Thursday, December 18, 2014

Prince Tancredi Falconieri Considers the Arab Spring


“Se vogliamo che tutto rimanga come é, bisogna che tutto cambi”

           Most useful in understanding the different outcomes of what appear to be similar processes in Tunisia and Egypt are the words Tomasi Di Lampedusa places in the mouth of Prince Tancredi Falconieri in the novel Il Gattopardi (The Leopard).  A challenge to an elite faced with ruin, they form the epigraph to this essay:  If you want things to stay as they are, they have to change.  Lampedusa’s novel is set in Sicily during the unsettled conditions of the Risorgimento.  The problem confronting the old nobility is what to do in the face of the new Italian nationalism and the revolutionary changes to the state and society that Giuseppe Garibaldi hoped to impose.  To preserve its influence and elite status (that is, to ensure that nothing changes), the family must accept the new forms of governance (that is, accept that everything has changed).   Prince Tancredi’s observation suggests that we think of the old elites, even in a revolutionary uprising, as active participants who are neither passive nor innocent.

The recent legislative elections in Tunisia provided an increasingly rare moment of optimism.  Political analysts are especially happy with Tunisia.  It has garnered high praise for passing the “Huntington two-turnover” test that every other Arab country has failed: the party that dominated the government immediately after the fall of the authoritarian regime has now peacefully given way to its opposition. Tunisia’s October legislative election therefore marks what political scientists call the consolidation of democracy because it seems that all political actors accept the verdict of the ballot box.   

            Explanations of the divergent political outcomes in Tunisia, where an Islamist party peacefully ceded what power it had gained, and Egypt, in which a similar party was forcibly ousted, have subtly and forcefully been attributed to a multitude of causes. Among the most commonly proposed reasons is that the revolutionary youth never gained mass support or had a solid organization either to compete with the Islamists in elections or push the revolution to its conclusion.  But looking at Egypt and Tunisia together tells us that’s wrong.  The revolutionary youth in both Egypt and Tunisia had little impact on the outcome either way whereas the old elite had a very large impact.  Democratization succeeded in Tunisia because the old elite was neither excluded nor subjected to the threat of political or administrative marginalization.

The underlying thread of many analyses since December 2010 has been that democracy can be and perhaps should be the result of a revolutionary rising. It is my belief that democracy, unlike revolution, is a profoundly conservative as well as inclusive solution to the problems of social change.  Democracy’s success thus more or less guarantees, for a protracted period of time, that there will be few political solutions—whether in terms of moderate public policy or dramatic institutional change—to economic inequality.

        To understand why the Tunisian and Egyptian uprisings have had different outcomes, I therefore propose to leave aside the dominant narrative of secularism, Islamism, and the political weakness of the youth in order to focus on a very different issue: what happened to the old ruling elite outside the central core of the presidency in the wake of the uprising. It is seductive to dwell on the more contentious and more emotionally laden issues such as whether Muslims can be democrats or the often incomprehensible constitutional wrangling. These lead us astray from the more fundamental and essential role of the ruling elite, without whom no country can make the transition from authoritarianism to democracy.

There are, as far as I can tell, two different ways of talking about democratization, social upheaval and dictatorship.  One, largely confined to the left, focuses on the tectonic plates of social cleavage.  These are the elements of the body politic: workers, farmers, landowners, officials, and a handful of capitalists.  The second, far more popular within American academic circles, largely reduces to the interplay of millions of individuals who must find ways to resolve their differences whether over constituting the institutions of governance, property rights, or political participation. 

Understanding the larger sociological background of revolt as well as choices that confront generic individuals are both worthwhile enterprises.  What I propose here, though, is that we will gain more traction in understanding the events of the last four years if we focus on a different set of admittedly elite institutional actors: members of political parties, government officials, and holders of significant economic resources.  The crucial question to be asked is whether the political conflicts in the wake of a mass uprising and the collapse of a regime provided a plausible existential threat to any particular group.  Rather than thinking of revolution vaguely as a rapid and complete change, I prefer a definition proposed by Otto Kirchheimer.  Does the new regime destroy the possibility that the old regime and its members can return to power?  This saves us from the implicit mysticism of structural-functionalism and its game-theoretical descendant in which individuals carry all of society’s institutions in their own heads. It allows us to focus on the crucial aspect of democracy:  are all parties, including the ones ousted by the collapse of authoritarianism, able to contest for governance?

Of the many contextual differences between Tunisia and Egypt we can note three.  First the Egyptian courts had a much longer history of systematic intervention in political disputes than did their counterparts.  Second, the Tunisian military had never in the 20th century played a direct role in political or government life.  Third, the level of mass mobilization in Egypt before the collapse of the authoritarian regime was far wider and exhibited much higher levels of spontaneity than did those in Tunisia.  This is another way of saying that politics in Tunisia more directly displayed the underlying capacities of institutions and organizations than did those in Egypt.

In both Tunisia and Egypt the authoritarian regime centered on a particular figure who had been in power for decades and around whom an increasingly small coterie of family and close associates clustered.  By 2010 wide sections of the political elite in each country had been marginalized by a narrow group at the very pinnacle of authority.   In each country the regime maintained its grip on power partly through reliance on the police and partly through the manipulation of a single party (the Constitutional Democratic Rally in Tunisia and the National Democratic Party in Egypt). 

