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Migration and Covid deaths depriving poorest nations of health workers | Global development

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The loss of frontline health workers dying of Covid around the globe, is being compounded in the hospitals of developing nations by trained medical staff leaving to help in the pandemic effort abroad, according to experts.

With new Covid waves in Africa, and with Latin America and Asia facing unrelenting health emergencies, the number of health worker deaths from Covid-19 in May was at least 115,000, according to the World Health Organization. Its director-general, Tedros Adhanom Ghebreyesus, acknowledged data is “scant” and the true figure is likely to be far higher.

In richer countries, the share of foreign-trained or foreign-born doctors and nurses has been rising for two decades. But the pandemic’s double blows of death and migration are leaving behind knowledge gaps in already fragile health systems, where poor pay and conditions are driving staff to leave, say advocates and health workers.

Global health specialists are launching initiatives to protect medical staff, and incentivise them not to be enticed abroad.

Women in Global Health, an international network advocating for equality, has jointly launched what it calls “a new social contract for women in the health and care workforce”. The Gender Equal Health and Care Workforce Initiative, a partnership between the WHO, Women in Global Health and the French government, aims to strengthen policy investing in and protecting workers.

“Health workers are exhausted, many want to leave. We cannot afford to lose one single worker at this time,” says Dr Roopa Dhatt, executive director of Women in Global Health. “Investing in women is the best investment we can make for all our futures and the future of health security.”

Nurses in scrubs do fitness class
Nurses use a Zumba fitness class to help them cope with working situations during a coronavirus outbreak at Kenyatta National Hospital in Nairobi, Kenya, in May last year. Photograph: Njeri Mwangi/Reuters

The world is reliant on women to deliver health and care services, Ghebreyesus told the Generation Equality Forum, where the first round of commitments to the initiative was announced on 1 July.

Women account for about 90% of nurses and midwives, close to 50% of all doctors, and make up 70% of all health and care workers worldwide.

“This reliance demands that we ask ourselves tough questions on workplace conditions and equity, including how we value and reward women in the health and care workforce,” Ghebreyesus said. “And how we guarantee that workplaces are free from discrimination, violence, sexual exploitation and abuse.”

As governments – including those of Mexico, Pakistan, the Democratic Republic of Congo and Liberia – commit to the gender policy initiative, Dhatt said that millions of health and care workers were unpaid or underpaid and had no access to Covid vaccines.

“We must provide incentives for women to stay,” said Dhatt.

The global south has long supplied many of the human resources for health systems in the northern hemisphere. And as the UK, the US and Europe have struggled under the weight of their respective pandemics, demand for imported medical expertise has intensified.

Across the world’s wealthiest countries, nearly 25% of doctors and 16% of nurses were born abroad, according to a brief from the Organisation for Economic Co-operation and Development (OECD). Published in May, it examined how rich countries have sought to attract staff from developing countries in response to the pandemic.

It acknowledged that nations from where staff were being enticed “were already facing severe shortages of skilled health workers before the Covid-19 pandemic”.

The UK launched its own incentive – a fast-track Health and Care Visa in 2020 to attract more health workers from developing countries – even as the government drastically reduced its foreign aid budget from 0.7% to 0.5% of national income, against OECD advice and putting global health systems at risk, according to academics.

The Philippines is the largest contributor of nurses to wealthy countries, OECD data shows. India provides the highest number of doctors, and the second-highest number of migrant nurses.

Mitigating push factors for professionals to leave their countries requires policy to “reinforce international cooperation, notably overseas development assistance and technical assistance, to help less advanced countries build up a sufficient health workforce and to strengthen their health systems”, the OECD brief said.

The Filipino Nurses Association UK has raised concerns about the disproportionately high rate of deaths among NHS and social care staff from the Philippines, saying that the nationality had the highest mortality of all ethnicities, at about 20%. The group set up a special helpline for Filipino health workers and their families as a result. In the US, more than 30% of nurses who have died of Covid were Filipino, though they make up just 4% of the country’s registered nurses, according to the National Nurses United union.

