Safe Injection Sites for Drug Addiction: Part of the Solution or Part of the Problem?

By Alex Richards

It is almost universally accepted that drug addiction is a serious global issue. Not only does addiction wreak pitiless destruction on the health and personal life of the addict, it is also a major cause of other crime, as a result of both gangs’ and drug cartels’ attempts to control the lucrative trade of illicit drugs and addicts’ attempts to appease addiction’s physiological extortion.

But despite decades of harsh prohibition and countless billions spent on the policing and incarceration of narcotics growers, processors, dealers and users, abuse of hard drugs is still entrenched in contemporary society. As such, many people have come to doubt traditional methods of dealing with this social ill due to their high financial cost and perceived ineffectiveness, as well as ethical concerns over the ostracism and incarceration of addicts.

Safe injection sites, sometimes called supervised injection sites or drug consumption rooms, were devised as an alternative to the strictly prohibitionist measures which compose the vast majority of drug policy across the globe.  Following the harm reduction philosophy, safe injection sites aim to reduce the negative impact of drug abuse while making it easier for addicts to quit drugs. Safe injection sites are a designated space (usually indoors) where addicts can use drugs more safely and without fear of legal reprisal. The sites provide clean needles to addicts to help prevent the spread of serious blood-borne diseases such as AIDS and hepatitis, have medical staffs to treat overdoses, and offer access to medical and rehabilitation services that would otherwise not reach many addicts who are often homeless, impoverished or mentally ill [1,2,3].

The first government-sanctioned safe injection site opened in Berne, Switzerland in 1986, and sites can now be found in Europe, Australia and Canada [2,4,5]. The first safe injection site in North America opened in Vancouver’s Downtown Eastside in 2003. The Downtown Eastside is a poverty-stricken [1,6,7] area of Vancouver which is experiencing what has been described as an “injection drug epidemic”. It is estimated that in 2000, there were approximately 4,700 injection drug users living there. It also estimated that 17 to 31 percent of intravenous drug users are HIV-positive and that the total medical costs of HIV in IDUs in Vancouver’s Downtown Eastside is upwards of $215 million [8]. The safe injection site, known as Insite and operated primarily by Vancouver Coastal Health, was created to help salve the dire effects of the crisis on the area’s social and medical well-being.

Vancouver’s safe injection site has certainly been busy, running at near capacity almost since its opening [1]. In the two year period between April 1, 2005 and March 31, 2007, 7648 different individuals were registered at the site, and there were an average of 645 users per day. Many would argue that Insite has accomplished its intended goals; During that same 2 year period, more than 2,500 referrals were made for addiction counseling and although there were 696 overdoses, there was not a single fatality at the site [9].

Despite the relative success of Insite, vehement criticism of safe injection sites is still plentiful. Federal Health Minister Tony Clement is a noted critic of safe injection sites, as is the Conservative government in general, citing them as unethical [10,11,12]. Opponents argue that it is wrong to let people use drugs with impunity and that safe injection sites are a dangerous legal double standard [6,13,14]. The International Narcotics Control Board, an independent UN organization, has expressed concerns that Insite violates international drug treaties [15,16,17]. Some people have also argued that injection sites increase crime in the local area and lead to increased drug use [6,18,19]. However, a report completed by two BC criminologists and commissioned by the RCMP refuted these fears (at least in the Vancouver context), finding that Insite neither increased crime nor drug use in the surrounding area [6,20,21].

Even now that Canadians have been able to observe the effects and results of a safe injection site, public opinion remains very divided.

The Only Thing Aid Feeds Is Hunger: The Failure of Development in Africa

by Lauren Sampson

In 2005, American economist Jeffrey Sachs published The End of Poverty: Economic Possibilities for Our Time, in which he calls extreme poverty a “global emergency” and exhorts the developed world to increase funding to debt-ridden countries, claiming that if development aid reached between $135 and $195 billion by 2015, world poverty will end. [1]

Well and good. Or, to phrase it correctly, well-meaning and good. Sachs’ idealism is a driving force behind the ideology of aid, which is a belief system espoused by everyone from Angelina Jolie to Bill Clinton. It boils down to the following: throw money at a problem, watch it disappear and commend yourself for your empathy, charity and liberalism.