In early 2010 there was every reason to think that Egypt was more likely to experience a successful transition to democracy than Tunisia.  Egypt had a far more open press environment, more competitive elections, and had experienced more turnover among government ministers.  For example, in 2010 the Tunisian prime minister, Mohammad Ghannouchi, was the same one who had been appointed more than 20 years earlier by Ben Ali.  Atef Ebeid, who President Mubarak had appointed as Prime Minister in 1999 (when Ghannouchi assumed his office) to replace Kamal Ganzouri had departed after a five year term.  Ahmad Nazif, Ebeid’s successor, had only served seven years when he was replaced on January 30, 2011.  Egypt had had three prime ministers in the two decades during which Tunisia had one.

The story of the protests in Tunisia and the massive uprisings in Egypt is sufficiently well known for me not to repeat it.  In its place it is worth looking more closely at other aspects of the subsequent events in the two countries.  In some ways they are remarkably similar but in other respects they differ notably.  An understandable desire by many observers and analysts to conflate a revolutionary uprising with the process of democratic transition has created a narrative that now lacks not only many details but is, in some ways, a significant distortion of the political trajectory of the two countries. 

As strikes and demonstrations became more widespread in both countries, members of the judiciary played an early role in shaping events.  Reformist judges appeared from the first days of the uprising in Tahrir square while in Tunisia the country’s attorneys were on strike by January 6.  Violence against property in the protests led to the promulgation of a curfew in both Tunis and Cairo and in both places the Armed Forces refused to fire on demonstrators.  In Cairo, however, where Field Marshal Mohammed Tantawi was both supreme commander of the Armed Forces and Minister of Defense, the army’s chain of command remained intact and shielded from civilian interference.  In Tunis, President Ben Ali dismissed the commander of the Armed Forces Rachid Ammar on January 13.  Ammar was re-instated the following day by long-serving Prime Minister Ghannouchi who Ben Ali had deputized as president before he fled the country. 

The Tunisian Supreme Court first appeared as an actor in the transition on January 15 when it declared that Ben Ali was not incapacitated but had quit the presidency.  Consequently, Fouad Mebaza3, the speaker of the Assembly, was installed as president rather than Ghannouchi, who then remained as Prime Minister.  Mebaza3, a member of the RCD Central committee since 1988, served as the president of Tunisia until December 13, 2011 when he was replaced by the human rights activist and Ben Ali opponent, Moncef Marzouki.  Had the Egyptian Supreme Constitutional Court made a similar ruling when Mubarak left office, it would have declared that either the speaker of the Assembly, Fathi Sorour or Farouk Sultan, president of the court, was his constitutional successor.  Both men were as closely associated with Mubarak as Mebaza3 was to Ben Ali.

By January 17, Prime Minister Ghannouchi announced a new cabinet  which contained 12 members of the CDR including former defense minister Ridha Grira, a graduate of the distinguished French institute for training high-level civil servants, the Ecole Nationale d’Administration (a distinction he shares with Adly Mansour, the president of the Egyptian Supreme Constitutional Court who served as President of the Republic from the ouster of Mohammad Morsi in 2013 until the election of Abdel-Fattah Al-Sissi in 2014).   

Initial attempts to contain popular unrest that had only grown since Ben Ali fled were unsuccessful.  Neither Ghannouchi’s resignation from the CDR nor the inclusion of trade union and opposition political figures silenced protests.  Within a day the trade union ministers had resigned and on January 27 Ghannouchi gave up and resigned as Prime Minister.

Ghannouchi’s replacement was not an outsider by any stretch of the imagination.  On the contrary, he was replaced by an even more central figure from the old regime.  The new Prime Minister, Beji Caid Essebsi, had served in several key positions under the Republic’s founder, Habib Bourguiba.  Essebsi was defense minister from late 1969 until June 1970 and then served as Ambassador to France.  In Tunisia, as in other former French colonies, the ambassador to Paris is a position of exceptional importance for economic, political and security issues.  Between 1981 and 1986 Essebsi was the country’s foreign minister.   After Ben Ali ousted Bourguiba, Essebsi moved to the legislature where he was president of the Chamber of Deputies from 1990-1991.  Essebsi, who would be Prime Minister in 2011 until he resigned to make way for Ennahda party leader, Hamadi Jabali, on December 24 thus played a key role in determining the nature of the democratic transition.   Before the courts in Tunisia (as in Egypt) dissolved the former ruling party in March, the Interior Ministry had already suspended it from official activity.   Essebsi thus presided over the liquidation of the party in which he had spent most of his adult career and from which he would draw many of the leaders for the new party he created for the 2014 legislative elections.  Essebsi and his associates were quintessentially what Egyptians derided as “feloul” or the remnants of the old regime.
It is possible that Essebsi only pursued this course under the pressure of demonstrations, but nevertheless it was Essebsi and a number of politicians from the old regime as well as some of their long-standing opponents who bore the responsibility for shaping a democratic outcome in Tunisia.  Thus, speaking on November 10, 2011 at the African Media Leaders forum, Essebsi noted that it was his government’s responsibility to ensure that the Tunisian revolution did not devolve into a fratricidal conflict nor deviate from what he called its virtuous path.