Medical personnel in protective clothing
Medical staff treat patients in a tent at a temporary Covid isolation facility in the car park of the National Kidney and Transplant Institute Hospital in Manila, the Philippines, April 2020. Photograph: Ezra Acayan/Getty Images

In the Philippines, two prominent specialists died of Covid in March 2020: paediatric surgeon Leandro Resurreccion III and Salvacion “Sally” R Gatchalian, the president of the Philippine Paediatric Society.

Gatchalian helped create the Philippines Coalition Against Tuberculosis and led a children’s TB initiative, while Resurreccion was lauded for having returned from Australia to dedicate himself to the Philippines’ health service.

Highly skilled researchers are scarce in low- and middle-income countries, said Glenda Gray, president of the South African Medical Research Council, adding: “Any loss of scientists, either through death or migration, is a concern.”

In fragile health systems, lost knowledge when a community health worker or highly trained medical expert dies can have a long-term impact. And research suggests physician migration costs low and middle income countries $16bn (£11.5bn) annually and lost medical knowledge contributes to excess deaths.

With emigration rates of doctors and nurses as high as 50% from some African and Latin American countries, it can mean that more doctors born in these countries are working in the OECD area than in their countries of origin.

Africa’s research community lost renowned HIV scientist Gita Ramjee to Covid in March 2020.

“Gita was fundamental and inextricably linked to the endeavours to find solutions to prevent HIV in women. She was tireless in this pursuit, her tenacity will never be forgotten,” Gray said. Winnie Byanyima, executive director of UNAIDS, said Ramjee’s loss was “when the world needs her most”.

“The psychological impact of deaths, infections and [increased workloads] prompted many doctors to request leave and, in the event of management refusal, some resorted to resigning from governmental hospitals,” Egyptian physician Abdel Hamid Mahmoud said.

Johan Fagan, an ear, nose and throat disease specialist at the University of Cape Town in South Africa, said policies such as the UK’s fast-track visa would spur further migration.

“These countries aren’t training enough of their own healthcare professionals and are exploiting the workforce in developing countries,” Fagan said. “In a pandemic, this has a significant impact on our health systems and how we’re able to deliver care.”

Algerian Dr Al Arabi Bin Hara predicted a new exodus of skilled workers from his country, saying: “Last year and at the beginning of this year, there was the smallest number recorded in doctors’ immigration because of the closed borders as [a result] of the measures imposed by the pandemic.

“The post-Covid phase will witness a mass flight of doctors, as long as the situation remains as it is and the suffering continues.”

What hurts, said Bin Hara, is that hospitals and clinics in Europe – particularly in France – were attracting Algerian doctors with critical specialisations.

Older people queue while nurses conduct their duties
Older people queue for a Sinopharm vaccination behind nurses at a hospital in Harare, Zimbabwe, in March this year. Photograph: Tafadzwa Ufumeli/Getty Images

In Zimbabwe, a country with one of the highest doctor emigration rates, Dr Charles Moyo said Africa would face a healthcare crisis if the tide of health worker losses was not stemmed.

“The healthcare system is already strained by limited resources and by Covid. If more manpower is lost, the entire healthcare system could collapse,” he said.

The International Council of Nurses (ICN), which has backed the Gender Equal Health and Care Workforce Initiative, celebrated the World Health Assembly’s adoption of the WHO’s updated global nursing and midwifery strategy, which presents policy priorities to support midwives and nurses.

ICN chief Howard Catton said the message was clear, adding: “We must invest now in nursing education, leadership, jobs and practice, and we need member states to own their new strategy and implement it now.

“Of course, the tragic irony is that if we had done this before, we would have had a better protected healthcare workforce, and fewer of our colleagues would have died.”

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‘To survive, I must appear fearless’: the former nun helping India’s garment workers fight sexual violence | India

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Many years ago, when Thivya Rakini was working as a domestic violence activist helping women to escape abusive husbands across the southern Indian state of Tamil Nadu, she took a pair of scissors and cut her long black hair back to the nape of her neck.