Say all you like about how every dollar counts. The simple reality is that over the past fifty years, developed nations have channelled $2.3 trillion USD into international aid. [2] Yet all that money hasn’t even come close to making poverty history. The rate of African poverty actually increased from 11% to 66% between 1970 and 1998. [3] And yet the cries for more money are unceasing.

To extend a medical metaphor, aid is intended to treat the symptoms of crushing poverty, not the disease, and sometimes it fails to do even that. Aid has in fact, become part of the problem – a hindrance to economic self-sufficiency and political autonomy.

Africa is an excellent illustrative example of the ineffectiveness of the once-hallowed aid ideology. In fact, ActionAid, a South African based anti-poverty organization, published a report in 2005 claiming that almost 50% of all aid received in 2004 was “phantom”. [4] That is, aid was badly aimed, calculated twice as debt relief, tied to donor products or attached to a series of conditions. [3] Approximately 40% of Canada’s aid fell into this grouping. [3]

And it gets worse. In 2004, ¼ of global aid (approximately $20 billion) was spent on “technical assistance”, a widely censured form of aid that involves the sending of consultants, trainers and other outside experts, from developed to developing nations. [3] Because foreign experts are often poorly informed or prepared as to local conditions, their training and advice can prove ineffective, or even counter-productive. Former World Bank economist William Easterly argues that such individuals epitomize the modern “white man’s burden”: well-meaning North Americans committed to utopian ideas intended to raise indigent states out of their wretched poverty. [2] Any benefits to the donor nation are attributed as by-the-way conveniences.

A less subtle example of Western beneficiation is tied aid, which must be spent on goods and services from donor nations. According to estimates from the Organization for Economic Co-operation and Development (OECD), tying aid essentially constitutes protectionism, increasing costs by eliminating competitive bidding. [4] Poor nations are then not permitted to spend aid money on goods and services produced domestically. Canada today ties 47% of its aid while the US ties 70%. [3] The interests of the first world have always and will always come first.

And of course, when money actually enters a country, it can often do more harm than good. Foreign aid has become the primary source of income for several African countries, constituting 97% of the government annual budget in Ethiopia and the Gambia. [5] If a country’s revenue is principally derived from sources outside of its territory, its government is no longer dependent on tax dollars and is consequently not accountable to its population. Aid money rolling into Africa can bankroll brutal regimes – a critique of the Live 8 concerts (prime examples of the cloying spectacle that aid has been reduced to) argued that aid to Africa has simply propped up dictators and despots. [6] William Easterly notes that the world’s 25 most undemocratic government leaders were granted $9 billion in foreign aid in 2002. [2] Conflicting interests are at play – while loans to Chad were frozen during Paul Wolfowitz’s time as President of the World Bank because of concerns surrounding government corruption, they were resumed after Chadian President Idriss Deby threatened to cut off oil exports to the West. [7] It is perhaps naïve to believe that anything other than economic expediency is the order of the day.

Ultimately, foreign aid is a vicious cycle, with the capacity to distort wages and exchange rates within a recipient country, reducing competitiveness. [5] It undermines any pretence at democracy by making African governments answerable to donors rather than their electorates. And it can further entrench unhealthy aid dependency, stifling investment and leading to higher rates of poverty – all of which, in turn, creates a demand for yet more aid. Dambisa Moyo, a Zambian economist, argues that:
“There is no incentive for long-term financial planning, no reason to seek alternatives to fund development, when all you have to do is sit back and bank the cheques”. [3]

The idea is slowly crystallizing in Western and African consciousnesses; for example, in February 2009, Rwandan government officials decided to reduce dependence on foreign aid by a considerable amount in order to strengthen economic autonomy. [8]

But why then is aid such a sacrosanct concept? Why are we morally bullied into forking over billions of dollars every year for foreign aid, which demonstrates only the most isolated of gains? The logic to this paradox is both political and personal. Presidents plug foreign aid programmes to divert an electorate from unpopular wars and flagging national programs. Aid workers point to the delivery of equipment and manuals as proof of a job well done and disregard actual usage or outcome. In the West, aid boosts a donor’s public image or self-esteem, functioning as a public relations move rather than a long-term viable solution. In Africa, aid can harm more than it helps. Donating money makes us feel noble, as if we’re part of the solution and places us on a sanctimonious perch, from which we can look down on Africa, shake our heads and write cheque after magnanimous cheque. It may not be useful but at least we’re doingsomething. Right?