Among the consequential choices his government made was the exclusion of members of the CDR from participating in the elections for the constituent assembly.  Arguably even more important, however, was the decision to encourage human rights activist Kamel Jendoubi to preside over the commission charged with writing the relevant electoral law and carrying out the election itself, ISIE.  Jendoubi and his fellow commissioners chose to employ a particular version of proportional representation that provided Ennahda with the number of seats that corresponded to its share of the vote but that also privileged smaller parties.  Other electoral rules, including other versions of proportional representation, would have translated Ennahda’s 38 % share of the popular vote into a majority of seats rather than the plurality it actually received.  Ennahda thus, by design, was unlikely to control the constituent assembly without receiving an overwhelming majority of the popular vote.

Ennahda had the votes in the constituent assembly to impose a constitutional article banning members of the old ruling party from engaging in politics.  In fact, just such an article (116) was drafted into the Tunisian constitution by a majority.  Under the rules of the assembly, however, it was rejected because it did not have the necessary super-majority.  The measure failed to gain a super-majority in large part because of significant number of Ennahda delegates abstained.  Such a constitutional article would have been an insuperable barrier to the old political elite regaining influence through electoral politics and would have made the creation of Essebsi’s Nida’ Tounis, the largest party after the last elections, impossible.   The most widely cited argument for not excluding former members of the CDR was simply that there is, in a democracy, no reason for stripping individuals of their political rights unless they have been convicted of criminal activity.  Whether Ennahda representatives were convinced of this argument on its merits or simply took a more hard-nosed view of the likely results of excluding their long-time opponents we do not know, but their decision was consequential.

In Egypt events have worked out quite differently.  There are, of course, many contextual differences between Egypt and Tunisia but one obvious and crucial difference was the inability or unwillingness of the Muslim Brotherhood to find a way to compromise with members of the old regime.  On the contrary, the Muslim Brotherhood often sought to marginalize and exclude as much of the NDP as possible.   These attempts to marginalize and exclude the NDP and its cadre as well as its leadership were highly popular with a significant portion of the Egyptian public.  The top NDP leadership included prominent businessmen, religious officials, and government officials all of whom were widely derided as corrupt figures of an authoritarian regime. 
Days before Husni Mubarak resigned, on February 6, 2011 Vice President Omar Suleiman met with members of the opposition including the Muslim Brotherhood in an attempt to broker an agreement about the future of Egypt. These were the days in which several groups of so-called “wise men”, including some of Egypt’s wealthiest and most important businessmen as well as academic figures and former officials engaged a public dialogue through public statements and occasional interviews.  Other opposition leaders including Muhammad El-Baradei opposed the talks which were unpopular with the demonstrators in Tahrir Square. The Obama administration backed the talks as a way out of the impasse in Egypt.  Both President Obama and Secretary of State Hilary Clinton called for an orderly transition.  Some disarray in the American position occurred when former US Ambassador Frank Wisner stated that Mubarak would have to stay in office indefinitely.  Press reports indicated that Mubarak would have agreed not to run for a new term and that some changes in the laws regarding freedom of expression would have been made.   

             The first attempt to broker some kind of agreement or transitional pact foundered.  Subsequently there were occasional talks between leaders of the MB and some of their political competitors and more than occasional claims that the MB had worked out a deal with the Supreme Council of the Armed Forces but nothing of the kind ever happened.  Talks routinely broke down; bargains once made were scuttled; and a heightened sense of distrust permeated relationships between all the dominant actors during the period after Mubarak left office.  

            Unlike in Tunisia, it proved, for example, very difficult to win agreement on the nature of the electoral process as well as substantively limiting the ability of the Islamist movements to dominate the legislature.  After initially promising to limit itself to contesting 25 % of the seats, the MB finally decided to contest nearly everywhere.  SCAF found it difficult to choose among a variety of electoral schemes but ultimately chose a mixed system in which some seats were contested by party list and others by individual candidacy.  Parties were nevertheless allowed to contest the individual seats although it was widely known that the Supreme Constitutional Court, in several prior decisions, had ruled such contestation unconstitutional. 

            Anger and contempt for the political figures of the old regime were common through the first year of the uprising in Egypt and the MB began to present themselves as a party dedicated to reforming Egypt by continuing the revolution.  Key to this objective was eliminating the “feloul” or remnants of the old regime.  This was surprising to many Egyptians because there was no reason to believe that the MB planned to make significant or rapid changes to the country’s economic or governmental structures which would have been the hallmark of a revolutionary party as widely understood in Western as well as Egyptian academic literature.

            Circumspect as the MB was, however, their reaction to the so-called Selmi document of late 2011 shows how different the situation in Egypt was from what obtained in Tunisia.  Ali Al-Selmi, vice prime minister, drafted a proposal that had the backing of SCAF and the government which was then still dominated by liberal elements of the old regime and a handful of its liberal opponents.  He offered a set of supra-constitutional principles to guide the work of the still-to-be chosen constituent assembly which had many substantive similarities to earlier such statements issued by the Muslim Brotherhood, his own Wafd party, and independent forces in March 2011.  It only allowed the civilian government to consider the total budgetary allocation to the Armed Forces and it gave SCAF the right to prior review of any legislation affecting the army.  There was opposition to ratifying the military’s hitherto unofficial authority in the new constitution, but the subsequent constitution drafted a year later by the Muslim Brotherhood-dominated assembly gave the Armed Forces significantly more control over its own finances and the government. 

His proposal also included significant restrictions on how the still to be chosen legislature could choose the constituent assembly.  First, Selmi proposed that elected legislators not be allowed to serve as members of the constituent assembly.  He also proposed a corporatist plan through which the SCAF would appoint the bulk of the members of the constituent assembly from the existing institutional framework of Egyptian society in which unions, professional associations, and other groups would choose their own representatives.