“Without my hair, I suddenly looked very frightening to a lot of people who couldn’t believe a woman would cut away her femininity like that,” she says. “I was sending a signal that that those men shouldn’t try to mess with me. Inside, I am really a very tender-hearted person but to survive I have learned that I must appear fearless.”

Rakini – a former nun, divorcee, domestic violence survivor and now union leader – has done a lot with her 42 years. She smashed cultural taboos and became a social pariah for choosing to leave her marriage and bring up her son as a single mother in a remote part of a deeply traditional and caste-bound state.

Now, in her role as president of the Tamil Nadu Textile and Common Labour Union (TTCU), Tamil Nadu’s only female-led garment workers union, she has turned her attention to the multibillion-pound global fashion industry.

Such is her reputation locally that, despite her hair growing long again, her appearance is often enough to strike fear into the hearts of garment factory owners across the Dindigul district of Tamil Nadu where the TTCU is based. “When they see me, they turn pale and run inside,” she laughs. “They tell their workers: ‘Don’t you be talking to her – she’s trouble.’ They try to shut their gates against me but I’ll always find a way in if there are women inside that need our help.”

Rakini talks to textile workers in Thennapatty village, Dindigul city.
Rakini talks to textile workers in Thennapatty village, Dindigul city. Photograph: Sivaram V/The Guardian

Since 2015, Rakini and the TTCU have been fighting what she describes as a “plague” of rape, harassment and sexual violence that has infested global garment supply chains and is being perpetrated on poor women making clothing destined for high streets across the UK.

“As a woman, everything I have done with my life is a source of shame to someone,” she says. “But it has given me freedom to fight on issues such as gender-based violence that are still covered in silence and stigma. I am not afraid to take it out of the shadows and say: ‘This is wrong.’”

Tamil Nadu, a major centre of Indian textile production, is one of the country’s economic powerhouses and home to tens of thousands of garment factories and cotton mills. It is also notorious for the poor wages and bleak conditions imposed on its largely female workforce.

Rakini (centre) with colleagues at the TTCU’s offices.
Rakini (centre) with colleagues at the TTCU’s offices. Photograph: Sivaram V/The Guardian

When Rakini joined the TTCU in 2014, it was a nascent organisation with just a few union leaders trying to help women organise and call for better conditions in their factories. She came on board to help deal with the huge levels of domestic violence that workers were facing. The union office soon become a makeshift shelter for women and their children who had nowhere else to go.

“At that time, we were blocked from most workplaces because many factories didn’t allow workers to join unions and the unions that were active were all run by men,” says Rakini. “Yet women suffering from domestic violence were also telling us about the terrible things they were experiencing in the workplace at the hands of their supervisors and male employees. So it became our mission to try and put a stop to this.”

In her seven years at the TTCU, Rakini has seen enough to pour scorn on the insistence of many global fashion brands that they do everything in their power to protect the millions of poor black and brown women working in garment supply chains. “The truth is that sexual harassment, rape, even murder has become part and parcel of the lives of women working in garment factories in my district,” she says. “International brands who buy from Tamil Nadu know very well that women in their supply chains are exploited to the core, they know the impact that their production targets and their poverty wages have on the workers’ lives. Their auditors know their inspections are meaningless. Their whole system is a lie.”

The TTCU began taking on cases of sexual harassment and abuse that none of the larger unions would touch. “In those factories, the women have no power. They are often the main breadwinners for their family and although their pay is meagre, they must keep their jobs at all costs. They feel they have to do whatever their bosses demand of them,” Rakini explains. “When we first started going to the factories to complain, the management would just kick us out. They didn’t care.”

Just over a year ago, in February 2021, Rakini got a phone call from the family of a young garment worker called Jeyasre Kathiravel, who had failed to come home from her shift at Natchi Apparels, a local clothes factory supplying brands including H&M. Rakini says that she had already approached Natchi Apparels in 2019 after women complained about being sexually harassed, but had been told not to get involved in factory business.

After Kathiravel’s disappearance, Rakini and the TTCU say they once again tried to approach Natchi Apparels, this time about Kathiravel’s disappearance but were rebuffed. Four days later, her body was found in farmland close to her village.