Wrong. Africa is not the place to try out a Marshall Plan 2.0, for development and reconstruction are hardly identical. Perhaps foreign aid is championed for the same reasons as democracy: it is simply the most familiar and idealistic system we have. But aid is not the only way to vitalize an underdeveloped region. As the rapid advance of Asia’s poorer countries in the past fifty years demonstrated, indigenous economic activity is a necessary source of domestic growth. [2]

What then are Africa’s solutions, the more effective ways to bankroll development? In Dambisa Moyo’s view, realistic steps must be taken to eradicate trade barriers within Africa. [5] The OECD should cut agricultural subsidies, which prevent African farmers from exporting their goods abroad. [4] Transferring money (particularly remittances from those overseas) needs to be made an easier, cheaper and more efficient process. [5] Moyo also argues that direct investment (particularly on the part of China, which sunk $900 million into Africa in 2004) and the consequent construction of infrastructure such as roads and railways to extract minerals and crops have had a largely positive effect. [3] Small scale banking schemes, including microloans (extension of small loans to stimulate entrepreneurship, as per the Indian Grameen Bank and Kenyan K-Rep Bank) and micro-financing (poor households and businesses are given access to financial services) are also possible sources of growth. [3]

The top-down system of international aid has mostly been a failure, for both ideological and economic reasons. It places conditions on loans that contradict the desires of elected governments and may harm the poorest inhabitants of a country. It is poorly synchronized and rarely accountable, as donors make lofty pledges (like the Millennium Development Goals) and then do little to see them through. Western beliefs and traditions are thrust upon unsuited regions while lessons of the past are never truly learned. Success is measured by how much money is promised, not what results are generated.

Even if the suggested prescriptions do not work instantaneously or on a grand-scale, they will at least give small-scale entrepreneurs, farmers and business people opportunities extant in other of the world and give Africans even a modicum of control of their own economic destiny.

Be the Change You Want to See in the World

By Lindsay Kline

Have you ever thought about participating in a humanitarian program? Wanted to go to Africa, Asia or Latin America to teach English or build houses? What about raise money for relief aid? If so, you have intrinsically approached development aid.  Furthermore, would you question the plausibility of such desires? I question your incentives, because I am seeking to show that development aid has a multi-faceted identity that includes economic, social and political approaches that cannot simply be defined as right or wrong. Rather, aid constitutes various approaches that provide opportunities for people of different backgrounds and motives for methods to participate.

Development aid is often criticized from standpoints of the economy. Belief are that development aid hinders self-sufficiency and political accountability, and that funds are often mismanaged. However, I feel that these criticisms are not satisfactory to the very nature of the existence of development aid. Is it necessary to be so critical? Can’t we just accept development as being a slow moving process that needs time in order to be fully implemented?  In contrast to these critical perspectives, a study from the Canadian International Development Agency (CIDA) proclaims that 78% of Canadians support Canada’s aid program. [1] This staggering statistic indicates that Canada has not taken the wrong approach and that programs are well sustained by Canadians. I raise these points to introduce methods of development aid that have proven to make a difference in developing nations, as well as provide us with evidence and hope that our approach has not been wrong, or right, but simply just different.

Developed nations such as Canada have been labeled as taking a “band-aid approach” with development aid incentives. This means that, we often make quick fixes to long-lasting and complex issues that extend beyond our relief efforts. A specific example of these initiatives includes Oprah Winfrey’s 40$ million dollar all girls school that opened in South Africa in 2007, her goals were to provide education on issues such as HIV/AIDS and further promote the important role of young girls and women in African society. [2] Live-aid that took place on July 13, 1985 is another example of a collaborative effort to bring issues of poverty to the table. Additionally, small-scale operations like World Vision are continually occurring to provide developing countries with clean-water, education, and better agricultural means among many other goals. These “band-aid approaches” allow the average person to participate in making a change. This approach embraces the idea that any form, quality or quantity of aid will help. Wouldn’t you rather stop for a moment and reflect on the changes that have occurred, and feel proud that small differences are continually being made, that at any moment you as an individual have the power to participate in making those differences?