If implemented, his proposal placed mild substantive constraints on what the assembly could write but it egregiously violated one of the few obviously legitimate elements of the transitional process.  That an elected legislature would choose the constituent assembly was one of a handful of provisions that had been the object of the March 19 referendum.  The MB called for massive demonstrations against the Selmi proposals and hundreds of thousands of people mobilized against them including sections of the left. Selmi himself became a lightning rod for protest and mistrust because of his own connections to the old regime. Selmi has a doctorate in economics and had served previously in Mubarak cabinets.  He was a prominent member of the Wafd, generally considered a secular pro-business party with a significant Christian base of support.  Rejecting the Selmi placed the MB firmly on the side of electoral legitimacy but it suggested an at best limited tolerance for reaching substantive agreements with the social, political or economic elite of the old regime. 

            The Muslim Brotherhood initiated demonstrations in Tahrir Square and were able to mobilize significant support against the proposal on November 18, 2011.  Police later attacked a sit-in by relatives of the people killed in the initial uprising and protests continued.  These included particularly violent confrontations between the police and youth, many of whom were drawn from the ranks of soccer fans and from poorer neighborhoods, which left 41 dead and perhaps 1,000 wounded.  The Selmi document was another victim and so was the government of Prime Minister Essam Sharaf who resigned on November 21.  He was replaced by Kamal Ganzouri, who had served as prime minister under Hosny Mubarak from 1996 to 1999.

            From the left the Muhammad Mahmoud events were widely viewed at the time as evidence that the Muslim Brotherhood was uninterested in pursuing the revolution to establish a democratic order.  Viewed in the framework of Tunisian politics, however, they suggest a different interpretation:   the Muslim Brotherhood refused to reach an agreement with members of the old regime about the new structure of the state.  The mobilization of street demonstrations and the willingness to accept the outcome of the violent confrontations that it had neither solicited nor endorsed placed the Muslim Brotherhood on a distinct path in the months to come.  This was the path of electoral politics, themselves a fundamental process for representative democracy.  It was also, however, a path in which elections and demonstrations together could be used to marginalize and diminish the role of other institutions of the state as well as the political opponents of the electoral victors.
            In the succeeding months a far more brutal and direct battle for power developed in Egypt that took the country in a very different direction from Tunisia.  The Muslim Brotherhood coalition gained 45 % of the seats in the new parliament and, in alliance with the Salafi “Islamist bloc”, could control the new legislature.  Among other measures it enacted a political ban on members of the old ruling party which, like its Tunisian equivalent, had been dissolved.  The Supreme Constitutional Court struck down this law as unconstitutional, using language similar to that deployed by Tunisian legislators in rejecting Article 116.  The Court also voided the elections to the lower house because the electoral rules violated established court doctrine about the rights of voters. 

            This is not the place to discuss in detail the long conflict between the Muslim Brotherhood, the courts, and members of the old political class.  It is telling that the MB, despite its commitment to the electoral process and its claims to the necessity of the alternation of power, remained unwilling to allow the one set of political activists most likely to challenge its dominance successfully to compete in an organized fashion for power.  It is in this sense that the MB can legitimately claim to be a revolutionary force.  The MB was certainly not an ideological party committed to socialism, income redistribution, or secularism.   For reasons that are too complex to address here they were certainly committed to eliminating a significant fraction of the old political class (the “feloul” or remnants of the old regime) and moved as rapidly as they could to do so. 

            No doubt the stories of the Tunisian and Egyptian experiences of political conflict in the wake of authoritarian collapse are more complex than the one I have told here.  I plan to examine some of those aspects, including the role of the army, elsewhere. The advantage of this story, however, is that it takes our attention away from the problems of secularism, post-secularism, moderation, radicalism and religion and places it firmly back into the structure of conflict and accommodation between political and institutional forces. 

            Sometime before his tragically premature death I had coffee one morning with Samir Soliman, the respected Egyptian political scientist.  In the years since it has become common to argue that the failure of the Egyptian revolution and Egyptian democracy can both be attributed to the failure of the secular left to organize sufficient popular support to challenge the Muslim Brotherhood.  Seen in this optic the tragedy of Egypt is the fault of the middle-class intellectuals who played such conspicuous roles in front of the television cameras in the early days of the uprising in 2011.  Samir had a different view of how democracy, if it was to work at all, would work in Egypt.   The only party that could conceivably challenge the MB and alternate with it, he argued, was a conservative party. Committed as he was personally to the politics of the left, he did not that day argue that the liberal left would be a likely counterweight to the MB nor did he mention from where such a party would draw its leaders or members.

            In Tunisia it is clear that a conservative-centrist party has emerged to challenge Ennahda and its roots are heavily in the old regime although it also boasts other supporters.  In Egypt for a variety of reasons no alternate center-conservative party was built.  That would have necessarily been a party with deep roots in the old NDP, the party many of whose members have re-emerged since the coup.  In the absence of a thorough-going revolutionary exclusion, they would, I think, have re-emerged anyway.  The question is whether they did so through elections or as part of an anti-electoral coalition.   Attempting to exclude the economic and political elites of the old regime may have seemed like both revolutionary and democratic good sense to the Muslim Brothers and to many Islamists and leftists between 2011 and 2014. 