Rakini outside the home of murdered textile worker Jeyasre Kathiravel.
Rakini outside the home of murdered textile worker Jeyasre Kathiravel. Photograph: The Guardian

Her supervisor at Natchi Apparels was arrested shortly afterwards and her grieving family claimed that he had been inflicting relentless sexual harassment and abuse on their daughter in the months leading up to her death, but that she had felt unable to stop what was happening. He has since confessed to her murder and is in jail awaiting trial.

In the weeks after the murder, despite threats and intimidation from the factory management, Rakini and the TTCU leaders spent weeks travelling between garment worker villages, taking testimonies from dozens of other women who said that they had been raped, coerced and intimidated into sexual relationships with their managers at Natchi Apparels.

At the time, the management at Natchi Apparels denied that there was any violence against female workers at its factory. It has since said that while it still disputes some of the claims, it has taken all the allegations seriously and as a result has “created systems, processes, and procedures to protect and promote the rights of female workers”.

“It was a very painful time because the workers said that they were coming under a lot of pressure from the factory over Jeysare’s death and they were scared of losing their jobs, yet they wanted to speak out about what they were experiencing as they were all terrified they would end up like her,” says Rakini. “Asking women to tell their stories of gender-based violence is a big responsibility and we understood the risks that they were taking and the trust that they were putting in us.”

Rakini with textile workers at Thennapatty village.
Rakini with textile workers at Thennapatty village. Photograph: Sivaram V/The Guardian

The sad truth, Rakini says, is that there is nothing particularly unusual about the levels or severity of sexual violence that were found at Natchi Apparels. She says that over the past five years, the TTCU has received dozens of reports of deaths, rape, physical assault and sexual harassment from workers at garment factories across the district. Yet the impact of the statements collected by Rakini and her TTCU colleagues in the weeks after Kathiravel’s death has been immense.

As a result of those testimonies and an independent investigation into sexual violence at the factory, its client H&M agreed to enter into negotiations with the TTCU and international labour groups. The TTCU helped negotiate a series of agreements at Natchi Apparels with both H&M and Eastman Exports, the company that owns Natchi. Last month, a year after Kathiravel’s death, a series of legally binding agreements that aim to eliminate all gender-based violence and harassment from the factory floor were signed.

“This is the first agreement of its kind in India and has the power to save women’s lives,” says Rakini. TTCU members will sit on the internal complaints committee and act as monitors on the factory floor, to supervise the supervisors and to help ensure a zero-tolerance approach to violence in the workplace.

Since the news of the agreement that has been reached at Natchi, the TTCU has been inundated with requests from women at other factories begging it to come to their aid. “This is just the start,” she says.

Rakini’s fearlessness in taking on the might of Tamil Nadu’s garment industry is extraordinary considering the mafia-like hold that textile companies exert over garment-worker communities. She and her TTCU colleagues have faced death threats and harassment and she says that she was nearly driven off the road while riding her scooter, when investigating the disappearance of two workers from a cotton-spinning mill.

Yet she is undaunted. “In my own life, all my struggles I’ve faced alone,” she says. “Now, at TTCU, for these women, I want to be the person I needed when I had nobody to turn to.”

Rakini was born in a small rural village in Dindigul, in the south of Tamil Nadu. Her father was a brick kiln worker turned local entrepreneur who ran a biscuit factory out of their home. One of five daughters, she was the only one to get an education after she waged a campaign of attrition against her parents to be allowed to go to the local convent school.

“I greatly admired my father but we were all afraid of him,” she says. “He was very strict and it was very unusual for daughters to be educated. All my sisters had left school by the time they were 10 so it was a struggle to convince him.”

Rakini persevered, even going on hunger strike. When her father finally relented, he went around the community asking people to help raise money to pay her fees. She loved the routine and discipline of the convent school, as well as the faith and serenity of the nuns. When she was 18, she decided to join the religious order and spent seven years training to become a nun at the convent. Yet, one year before her training ended, she grew disillusioned with the order after witnessing her abbess turn away a desperate woman and her baby who came begging for help.

“I realised that I couldn’t stay in a place where they would turn away the most vulnerable,” she says. “I felt a duty to God and to my family, but a greater duty to that woman who came in desperation but was turned away.”