Have you ever watched the film Hotel Rwanda? Shake Hands with the Devil? The Killing Fields? Or even just the Evening News? Have you heard the song Imagine? Or Feed the World? All of these media sources have an integral part in the promotion of development aid. Essentially, they help to educate industrialized nations of the events going on in developing countries. In a 2004 CIDA study related to knowledge of aid programs and information, however, results indicate that 55% of Canadians “do not consider themselves informed about Canada’s aid program for poor countries.” [1] In order to alter this number media’s prevalence in broadcasting world events provide various perspectives, points of view and opinions that should inform Canadians of Canada’s foreign policy. Media’s predominance in society promotes that “information would be best delivered through television, newspapers, and the Internet as these are the preferred sources of information on Canada’s aid program.” [1] The media helps us to learn what’s going on, form opinions and inform others, become involved, question government action or inaction to ultimately increase development aid.  For these reasons, I feel that while our approach to development aid relies much on popular culture, images, and stories produced by the media, isn’t this promoting long term education that citizens are willing to engage in?

Millennium Development goals, government aid and United Nations initiatives have been integral to our approach to development. Have they worked? Not always. Are we wrong for trying? Definitely not. I make this statement for the reason that long-term goals do not necessarily experience the same highs as short-term goals like the “band-aid” approaches or media’s involvement. For example, long-term objectives set forth by the United Nations Millennium Development Goals have eight provisions that adhere to growth and development plans for undeveloped countries to be met by 2015. Current studies indicating success show that “Asia and the Pacific regions are on track to reducing poverty and implementing basic education and that hunger and basic education goals seem likely to be met”. [3] This progress indicates that aid constitutes more than a simple economic approach, rather social and political initiatives promote development by addressing issues at a grass roots level to further build upon a bottom- up approach. This approach provides most beneficial outcomes, however, requires careful time and consideration in order to be successfully implemented as a long-term initiative. Current UN Secretary General Ban Ki-moon recently stated “we have made important progress in this effort, and have many successes on which to build. But we have been moving too slowly to meet our goals”. [4] While these goals are far from being achieved I question whether this is our own wrongdoing? Or due to unforeseen international events such as 9/11, natural disasters, war on terrorism or the election of President Bush that hindered the progress of such incentives. The problem with setting long-term goals is that countries committing themselves to objectives are doing-so without recognition that other events can and will occur to hinder these processes. We can become critical of the pledges we make to development when goals have not been met. However, when we realize simply that other occurrences have prevailed along the way. Approaches taken by institutions and governments have not been wrong, as much as they have been too focused on long-term goals. Therefore, my suggestion is to encourage a changing-of-lenses from economic to social and political perspectives to create stable, short-term goals that continually can be met and inhibit questions of why our approach isn’t working. 

The international community has unnecessarily categorized development as having right or wrong qualities. What constitutes development that is right? Has there always been a right way? Have we taken an easy approach that seems best fit for our society? Or historically seems to have been the only way? While these questions provoke thought and interest, they are also intended to help us realize that approaches exist by means of individuals taking advantage of their resources and making something out of nothing. Providing development aid has been our creation and continues to be supported by us, therefore, it is our responsibility to maintain various social and political strategies linking aid reception to developing countries in order to continue making changes no matter how big or small.

The Palestine Question

By Omer Aziz

Every year, the United Nations, in both the General Assembly and the Security Council, votes on a multitude of resolutions involving Palestine and the settlement of peace. It should be of no surprise that a pattern exists in which countries vote for and against these Resolutions. To take a representative example, the U.N. voted on Resolution 62/26 on 22 Jan. 2009. This Resolution recalled past resolutions in its perambulatory statement and then proceeded to outline the action to be taken. It requested “the realization of the inalienable rights of the Palestinian people, including their right to self-determination, to support the Middle East peace process” and further cooperation on the Question of Palestine. [1] The vote on the Resolution was decisive: 107 yes, 8 no, and 57 abstentions. The ‘No’ side were: Australia, Canada, Israel, Marshall Islands, Micronesia, Republic of Nauru, Palau, and the United States. Like so many resolutions every year, it was the world on one side, and the United States, with some of its allies (note that France and Britain abstained) on the other. The question then remains, why is the issue of Palestine still a question when almost the entire world recognises it to be a problem that needs to be solved?