            Egyptian revolutionaries (in the conventional left-wing sense) and the leaders of the MB feared the re-emergence of the feloul as a political force.  They correctly understood that a powerful conservative party with significant support from Egypt’s business elite was not a friend.  Such a political grouping was not inclined to support either the projects of economic and social equality that animated the left or the projects of creating new state institutions that the MB favored.  The MB were committed to elections. As the old elite increasingly re-asserted itself the MB responded by attempting to marginalize both their institutional and electoral capacity. In this they echoed the very old concern of revolutionaries in Europe and Latin America that electoral democracy is not necessarily the friend of movements for economic redistribution nor do they necessarily lend themselves to the creation of strong protections for the political, civil, or social rights of the poor and the weak. 

The idea that democracy is the last station on the revolutionary road remains seductive and it informs a certain idealized understanding of American history and the process of democratization.  Representative democracy itself, however, is less likely the successful conclusion of revolution and more likely the premature end of its utopian hopes and dreams.  Only if nothing changes, can everything change.

Wednesday, August 20, 2014

Sisi Victorious (with apologies to the late Ossie Davis)

                  SISI VICTORIOUS

A year after the violent dispersion of protesters at Rabaa and Nahda squares in Cairo Egyptian President Abdel Fattah Sisi has reason to be pleased with the state of the world.  The early mutters of disapproval in Washington have died down and even a recent report by Human Rights Watch asserting that the government crackdown on supporters of former President Muhammad Morsi comprised a series of crimes against humanity will probably be ignored. That Egypt today, with an authoritarian regime underwritten by the armed forces, is far less torn by conflict than Libya, Syria, or Iraq may be one reason for feeling self-satisfied.  Another, and one of the most surprising reasons for such feelings, besides the usual cynicism of international politics and foreign policy, is due to the remarkably accommodating policies of Egypt’s neighbor to the northeast, Israel.
                  While the most common optic used to view events in the region remains that of the Israeli-Palestinian conflict, it has also become increasingly fashionable to think in terms of a struggle for influence between the Kingdom of Saudi Arabia (aided by its friends in the United Arab Emirates) and the Islamic Republic of Iran (with an occasional assist from Qatar).   Through these lenses Egypt is no longer an independent player in the Arab world but merely a dependent supplicant for favor in a conflict between far more powerful forces.  While this may be true to some degree, it ignores how rapidly Egyptian diplomacy has used the assets—meager as they may be—at its disposal to reverse the negative impact of the criminal violence through which the current regime came to power.  Whether this is due to remarkable skill or dumb luck remains to be seen, but the new government has done a superb job of taking advantage of opportunities.
                  Not the least of those assets has been Israel.  To say this is to admit an unconventional view of the current situation in the region.  The dominant approach is to say that Egypt is the ally or even the cat’s paw of Israel.  The Israelis, after all, rely on Egyptian weakness to carry out their assault on Gaza and Israel is the dominant military and economic power in the eastern Mediterranean. Many believe that Egyptians (and thus any democratically elected Egyptian government) really want nothing more than for their army and their economy to come to the aid of the beleaguered Palestinians.  Exactly why, after even the Morsi government closed down tunnels to Gaza and maintained the blockade, anyone should unquestioningly believe this is something of a mystery. It is true that the Muslim Brotherhood, of which Morsi was a leading member, had a fraternal relationship with Hamas.  It is equally true that the Freedom and Justice party leaders vociferously campaigned at rallies on their intentions to liberate Jerusalem. As all the little communist parties of the world learned to their sorrow during the years of Stalin’s Comintern, the interests of big brother take precedence.  Morsi and his allies may have talked a good game of fighting Zionism but in the end they turned out to be mainly interested in the victory of Islamism in one country.
                  The Sisi government (which includes the transitional period) is far less enamored of the Palestinian cause and Hamas than was the Muslim Brotherhood.  The new government, faced with continuing unrest in the Sinai Peninsula and ongoing armed attacks on border guards, police and army units, sees the entire region as a security threat.  Gaza is, in this view, a source of and a refuge for armed elements that the new government sees as threatening.   That Hamas militants paraded through the streets of Gaza before the recent fighting while holding weapons and making the raised four-finger sign of Rabaa could not have been pleasing to President Sisi and his government.
                  Egypt’s new generals, it has been widely observed, have little combat experience.  Unlike former Defense Minister Tantawi they never fought the Israeli Defense Forces.  If they have never been victorious in battle neither have they suffered defeat at the hands of the IDF.  Nor does the Israeli government of Benjamin Netanyahu appear to harbor any ill will toward an Egyptian military that stolidly guards its own borders.  On the contrary, ministers and pundits alike committed to the Netanyahu government see political Islam (whether in Iran or the Arab world) as the most dangerous strategic threat they face.  In their rhetoric, and perhaps in their own strategic calculus, the Muslim world is a seething cauldron of rage about to pour down on the Jewish state.  Against this possibility the Egyptian military are a bulwark.
                  It is thus not so surprising that Israeli diplomats and American organizations strongly connected to Israel urged the Obama Administration not to cut aid to Egypt in the wake of the coup.  One way to look at this is that the new regime in Egypt had been rewarded for truckling to Israel.  Another way—at least as honest a description—would be that the Israeli government carried water for the Egyptians.  To repeat: the Israeli government judged its interests best served by aiding the strategic interests of the Egyptian regime in exchange for no formal promises or assurances.
                  Israeli intelligence about Gaza is known to be relatively impoverished. Unsurprisingly, Israel is better informed about the more open society in the West Bank than what many describe as the open air prison of Gaza.  Despite the fantasies of Jeremy Bentham and Michel Foucault, prisons are not easy places to observe nor does the Hobbesian world of incarceration lend itself to stable patterns of alliance or preference.  If Israeli officials rely to any degree on Egyptian colleagues for intelligence about Gaza, they would not be the first occupying power to risk being systematically misled by those from whom they seek information.
                  Israel’s assault on Gaza and weakening of Hamas has gone well for President Sisi.  The Israelis and Islamist Palestinians have wounded each other.  Hamas has been materially weakened and Israel has, in the eyes of important sections of the developed world, forfeited much of its moral and political capital.  Egypt, a country which for a year had labored under the threat that the US or the European states would diminish both economic and diplomatic support has now become once again a crucial interlocutor.  In fact, as President Obama’s attention is drawn increasingly to Syria and Iraq as well as Ukraine, Egypt is a welcome partner. Cairo becomes the venue and the primary agent in facilitating talks between the two warring parties.  Whatever possibility there was that the Obama administration would further cut aid to Egypt has vanished in the plumes of Hamas’s rockets and the explosions of Israeli ordnance.