When she left the order and tried to return home, her family turned against her. “My father said to my mother: ‘I’ll cut her into pieces,’ because I had brought great shame on them,” she says.

Rakini with Jayasre Kathiravel’s parents.
Rakini with Jayasre Kathiravel’s parents. Photograph: Sivaram V/The Guardian

Rakini further enraged her community when she decided to marry a man without her family’s permission. “It was unheard of for a woman to do such a thing. It was seen as a great insult to my family,” she says. “After that, I wasn’t a daughter to them any more.”

She had a child but, soon after, she says her husband and his family started brutally beating her. “I hadn’t brought a dowry so my mother-in-law said I was worthless,” she says. She claims they poured boiling food over her and kicked her on the ground as her baby son lay beside her.

“One day, I just thought: ‘They’ll kill me and I have so much more living to do,’” she says. “I left the house and the next day I went to my son’s creche and picked him up and we ran away. Since then, it has just been the two of us. Over the years we have faced great harassment and stigma, and I have struggled to support us both as a single mother, but I have never once regretted my decision. I am the only one that runs my own life.”

Now, her goals as president of the TTCU are to extend the union’s reach into more factories across the region and get other international brands buying from factories in Tamil Nadu to sign similar agreements as that now at place at Natchi Apparels. “We are a very small union, in a very remote area, far away from where most of the clothes our members make are sold. Yet we have shown what can be achieved if you act fearlessly in the face of oppression and refuse to be silenced,” she says.

“I have known my own power my whole life. Now, I want other women to understand that they, too, deserve to live a life where they don’t have to be scared. We are all human and our voices all deserve to be heard.”

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Xinjiang Police Files: Secret police files put a face to China’s repression in Xinjiang: Child prisoners and ‘shoot to kill’ orders | International

Voice Of EU



China’s extensive and brutal campaign of repression against Xinjiang’s Uyghur Muslim minority is taking on a face for the first time. Tens of thousands of police files, photographs and official documents by senior officials of the Communist Party of China (CPC) to which EL PAÍS has had access offer unparalleled proof of the magnitude of the prison system established in China’s far western region of Xinjiang and the paranoia that guides Beijing’s policies against ethnic minorities. The investigation was led by Adrian Zenz, a German scholar and expert on the Xinjiang internment campaign, in collaboration with 14 media outlets from 11 countries.

Named the Xinjiang Police Files, the cache of secret documents makes it possible to identify thousands of inmates in so-called re-education centers built by China, including minors; to determine their internment status; and to show through images taken inside the facilities how officers practice detention, interrogation and abuse. The files also detail instructions for the police officers that are reminiscent of prison routines, and contain transcripts of public speeches by top leaders of the CPC in Xinjiang, among them the former regional secretary Chen Quanguo, showing support for the doctrine of maximum security against prisoners, and advising to open fire if a prisoner compromises the safety of the camp or tries to escape.

“Behind this systematic repression is the fear and paranoia expressed by [Chinese President] Xi Jinping about the resistance of the Uyghurs to the state’s attempt to control them,” said Zenz, Director and Senior Fellow in China Studies at the Foundation, in a telephone conversation with EL PAÍS. According to the study carried out by this academic, the confinement of Uyghurs in re-education camps is the “largest internment of a religious ethnic minority since the Holocaust.” At least one million citizens, most of them Uyghurs, have been locked up in re-education camps scattered across the geography of Xinjiang, according to a figure that is widely agreed on by journalists, academics and the United Nations.

The Xinjiang Police Files have been obtained by an anonymous third party by hacking into computer systems operated by the Public Security Bureau (PSB), which has police functions, in the Xinjiang counties of Konasheher, located in Kashgar prefecture, and Tekes, in Ili Kazakh prefecture. This individual, who prefers not to be identified for security reasons, acted on their own initiative, without conditions or a mandate from any of the researchers involved in the project. The documents and images have been authenticated by this group of journalists, as well as the existence of three re-education centers from which the files were obtained, thanks to a geolocation process based on the photographs taken by the officers.