The problem of Palestine as it exists in 2009 began in 1967, during the Six Day War which resulted in a decisive military victory for Israel, and the annexation of East Jerusalem, the Gaza Strip, the West Bank, the Sinai Peninsula, and the Golan Heights. [2] A corollary of the ‘67 War was one of the most cited UN Resolutions since the institution’s inception, namely UN Security Resolution 242, which, called for:

1. Withdrawal of Israel armed forces from territories occupied in the recent conflict;
2. Termination of all claims or states of belligerency and respect for and acknowledgment of the sovereignty, territorial integrity and political independence of every State in the area and their right to live in peace within secure and recognized boundaries free from threats or acts of force. [3]

Three years prior to the 1967 War, the Palestinian Liberation Organization was born, and in 1973 Israel went to war again with Arab states in the region. Following this War, the first movements towards peace were made, resulting in the US brokered Camp David Accords in 1979 between Israel and Egypt, with Israel returning the Sinai Peninsula and Egypt recognising Israel. [4] In fact, it was in February 1971, that Sadat, the President of Egypt, offered a full peace treaty to Israel in return for Israel’s withdrawal from territories it occupied since 1967. Golda Meir’s government in Israel rejected the offer and continued to position troops in the Sinai under General Ariel Sharon, under whose command, the Israeli “Defence” Forces were destroying Bedouin towns and building kibbutzim. [5] This decision was backed by the United States, under Henry Kissinger’s policy of “stalemate,” with the rejection of diplomacy leading to the ’73 War until both Israel and the United States realised that Egypt could not be dismissed. By 1989, a coalition government came to power in Israel, and offered its own “peace” plan: there would be no additional Palestinian state between Israel and Jordan – Jordan already being a Palestinian state. As Noam Chomsky argued at the time, this would be the analogical equivalent of the Jews not needing a second homeland because they already had New York. [6] The second major break-through in “peace” talks came in 1993, with the Oslo Accords, which created the Palestinian National Authority, the policemen of the Territories, and led to recognition of the PLO by the United States and Israel. What were not “conceded” were East Jerusalem, settlements, sovereignty, Palestinian refugees, and borders. [7] For many Palestinians, the Oslo Accords were no peace, but, in the words of Edward Said, were a “Palestinian Versailles.” [8]

After the new millennium, the failure to achieve any sustainable peace has been magnified. Camp David in 2000, the Taba Summit in 2001, the Roadmap for Peace, and the Annapolis Conference to name a few were talks which were held and all failed to establish any lasting settlement. [9] Yet, even with all the handshakes, flowery talk, and high-level visits, Palestinians remain a dispossessed people, and Israelis are no closer to living in security. The way forward should learn from past mistakes, not emulate them. First and foremost, both Israel and Palestine should commit themselves to a peaceful settlement. This means that Israel cannot launch “defensive” or “pre-emptive” wars into Palestine, and Palestinians cannot launch rockets into Israel. Palestinians should recognise Israel as the homeland of the Jewish people, and Israel should recognise the dispossessed Palestinian people. The borders of Israel should be the pre-1967 borders, with Israel getting some of the major settlement lands in the West Bank, giving Palestinians equal land in both quality and quantity. The Capital of Israel should be West Jerusalem, and the capital of Palestine, East Jerusalem. Israel should also accept a fixed number of Palestinians refugees to morally compensate the Palestinians for their plight since 1948. Finally, the State of Palestine should be recognised by states around the world as having the same rights as all other states (e.g Control over its internal affairs, a military, control over its borders etc.), and immediately be given a seat at the United Nations.

This recipe for peace seems highly unlikely. If Israel favours peace rather than expansion, it would negotiate such a deal. If the United States favours peace rather than uncompromising and unconditional support for its ally in the Near East, it will help broker such a deal. If the community of nations favour an end to this sixty-one year old conflict rather than indifference or complacency, they too will politically and morally support the deal. It is time for states and leaders to stop glossing over the past, and start looking at the reality of the Palestinian situation as one that needs to be immediately solved rather than prolonged for another year, another decade, or another generation. It’s time that the question of Palestine finally be answered.

In Defense of Israel

By Matt Turnbull

Regardless of how Israel first came into being as a nation and which groups were displaced at that time, the fact remains that it is now its own country.  As such, it has the same rights as any nation to protect its own interests, citizens, and territory.  And over years of conflict and crisis it has been relentlessly attacked by surrounding nations, each with the stated agenda to wipe out Israel and all of its inhabitants. 

The Palestinian people have been party to these attacks on Israel, allegedly with munitions delivered via underground tunnels.  Even after ceasefires have been called, even with encouragement by international peacekeepers to forge a path to peace, even during and after the Gaza offensive – following which Hamas declared victory – the attacks have not stopped.  They range from rocket and mortar attacks on nearby Israeli towns, sometimes up to 46 km away, to rock throwing at border guards and police. [1][2] There is a culture of hostility towards Israel and the cause has been taken up by Palestinian youth.

