Western diplomats on the ground in Nigeria could be doing more to help identify kleptocrats and prevent them from establishing financial footprints abroad. Both UK and US officials have the power to deny travel visas to Nigerian kleptocrats on the basis of credible corruption allegations or unexplained wealth, but rarely do so.
Under UK Immigration Rules, for example, the Home Secretary has wide discretionary powers to exclude non-citizens from the UK when it is “conducive to the public good”. Existing immigration policy guidance allows officials to withhold visas from individuals linked to “proceeds of crime and finances of questionable origins” and “corruption”.
Though by no means a silver bullet—or a substitute for fixing corporate and property laws—visa bans should be a foundational element of any UK or U.S. anti-corruption strategy. Until kleptocrats from countries like Nigeria are stopped from visiting their luxury homes or spending their ill-gotten gains in cities like London, their “Death Star” reputation will be hard to shake.
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Russia: Look inside Russia's most fearsome'Black Dolphin' prison

What the US can (really) learn from Singapore’s healthcare system

Quartz Africa

The global healthcare spectrum: from inefficient to efficient
40 50 5% 10% 15% 60 70 80 90 30 20 10 Efficiency Score Healthcare as % of GDP
Source: The Commonwealth Fund, Bloomberg Healthcare Efficiency Index
hong kong
88.9Efficiency Score
5.4%Healthcare cost
as % of GDP
Hong Kong enjoys the benefits of being one of the healthiest places on the globe: Residents enjoy a life expectancy of 85.9 years for women and 80 years for men, making it overall the third highest in the world. Much of healthcare spending is paid for by its progressive income tax and free treatment is available to all citizens. Still, residents are encouraged to hold private insurance to get more comprehensive care and keep from overloading the public system.

The US healthcare structure continues to be the focus of intense debate, centered on both its effectiveness and its fairness. In the past decade or so, that conversation has only become more heated as factions square off about the degree to which the government should be involved, if at all.
It’s certainly no surprise that passions run deep. But setting aside political or ideological views, at some point most of us are going to depend on the broader healthcare system. To hope for quality care at a fair price seems like a reasonable expectation. What’s more, the economic impact of healthcare policy could be staggering. According to data from the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation, global spending on health could jump to $18 trillion in 2040, up from about $8 trillion in 2013.
Given its global importance, it’s imperative that the key stakeholders involved in the healthcare discussion consider all options and also examine systems that have shown success in other parts of the world. One of those places is Singapore.

Why Singapore?

In 2017, the Bloomberg Global Health Index ranked Singapore as number 4 in the world, bolstered by a long life expectancy of 81 years, and low infant mortality rate of 1.5 per 1,000 live births. Another Bloomberg index of the world’s most efficient healthcare systems ranked Singapore first in 2014 and second in 2017, behind only Hong Kong. (The US came in at 50th on the 55-country list.)

Lee Kuan Yew School @LKYSch

Singapore’s success in healthcare is built on many measures developed & refined over decades.

What differentiates the small island’s healthcare system from those in other large, developed countries? Dr. Kai Hong Phua of the Lee Kuan Yew School of Public Policy, cites three key reasons:
 …global spending on health could jump to $18 trillion in 2040, up from about $8 trillion in 2013.  1) The Public-Private Balance. Singapore’s universal health coverage system is largely overseen by the government’s Ministry of Health, but also includes support from citizens and the private sector. “The Singapore government has experimented with a host of different reforms which reflect evolving stages of socioeconomic development, as well as changing priorities in public health—from environmental measures to personal lifestyles and healthcare consumption,” says Dr. Phua. The government also weighs its citizens’ values as a social determinant of health: there is a cultural emphasis on family support in Singapore, which brings with it a strong support network.
2) Sustainable Financing. The government adopts a diversified but integrated approach which includes:
  • Tax measures that pay for accessible public health services and subsidize indigent coverage;
  • Individual saving plans for acute medical care consumption, and;
  • Defined coverage for medical insurance.
The latter only covers catastrophic care, which can help avoid the pitfalls of “moral hazard” (when consumers purchase additional unnecessary care because they’re insured) in comprehensive plans, as well as adverse selection—both of which are typical of private insurance. Subsequently, there are cost-sharing features on both the supply and demand sides of healthcare.
3) Strong Regulatory Governance. Though it encourages free market competition and choice, the government makes substantial targeted investments in areas where market failures would make healthcare costs unaffordable. Because it controls the dominant public hospitals and supply of doctors, there is less emphasis in Singapore to protect the interests of the private sector through supplier-induced demand.

A Roadmap for the Rest of the World?

Many American observers—including William Haseltine, in his 2013 book examining Singapore’s healthcare—said the island’s system might offer a glimpse of how healthcare could look in other parts of the developed world. While those observers may have focused particularly on aspects like cost-sharing or personal responsibility incentives, the key seems to be the quality of government oversight in Singapore’s public policy implementation. And the collective accumulation of savings for healthcare, especially in old age, may be the salvation for increasingly expensive medical systems in ageing societies.

But others—like Dr. Phua—suggest that Haseltine’s optimistic Singapore appraisal may be too focused on the potential solutions it can offer the US healthcare system, rather than investigate its grounding principles. Haseltine glosses over some crucial tenets of the Singapore’s system success: it thrives because its society embraces public health as well as disease prevention, and its health financing scheme epitomizes good governance.

Still, Haseltine notes some factors that may be transferable to other countries’ health systems, especially those facing large demographic shifts. “Today, the emphasis is on planning for the coming demographic crises using the same cross-ministry approach that has worked so well in the past,” Haseltine said in “Affordable Excellence: The Singapore Healthcare Story”. “How can the current system be adapted to provide excellent care for the elderly at a cost the country can afford? This is the central issue for all developed economies. Those planning for the future might well look to Singapore for ideas on how to prepare for the challenges ahead.”
Indeed, Dr. Phua notes the importance of adjusting the various “control knobs” of healthcare financing in order to achieve the proper balance in the system in the future. That is, allocating proper resources to the poor and the elderly, more robust lifelong savings to generate further resources for future aging needs, and insurance to provide greater risk pooling to cover high-cost catastrophic illnesses. This helps to avoid public cutbacks and rationing, or widening gaps between generations and the haves and have-nots.
“Notably, Singaporeans believe in good governance and support stronger regulation and information-sharing within the health sector. They want to enjoy old age with greater peace of mind—with good health and medical care at affordable prices,” he said.
That sounds like a model that could work for the rest of the world.
For additional insights on Singapore’s health policy experience, visit Global-Is-Asian.
This article was produced on behalf of the Lee Kuan Yew School of Public Policy by Quartz Creative and not by the Quartz editorial staff.