Mugshot of Ilham Ismayil, 27, at a so-called re-education center.
Mugshot of Ilham Ismayil, 27, at a so-called re-education center.

The prefecture of Kashgar, located in what is officially the Xinjiang Uyghur Autonomous Region, on the the border with Kazakhstan and Kyrgyzstan, is precisely one of the stops planned on the official trip initiated this Monday by the United Nations High Commissioner for Human Rights, former Chilean president Michelle Bachelet. Her visit to the re-education centers for Uyghurs, the majority ethnic group in this region of some 25 million inhabitants, was one of the fundamental demands made on Bachelet by human rights organizations. The Xi government first acknowledged the existence of these facilities in a white paper (a reference document that guides state policy) in October 2018. However, Beijing rejects the accusations about the repression of minorities in Xinjiang. and claims that these centers serve for the education and training of “students” who are free to move around. The regime calls these camps Vocational Skills Education and Training Centers.

12% of adults locked up

The Xinjiang Police Files show a very different reality. As an example, according to an analysis of thousands of police files in Konasheher (the records of the security services covers about 286,000 citizens, almost the entire population of this county), and based on the census in the 2017-2018 period, it emerges that at least 12.3% of the adult population suffered some type of internment in re-education centers, detention centers (for inmates awaiting sentencing), or prisons.

Asked about the contents of the leak, a spokesman for the Chinese Embassy in the United States, Liu Pengyu, stated in an email: “Xinjiang affairs are related, in essence, with the fight against violent terrorism, radicalization and separatism, not human rights or religion. Faced with the serious and complex anti-terrorism situation, Xinjiang has taken a series of decisive, solid and effective de-radicalization measures. As a result, Xinjiang has not seen any cases of violent terrorism for several years in a row.”

On Tuesday, Chinese Foreign Ministry spokesperson Wang Wenbin described the information as “a new example of anti-Chinese forces trying to slander China,” EL PAÍS correspondent Macarena Vidal Liy reported from Beijing. “It’s just a repetition of an old trick. Spreading rumors and lies will not deceive the world or conceal the fact that Xinjiang enjoys stability and prosperity, and their residents enjoy safe, happy and fulfilling lives.”

The Xinjiang Police Files contain, among other documents, 5,074 mug shots taken in police stations or confinement centers in Konasheher County between January 6 and July 25, 2018. This is one of the great contributions made by this research project to the study of Chinese repression. Of these photos, 4,989 have been attributed to an individual with detailed information on file. EL PAÍS has analyzed a final sample of 2,884 photographic records of detainees that have specific data attached from the files obtained from the PSB computer networks. The bulk of internees are under 30 years of age (69%), for a total of 2,001 citizens. Men also predominate: 2,490 (86%) compared to 394 women (14%). Among the inmates, there are people of all ages (between 15 and 73) and of all educational backgrounds (from those who never went to school to university students).

This investigation follows several others that since 2019 have tried to prove the magnitude of the systematic repression campaign carried out by China’s communist regime against the Uyghurs, most of whom are Muslim. Xinjiang, which borders seven Central Asian countries to the west, is of special relevance to Beijing, first because it is a commercial crossroads on its revitalized Silk Road, and, secondly for security reasons: inner China is dominated – socially, politically and economically – by the majority Han ethnic group. This region, located in the eastern part of historic Turkestan, between the Caspian Sea and the Gobi desert, with a history and culture linked to the Turkic peoples, and differentiated facial features, has maintained a traditional desire for autonomy that Beijing has rejected and practically annihilated.

The relocation of Han citizens in an effort to change the demographics of Xinjiang led to heavy fighting in the late 2000s. One of the bloodiest episodes was the clash between Uyghur and Han ethnic groups in July 2009 in Urumqi, the region’s capital, which ended with around 200 deaths. After several attacks by armed separatist groups, Xi gave the green light in May 2014 to the campaign called Hard Strike Against Violent Terrorism, in which the current repression throughout the region is framed.

A satellite image of a detention camp.
A satellite image of a detention camp.