This prevailing hostility is understandable: historical reasons, religious differences, mistreatment by Israeli police, and lack of basic supplies are among the factors contributing to this attitude.  How widespread and prevalent it is amongst the entire Palestinian populace is difficult to perceive, but the actions of the few are the most important.

Whatever the motivation, this hostility is completely non-conducive to dialogue.  Israel has no incentive to provide aid to their aggressors.  The escalating cycle of animosity could potentially go on indefinitely, with each side continuing to become more aggressive and irresponsible – the difference is that Israel has the means to keep it up indefinitely. 

Israel holds all the cards: it controls the crossings, the necessities of life, greatly superior force, and therefore the means to peace.  When it comes down to a long-term slugging match the conflict is entirely one-sided.  But cooperation can lead to improved infrastructure, greater mobility, and more lenient regulation on materials allowed in and out of the strip.  Currently, Israel denies many materials entry, on the basis that they could possibly be used to build weaponry. [3][4] This reasoning has not yet been shown to be flawed.

Of course Gaza shouldn’t be deprived of basic needs in order to calm belligerence; the argument can be made that this only exacerbates anti-Israel sentiment.  But these hostile sentiments are precisely what deter Israel from providing aid to the region.  Why supply a population that despises and attacks them?  There is a terrible cycle where Israel refuses aid, making Palestinians more hostile because of major shortages, leading Israel to refuse further aid for fear of its use as military materiel.   

Aid to Gaza is linked to the level of security perceived by Israel. [5] According to the UN, the level of goods entering Gaza decreased after the Hamas takeover, increased after the July 2008 truce was instated, decreased to minimum levels once the truce was broken in November, and increased again after the Israeli military operation in January 2009. [6] Israel is only willing to supply Gaza when it feels secure, and sure that Hamas will not divert aid for its own use.

Although it’s possible that the reduction of violent resistance in Gaza would not correspond to reduced aggression and abuses by Israeli forces, it’s far less likely that the Israeli response will become more lenient of its own accord – that is to say, it’s possible the situation won’t improve if Palestinian violence decreased, but it almost definitely won’t while hostility continues.  As said before, Israel can keep this up as long as Gaza can; it has no urgent need to stand down, and while it is still being attacked, it has no reason to.

A two-state solution is not the answer at this time.  As a nation, Palestine would have even greater agency to carry out its attacks, which are borne of long-standing hatreds and not self-defence.  Being an independent country hasn’t stopped any of Israel’s many other aggressors from attacking or building up munitions, and it would be short-sighted to assume that granting nationhood to Palestine would be the end of outright violence, let alone ongoing animosity. 

But Palestine absolutely does need to be in control of its own destiny and affairs.  In order to establish a strong economic base it needs to develop businesses, infrastructure, and trade, all impossible while Israel’s blockades persist.  And in order for the blockades to be lowered, their necessity must disappear; Palestine must prove they are obsolete.  Trust must be established.  Strong and honest trade links with its powerful neighbour will be absolutely integral to rebuilding Gaza.  A governing body devoted to opposing Israel is also a major roadblock.  Hamas has not proven its commitment to peace, or even to its people, as both Israel and the opposing party Fatah have argued. [7][8]

One would hope that the Palestinian people as a whole would prefer not to be in a perpetual state of conflict and starvation.  Hamas’ currently very low approval ratings coming up to elections may be a reflection of this, but it depends who you ask. [9] What is most needed is a displacement of the autocratic and violent few in favour of a more cooperative and conciliatory government.  The changes will not be immediate – the new order will have to prove its commitment to peace before Israel will feel secure enough to change its policies.  But continued violence will not encourage cooperation.  A neutral third party would also be preferred to enter the region and disarm rebellious elements – an impartial group, if one could be found.  This would hopefully avert another situation similar to the Gaza offensive. 

But even if this were to occur, the most important step would still be altering the culture of hostility between Israel and Palestine.  There’s no way to confiscate all the rocks in Gaza.  Altering these long-standing attitudes will be the longest, most difficult, and least measurable part of the process, but it is the only way that two disparate peoples could eventually coexist peacefully. 