                  On the home front the picture facing the Egyptian government is less rosy, but it is not quite as dismal as Sisi’s opponents suggest.  A year after the government violently dispersed the demonstrations at Rabaa and Nahda squares, it has managed to write and implement a new constitution.  That the new constitution was approved by 98% of the voters and President Sisi elected by 96% has not embarrassed the new government nor does it seem to be an element of popular discontent for now.
                  The government faces far more severe problems than the validity of its mandate.  It has so far proven incapable of resolving many of the issues that President Morsi unsuccessfully confronted.  In the process it has become clear that the profound challenges that faced the Morsi government were not manufactured by the deep state, foreign interests, or anything other than the present structure of the Egyptian economy and politics. 
                  There has been significant commentary about Egyptian food imports and the dire consequences of bread shortages in a country where bread is a necessary dietary staple.  Nevertheless, among the most pressing problems in Egypt is that of electricity supply.  The persistent outages that occurred before the coup have become longer and more frequent over the last year.  Initially there was a respite as power consumption dropped below production for a brief period but the general trend has been negative.  The government plans to resolve the issue in the short term by increasing coal imports but these will necessarily increase the drain on foreign currency reserves. A cleaner alternative would be natural gas. Although Egypt has very large reserves of natural gas, it faces increasing shortages.  The government has diverted more of the gas from exports (including small but very controversial shipments to Israel) to domestic consumption but has been unable to increase production.  The major stumbling block is the unwillingness of the government to increase the price for foreign partners as well as the government’s inability to pay its previous energy debts.  A possible resort to increasing imports of liquefied natural gas may briefly alleviate the physical shortfall but at the cost of further drain of foreign reserves and foregone investment in production. 
                  Long-term problems include high unemployment and continued weakness in production and investment as well as the diminished activity in the tourist sector.  Although Egyptians like to think of the tourist attractions in their country as unique this is something of a mistake.  It is true that no other country has pyramids so large or Pharaonic monuments so grand, but the Pyramid of the Sun in Teotihuacan is also unique. Having visited Luxor once globetrotters are as likely to want to see Angkor Wat as make a return visit to the temples on the Nile.  Other Egyptian tourist attractions—sandy beaches, clear blue water, exotic scenes for scuba diving—must compete with similar accommodations in Thailand, Mexico, Brazil, and even socialist Cuba’s white sands of Varadero. Tourism is a source of hard currency and Egypt’s historical attractions are uniquely important in human history but the global tourist market is highly competitive. The number of tourists coming to Egypt dropped from 14 million in 2010 to around 9 million last year. That other destinations can be visited without fear of disruption or political unrest makes them even more desirable today.
 One bright spot is remittances, which according to the central bank, flow on the order of $22 billion annually.  In academic discussions of the Egyptian economy remittances are often referred to as a form of “rent” probably because, like royalties on oil production or Suez Canal transit fees, they are paid in hard currency. They are better thought of as as a form of export of human capital.  The higher returns abroad to the joint investment between individual Egyptians and the state in education are partially returned to Egyptian society through this mechanism.  What is insufficiently appreciated is that the particular form inter-Arab economic relations have taken in the past five decades makes it possible for this economic arbitrage to function effectively from the vantage of the state.  Ordinarily migrants take their education with them as well as their entrepreneurial talents when they settle abroad.  Egyptians cannot, for the most part, do this because although they can often enter other Arab countries in search of employment they cannot easily become citizens in their new homes and must return to Egypt.  The Arab world would look would look very different today if millions of Egyptians had permanently left the country over the past three decades and become citizens in Gulf countries or Libya.   
                  President Sisi has also announced a plan to dig a second Suez canal and widen the existing channel.  This would allow more ships to transit and increase revenues to the government.  Increasing the capacity of the Suez Canal is certainly a better investment than building a second Nile in the Western Desert parallel to the existing one.  Whether the government can accomplish this in the year that President Sisi set for the project is dubious and even the Suez Canal is no longer a certain source of rents or hard currency.  Today, unlike in decades past, Suez and Panama--in opposite hemispheres--can compete for the shipping trade between China and Europe.  With Suez tolls for some ships set at more than a million dollars for the round trip, the journey around Africa or through a widened channel in Panama have become competitive for some shippers.
                  The numbers make the economic situation appear impossibly grim. There are also many accounts detailing the stranglehold the army is said to have over the economy with estimates of military enterprises accounting for between 5% and 40% of the whole.  It is something of a mystery in this case why Egypt does not experience the complete collapse pundits have been predicting regularly for the last three years.  Remittances and the financial support of the Gulf monarchies certainly make a difference. The state budget is nevertheless under pressure and there is little reason to believe that the Armed Forces, despite the engineering degrees held by many of its officers, will be able to chart a successful course out of the current mess.
                  What Sisi and the generals may be able to rely on at least for a while is the informal economy.  Estimates of the size of the informal economy—defined as those enterprises that pay no taxes and which have no legally recognized property rights—range from between thirty to forty percent.   There is every reason to believe that the informal sector plays an important and possibly even nearly a dominant role in urban housing markets and that informal systems of property rights and adjudication procedures exist.  Living in the informal markets for labor and commodities is precarious but on balance it is clear that millions of Egyptians manage to do so.  There is no need to romanticize the difficult lives of those for whom pennies (or more appropriately piasters) spell the difference between ruin and relief.  What studies there are suggest that for some Egyptians, informal employment is a first step in a ladder to a viable livelihood and for others (women and poorly educated men for example) it may well be an inescapable trap.  Nevertheless for the moment it provides some stability in an economy that is increasingly at risk. And it may well be that Egyptians in the most precarious situations are the ones who most desire stability, even at the cost of increased political repression. Sisi’s supporters, who helped to drive President Morsi from office, are not drawn only from the ranks of well off liberals any more than were the enemies of Maximilien Robespierre during Thermidor of 1793.  He went to the guillotine with the assent and even the enthusiasm of much of Paris as well as the French countryside.   Although Robespierre’s downfall is linked in modern imagination with the Terror it appears in retrospect to have been more closely connected to how opposing elites deployed issues of more widespread popular concern: rising prices, bread shortages, and the absence of fuel.