The Uyghur citizen Abdurahman Hasan is one of the relatives who has confirmed the veracity of the police records by identifying his wife during an interview held in Istanbul (Turkey) with the British news channel BBC News, which is part of the media group behind this investigation. Hasan, a businessman from Kashgar who frequently traveled abroad, an activity that regularly arouses suspicion in Beijing, left Xinjiang in January 2017 amid a crackdown. In the summer of that year, his wife, Tunsagul Nurmemet, then 21, was arrested, along with Hasan’s mother. According to her file, Nurmemet was convicted of “gathering a crowd to disrupt the social order, picking fights and causing trouble.” “Her life revolved around her family and she didn’t interact much with others,” Hasan explained during the conversation in the Turkish city. “She only visited relatives, I don’t know if she had many friends. She didn’t have a big social network, so how was he able to gather a crowd?” Her sentence amounts to 16 years in prison.

The picture obtained from the Xinjiang Police Files shows an unrecognizable Nurmemet in relation to the ID photo available in databases of Uyghur victims of Chinese repression. According to the information that Hasan received in the summer of 2017, his wife and mother had been “taken off to study.”

This version coincides with many others heard by overseas relatives. This was the case with a woman named Nursiman Abdureshid, 33, interviewed by EL PAÍS in Istanbul. Her relatives appear on police records in Kashgar prefecture. In the summer of 2017, Abdureshid, who had been living in Turkey for two years, learned through a call to relatives that her father and younger brother had been taken to an “education program.” The eldest of her brothers had been locked up since 2016 for an alleged debt. They asked her not to call anymore, that her relatives were fine. In June 2020, Abdureshid managed to get the Chinese embassy in Turkey to confirm the sentences imposed on her family members, all exceeding a decade behind bars. “I asked about the reasons why they had been sentenced,” Abdureshid recounted during the interview. “They told me that it was for ‘disturbing the peace’ and because they might have the intention of participating in terrorist activities.” The woman’s father had been a state official and a member of the CPC. She believes that her departure from Xinjiang, as well as her sister who lives in the US, may have triggered the repression against her family.

Secret documents leaked from the police files.
Secret documents leaked from the police files.

The Xinjiang police archives also contain dozens of photographs taken by authorities and security services in Tekes County, Illi Kazakh prefecture. Around 30 of these images, taken between April 2017 and September 2018, capture scenes inside the re-education center of that county. Contrary to what is publicly claimed by Beijing, the attitude of the officers inside the facilities, their weapons and the treatment of the inmates is far from what could be expected from a professional training center.

Handcuffs, hoods and the “tiger’s chair”

The photographs show the inmates with hoods over their faces and their wrists handcuffed together when they are transferred from one place to another. There are officers with batons, who are usually of Uyghur ethnicity, while others – typically Han Chinese officers – carry assault rifles and riot gear. According to the photos from Tekes Detention Center, the inmates are interrogated in so-called “tiger chairs” – a steel chair with iron legs and handcuffs designed to restrain people, often in painful positions. These chairs are one of the many instruments of torture used against the Uyghurs, according to the NGO Human Rights Watch. Photographs from the police files confirm what was exposed in the 2019 leak of 400 pages of internal Chinese documents: inmates injected with unknown substances, forced to recite the rules of the camp and listen to the propaganda of local authorities.

It is estimated that one million people have passed through China’s re-education centers, but this is likely to be a very conservative figure. The leak includes a transcript of a speech by China’s Minister of Public Security Zhao Kezhi on June 15, 2018 In this speech, which is classified as “secret,” Zhao warns that more than two million people in southern Xinjiang alone had been “severely influenced by the infiltration of extremist religious thought.” These are two of the three “demons” on Beijing’s axis of evil: terrorism, separatism and radical Islamism.

In the speech, Zhao celebrates the “success” of the “strike hard” and “de-extremification” campaigns in Xinjiang, and claims that 20,000 “terrorists” had been eliminated – without specifying how. This number is five times higher than what has been reported in the past 10 years.

