Cooperation Over Water in the Eastern Nile Basin: Obstacles & Opportunities

The Nile River is shared by ten states: Kenya, Rwanda, Tanzania, Uganda, Burundi, the Democratic Republic of Congo, Ethiopia, Eritrea, Sudan, and Egypt. Tension between upstream and downstream states in the Nile Basin has long been a part of the history of their relationship with much of the tension being between Egypt, Sudan, and Ethiopia. In order to encourage cooperation over water resources, Dennis Wichelns and his colleagues proposed an economic framework for cooperation. The framework proposes that Egypt, Sudan, and Ethiopia form an intra-regional trading system that depends on each of their comparative advantages. Egypt would grow high-value export crops, Sudan would grow grain, and Ethiopia would develop its hydropower resources. The proposed system ostensibly seems to be the perfect solution to the tension and hostility that exists between the three countries, however, it disregards the legal obstacles to implementation, in addition to Egypt’s status as the Basin’s hegemon. This project aims to determine if Wichelns et al.’s (2003) framework is feasible given the 1959 Agreement, signed between Egypt and Sudan, the 2010 Cooperative Framework Agreement between Ethiopia, Burundi, Uganda, Rwanda, Tanzania, and Kenya, and Egypt’s status as the Basin’s hegemon. In order to answer these questions, I resorted to three sources of information: 1) existing literature, 2) interviews with experts in the field of water management, and 3) newspaper articles. Based on the information I collected, and my analysis, I was able to determine that the 1959 Agreement presents an obstacle to implementing the framework because neither Egypt nor Sudan are willing to re-negotiate their water allocations. However, the Cooperative Framework Agreement does not present an obstacle; rather it is an opportunity for Egypt and Sudan to exert their influence over development in the Nile Basin. Additionally, being the Basin’s hegemon would not hinder the framework for various reasons, including the role of virtual water, and Ethiopia’s counter-hegemonic strategies. Based on my findings, I conclude that Wichelns et al.’s (2003) framework is not feasible, primarily due to the 1959 Agreement. In light of this, I present three recommendations to promote cooperation between Egypt, Sudan, and Ethiopia. First, Egypt and Sudan should sign the Cooperative Framework Agreement; second, Egypt should improve its irrigation efficiency to reduce its water use; and third, cooperation should take a project-by-project approach. The paper ends with reflections on the role of a newly independent South Sudan in Nile Basin negotiations, in addition to the implication of a new government in Egypt

Climate Change and Peacebuilding:Subthemes of an emerging research agenda

Climate change is having profound effects on global security and peacebuilding efforts. While existing research has mainly focused on the link between climate change and conflict, it has largely overlooked the complex interplay between climate change, conflict-affected states, and peacebuilding. Climate change exacerbates existing vulnerabilities in conflict-affected societies by adding stress to livelihoods and negatively impacting food, water, and energy security. This is particularly concerning as climate change is often felt most acutely in settings where public institutions are already failing to meet the population's needs. Consequently, climate change can contribute to exacerbating grievances and hinder the ability to maintain, reinforce, and build peace. Although practitioners in the peacebuilding field are beginning to respond to the effects of climate change, academic research has not adequately addressed the question of how climate change affects peacebuilding and how peacebuilding strategies can respond effectively. To fill this gap, a multidisciplinary approach drawing from climate security, environmental peacebuilding, environmental studies, and peace and conflict studies is needed to develop a research agenda that encompasses the intersections of climate change and peacebuilding. By recognizing the importance of climate change in peacebuilding efforts, this research agenda aims to provide critical insights and guide future studies

Security Risks of Environmental Crises: Environment of Peace (Part 2)

SIPRI’s Environment of Peace initiative focuses on managing the risks that are created by two interwoven crises: the darkening security horizon and the immense pressures being placed on the natural world and the systems that support life on earth. The Environment of Peace research report is an in-depth look at the evidence base and analysis of the policy report Environment of Peace: Security in a New Era of Risk, including many real-world case studies. The report is the result of two years’ work by more than 30 researchers, led and guided by some of the leading voices in the fields of environment and security. Accessibly designed, the new research report is available to download in four parts: Elements of a Planetary Emergency (part 1); Security Risks of Environmental Crises (part 2); Navigating a Just and Peaceful Transition (part 3); and Enabling an Environment of Peace (part 4). This part—Security Risks of Environmental Crises (part 2)—shows how combinations of environmental and security phenomena are generating complex risks. Through a theoretical framework informed by the literature, Cedric de Coning, Research Professor at the Norwegian Institute of International Affairs (NUPI), and his team explore different pathways from environmental stress to conflict and how the darkening security horizon and environmental crises are interacting to generate different types of risk: compound, cascading, emergent, systemic and existential. The analysis is supported by numerous case studies, spanning a variety of social-ecological systems and different types of risks. Part 2 also discusses options for responding to these complex risks

Environment of Peace: Security in a New Era of Risk

The environmental crisis is increasing risks to security and peace worldwide, notably in countries that are already fragile. Indicators of insecurity such as the number of conflicts, the number of hungry people and military expenditure are rising; so are indicators of environmental decline, climate change, biodiversity, pollution and other areas. In combination, the security and environmental crises are creating compound, cascading, emergent, systemic and existential risks. Without profound changes in approach by institutions of authority, risks will inevitably proliferate quickly.Environment of Peace: Security in a New Era of Risk surveys the evolving risk landscape and documents a number of developments that indicate a pathway to solutions––in international law and policy, in peacekeeping operations and among non-governmental organizations. It finds that two principal avenues need to be developed: (a) combining peacebuilding and environmental restoration, and (b) effectively addressing the underlying environmental issues. It also analyses the potential of existing and emerging pro-environment measures for exacerbating risks to peace and security. The findings demonstrate that only just and peaceful transitions to more sustainable practices can be effective––and show that these transitions also need to be rapid.Environment of Peace: Security in a New Era of Risk offers policy principles and recommendations for navigating this new era of risk. A longer report setting out the evidence base in detail will be published later this year

Environment of Peace: Security in a New Era of Risk

The environmental crisis is increasing risks to security and peace worldwide, notably in countries that are already fragile. Indicators of insecurity such as the number of conflicts, the number of hungry people and military expenditure are rising; so are indicators of environmental decline, climate change, biodiversity, pollution and other areas. In combination, the security and environmental crises are creating compound, cascading, emergent, systemic and existential risks. Without profound changes in approach by institutions of authority, risks will inevitably proliferate quickly.Environment of Peace: Security in a New Era of Risk surveys the evolving risk landscape and documents a number of developments that indicate a pathway to solutions––in international law and policy, in peacekeeping operations and among non-governmental organizations. It finds that two principal avenues need to be developed: (a) combining peacebuilding and environmental restoration, and (b) effectively addressing the underlying environmental issues. It also analyses the potential of existing and emerging pro-environment measures for exacerbating risks to peace and security. The findings demonstrate that only just and peaceful transitions to more sustainable practices can be effective––and show that these transitions also need to be rapid.Environment of Peace: Security in a New Era of Risk offers policy principles and recommendations for navigating this new era of risk. A longer report setting out the evidence base in detail will be published later this year

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research