Friday, March 07, 2014

The Needle and the Gun


            The recent announcement by the Egyptian government that the Armed Forces have discovered a device to detect and possibly cure hepatitis “C” and AIDS has been met with disbelief, ridicule and occasional contempt.  It was not met with a great deal of anger, but perhaps this was because Egyptians were all too aware of the context within which the device has been offered.  Or perhaps after three years of revolutionary upheaval many Egyptians are too exhausted. The foreign media has echoed some of the ridicule but with rare exceptions has been either willfully or blindly ignorant of the public health background of the last two decades. Whether these events were an indication of malice, hypocrisy, incompetence or simple lack of attention by the relevant authorities remains uncertain.

            Announced at a mid-February 2014 press conference by Ibrahim Abdel Atti, a general by courtesy, the device—named C-Fast—resembles a radio antenna connected to a trigger mechanism.  It is thus supposed to be instantaneous (whence its name) and non-invasive. Abdel Atti claims that he spent two decades developing the device, most recently with support from the Armed Forces.  Similar technology, he claimed, was at use in “complete cure” which ostensibly did what its name implied.  Several Egyptian scientists, including the president’s science adviser, have publicly announced that the device itself is most likely a fake and that neither the device nor the theory on which it was supposedly developed has any validity. 

            If the underlying health issues were less serious the events of the past week might have the quality of an arcane comedy or a peculiar vaudeville act. But there is every reason for Egyptians to be worried about hepatitis C.  It is a severe liver disease whose full effects may take decades to manifest.  These include cancer of the liver and cirrhosis either of which is fatal if untreated.   The most common medications are uncertain and require a course of treatment lasting months.  Even after government assistance, they may cost hundreds or thousands of dollars which puts them beyond the reach of many of Egypt’s poor who may subsist on $2 a day.

            As a story in the New York Times on February 26, 2014 coyly noted Egypt has “the highest prevalence of hepatitis C.”   The superlative here refers to the entire globe: the rate of infection among Egyptians is the world’s highest.  According to a report issued by the US Centers for Disease Control but largely authored by Egyptian specialists about 10 % of the Egyptian population, or 6 million people in 2008, had chronic hepatitis c virus (HCV) infection.   Egypt, with less than a quarter the population of the United States has twice as many people infected with the virus.  Another telling comparison is that Egypt with less than 1% of the world’s population has roughly 4% of the world’s cases of hepatitis C. 

            In general hepatitis C rates are higher in the countryside than the cities, among men than women, and among those who are older.  The same report indicates that between 2008 and 2011 the Egyptian government treated about 190,000 Egyptians with one or two medications that cure between 60 and 80% of cases.  However, about 40,000 Egyptians die every year due to liver cancer or cirrhosis (not all of which is attributable to HCV) and it is the second highest cause of death in the country after heart attacks.

There is every reason for Egyptians, especially the poor and the illiterate, to be concerned about hepatitis C and to hope that someone can develop a quick and inexpensive treatment.  That many Egyptians welcomed the claims about C-Fast is not surprising. There is no particular reason that ordinary Egyptians should have very clear ideas about the best science for the detection and cure of AIDS or hepatitis C.  Whatever the vices of General Abdel Atti’s device, it has the virtue of being harmless in itself.  This is more than can be said of a drug such as laetrile that was popular in the United States at least through the 1970s and is still occasionally touted as a cure for cancer.  Laetrile, made from apricot pits, has no impact on cancer but it does contain sufficient cyanide that patients taking it have a real risk of being poisoned. 