The leak also contains transcripts of speeches delivered by then-Xinjiang Party Secretary Chen Quanguo. Chen is considered the mastermind of China’s repression against the Uyghurs, and the man responsible for the spread of re-education centers, which have been growing in number since 2017. Before being appointed Xinjiang party secretary, Chen had made a name for himself in Beijing for his ruthless securitization of Tibet.

A group of inmates at the Tekes detention camp in 2017.
A group of inmates at the Tekes detention camp in 2017.

In a speech on May 28, 2017, the Communist leader describes the detention centers as “humane” because inmates have air conditioning, daily food rations and the possibility of receiving visitors. While an analysis of the documents from the 2019 leak suggests that most inmates were detained for a year, his 2017 speech indicates that this may not be the case. “If they leave,” the transcript reads, “the problems come back immediately, this is the reality of Xinjiang.”

Chen’s rhetoric is even more aggressive in a 2018 address. The text advises guards to open fire on any inmate who tries to attack the center, stating: “kill first, report later.”

His advice did not fall on deaf ears. Several documents in the leak indicate that his policy has become fundamental to policing Uyghur inmates. If a so-called “student” tries to escape, local authorities are advised to close the road and call for special forces. The document states that armed police may fire a warning shot. If the prisoner continues to flee, they have orders to “shoot to kill.”

“The re-education camps,” concludes Zenz, who has been sanctioned by the Beijing authorities for his influential research on Xinjiang, “are designed to the change the minds of the Uyghurs, their hearts, to break their loyalty to their culture, history, their Turkic heritage, including religious faith; to change all that, nip it in the bud and steer it towards the Communist Party of China.”

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‘Global crisis’ of violence: 161 healthcare workers were killed last year, study finds | Conflict and arms

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Violence against healthcare workers has become a “global crisis”, with 161 medics killed and 188 incidents of hospitals being destroyed or damaged last year, according to a new report.

Data collected from 49 conflict zones by the Safeguarding Health in Conflict Coalition (SHCC), also found that 320 health workers were wounded in attacks, 170 were kidnapped and 713 people were arrested in the course of their work.

The US-based group said on Tuesday that, although the total number of attacks was similar to those recorded in recent years, there had been an increase in violence in areas of new or renewed conflict in 2021, “underlining the fact that attacks on healthcare are a common feature in many of today’s conflicts”.

Leonard Rubenstein, chair of the coalition and a professor at Johns Hopkins University’s school of public health, said: “The world’s attention has understandably focused on Russia’s invasion and its apparent strategy of targeting hospitals and ambulances, with more than 200 attacks on healthcare in Ukraine confirmed by the World Health Organization through [to] the end of April. Such violence against nurses, doctors and other health workers, however, takes place throughout the world and amounts to a global crisis.”

In Afghanistan, the coalition recorded an increase in reported violence last year compared with 2020, after the takeover of the Taliban. The attacks included the death of a prominent surgeon who was killed while travelling in the country’s Baghlan province in February 2021.

A wrecked operating room in a hospital with oxygen tanks and lights, and a large hole in the wall from shelling
A hospital damaged in the fighting in Ethiopia last December. Photograph: Anadolu Agency/Getty

In Ethiopia’s Tigray region, where the federal government is fighting the Tigray People’s Liberation Front, 79% of health facilities have been destroyed since the conflict began in November 2020 and only 3% remain fully functional.

The SHCC found that 30 health facilities were damaged in Gaza last year, and in Myanmar, the public health system has all but collapsed since the coup in February 2021, with more than 300 health workers arrested.

The group said the figures, drawn from governments, media reports, international organisations and aid agencies, were likely to be a significant underestimate, due to underreporting from many countries around the world – in particular those that have experienced internet shutdowns.

Christina Wille, director at Insecurity Insight, which led the data collection and analysis, said: “Violence against healthcare resulted in widespread impacts on public health programmes, vaccination campaigns and population health, contributing to avoidable deaths and long-term consequences for individuals, communities, countries and global health writ large.”

The report calls for the UN security council to refer credible reports of attacks on healthcare, which are considered war crimes, to the international criminal court, for governments to use their powers to prosecute these crimes, and for military leaders to review and reform practices and provide training to prevent attacks.

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