            The problem with a harmless treatment is that it induces a false sense of security among patients who will nevertheless succumb to a deadly disease.  It is not clear whether the peak incidence of the disease occurred in the past several years but it will be a severe public health problem for decades to come.

            That the epidemic itself was in large part the effect of an earlier Ministry of Health program designed to eliminate endemic schistosomiasis (also known as bilharzia) was well known and recently reported in The Economist.  Schistosomiasis also causes severe liver disease.  That campaign itself was necessitated by earlier decisions by many Egyptian governments (including those at the turn of the 20th century when the country was effectively under British control) to extend perennial irrigation.  Egyptians suffered from schistosomiasis thousands of years ago but perennial irrigation allowed a parasite that moves from snails to humans and back again to routinely complete its life cycle and infect large numbers of people.

From 1960 until around 1980 the government injections of tartar emetic were used to control schistosomiasis.  The decision by the government to employ re-usable glass syringes that were often not effectively sterilized between uses spread the HCV epidemic even as it began to reduce the incidence of schistosomiasis.  By the mid-1980s an oral drug had begun to replace the earlier treatment.  Unfortunately by then HCV was endemic and an unrelated hepatitis B virus had also begun to spread. 

There are other sources for the spread of HCV.  The growing incidence of adult diabetes has also led to a growing incidence of kidney failure (more formally, end stage renal disease).  As a consequence more Egyptians are undergoing dialysis which, when the machines are not adequately sterilized, has become another vector for the spread of HCV. 

Egypt has more than 1,000 dialysis units that provide care for patients with kidney disease.  Dialysis costs about $3200 a year for three treatments a week (in the US the cost is about 50 times as great and would also be beyond the reach of most who suffer from the disease if Medicare did not pick up the bill).  This is well beyond the income of most Egyptians with ESRD.  Needless to say 1,000 units is far from sufficient for a country with millions who have ESRD.  Recent estimates indicate that about 10% of Egyptians suffer from diabetes (about half of which is undiagnosed) and perhaps twice that many suffer from hypertension which is the other major precursor to ESRD.
Dialysis clinics are spread throughout the country but are most easily available in the large cities.  Thus there is relatively large dialysis center not far from Tahrir Square tucked into a small side street opposite an art gallery and not far from automobile repair shops.  In Giza, on the boundary between the upscale neighborhood of Muhandiseen and impoverished area of Imbaba there are several clinics specializing in kidney and liver disease.  At the height of the demonstrations in Tahrir Square, empty as the streets of Cairo and Giza may have been, the clinics were filled with patients, some from Upper Egypt and some from upper class Cairene families waiting to see their physicians and watching the news reports on television.  Neither kidney nor liver patients could let revolution prevent their search for treatment.  My only reason for being aware of this is that I spent most of a day there on several occasions waiting for my own appointment.

            Treatment of HCV has been expensive and until recently quite uncertain.  In December 2013 the English-language Ahram reported news of a trial in the US. These results were clearly well known to officials of the Health Ministry.  The US Food and Drug Administration has recently approved an orally delivered medication that is extremely effective when used to treat the particular variation of HCV common in Egypt.  Dr. Wahid Doss, head of the Egyptian National Liver Institute, was quoted in news reports (including the Ahram report) about the results of a study in the United States that showed Sofusbuvir in conjunction with Peginterferon and Ribavirin achieved a 97% permanent clearance rate of the virus after 12 weeks of treatment.  
            All of this information and more was available to the Egyptian government and Egyptian medical organizations and it was in the public record when the first reports of C-Fast were made.  In the space of a week and a half the emptiness of the claims of Abdel Atti and the C-Fast device had been revealed.  On the positive side it is apparent that the repressive as the new government may be and despite the danger of scientific quackery Egypt’s scientific community remains active.  It is easy to dismiss the value of expertise but for many Egyptians today in many areas of society there is a far greater problem in not having access to expert advice and care than in having too much of it.

The size of the public health tragedy that confronts the country and the very limited resources for dealing with it are truly daunting.  Much as been written of the macroeconomic challenges Egypt faces, the cost of fuel and food subsidies, the continuing problems with electricity supply and butane.  And of course there is repressive response of the state to public political opposition.
The 2011 electoral program of the Muslim Brotherhood’s Freedom and Justice party correctly noted the extent of the hepatitis and diabetes epidemic facing the country but proposed no immediate proposals to address it and no significant increase in funding already existing institutions or policy initiatives.  The current government is clearly aware of the extent of the crisis and of how it affects the lives of ordinary Egyptians.  Despite information available from the government’s own scientific advisers and the Egyptian professional medical community, the government promoted a quack response.  Had the C-Fast device not been critiqued, ridiculed and (one can only hope) withdrawn, its use would have been worse than doing nothing.  It is sobering to realize that every month almost as many Egyptians unnecessarily die due to the consequences of government incapacity and inaction as were killed in the public squares in the summer of 2013.  These deaths are unintended and clearly cannot be considered the policy of the state.  No violation of rights is involved.  They are nevertheless a significant human tragedy for which negligence may be a reason but not really an excuse.