Israel holds the keys to the important first step: independence.  But it has no inclination to help the Palestinian people given the hatreds and hostilities borne towards it.  Yet these hostilities will only be exacerbated by continuing to deny them the basic needs of life.  As long as Palestinians continue to attack Israel and live under a government with the stated agenda of doing so, Israel cannot help them, for its own safety and the safety of its people.

Sex Reassignment Surgery under OHIP

By Siobhan Doria

Effective on June 3rd, 2008, Regulation 552 of the Health Insurance Act has been amended to reinstate sex reassignment surgery (SRS) as an insured service under the Ontario Health Insurance Plan (OHIP). To be eligible for the procedures one must complete a Gender Identity Clinic Program to ensure the mental readiness of the candidate. [1] Before addressing the question if SRS should be covered by OHIP, it is necessary to note what particular surgical body changes are insured; as well as provide a basic understanding to the discrimination and fear the transgender population face in society.

For male to female reassignment surgery the removal of male genitals, construction of vagina, labia, and clitoris is compensated. For female to male surgery the removal of breasts and chest reconstruction, the freeing of the clitoris and construction of testes, or removal of female genitals, construction of male genitals, as well as the removal of the uterus and ovaries upon recommendation as of part of transition. However, there are procedures that are not covered by OHIP: breast implants, facial surgeries, neck and vocal chord surgery, hair transplants and removal, and liposuction. With that being said, hormones supplements are similar to other prescriptions, in that, they are either paid for by the patient, a company health insurance program or, for those who qualify, a government program such as the Ontario Drug Benefit Program. [2]

Medical coverage varies across Canada. Some provinces fully cover SRS while some offer partial, and others provide coverage for related therapies. Those standards concerning which specific services are covered by medicare must recognize the necessities of transgender medical requirements. We need to ask who is in the best position to know a person's sex? These decisions must be based on fact not determined by preconceived notions of what it means to be transgender. They should be about distinguishing between what is and what isn’t life threatening or deemed “medically necessary.” [3]

Before formulating conclusions it is critical to understand the conceptualization of sex and gender. Gender in this article is referred to as the social meanings and value attached to being female or male in any given society. Its focus is identity which is expressed through the concepts of femininity and masculinity. In comparison, sex refers to the biological differences between females and males defined in terms of anatomy, which consists of two types of human being. [4]

Transsexualism is a term used to describe anyone who bends or challenges "traditional" gender roles: gay cross-dressers, straight cross-dressers, transsexuals, drag queens and kings. [5] Transsexualism shatters the beliefs of binaries and stimulates questions of the significance of gender identity in our lives. The majority of us believe that gender is male or female for the sole reason that we are comfortable living in our birth designated sex. But, where do those who are transgender fit in the artificial gender binary? Transexuals have made it possible to imagine that a person could feel themselves to be a particular gender “trapped” in the “wrong” sex, as well as ask ourselves what counts as a person and a coherent gender? [6] 

We live in a world that is black and white. There is male and female, masculine and feminine. With such a strong emphasis on sex divisions members of the transgender community face, job discrimination, the inability to rent apartments, violence, and the inability to alter government issued identification cards. [7] Obtaining appropriate identity documents can be a challenge which further diminishes the ability to gain appropriate health care. [8]

The Canada Health Act was designed to guarantee individuals freedom from the burden of medical costs concerning necessary procedures. It was created to ensure medical treatment is accessible and inclusive. Demanding individuals to pay for medically necessary treatment is unethical. Reassignment surgery is not a luxury or cosmetic. It is a necessary procedure that some transgender pursue to aid themselves in leading productive and satisfied lives.

I wonder, what are the limits of medicare coverage? Does prejudice against an identifiable minority affect who is covered? Is it fair that the Canadian tax payers pay for the health care of people who chose to smoke? Or liver transplants for alcoholics? People should be careful not to use what is $200,000 on a $40.2 billion health budget as an excuse to continue the cycle of transphobia.9 Our  beliefs and attitudes need to be motivated by compassion and understanding of gender issues, not by our concerns of government spending and the nature of the operation.

Everyone deserves the opportunity to prosper, to have dignity, and to be emancipated from socially constructed labels. As a heterosexual I cannot truthfully express the pain and feelings of discomforts transsexualism face. I can only subjectively ask, who can I become in such a world where the meanings and limits of the subject are set out in advance for me? By what norms am I constrained to? [9]

From the moment a doctor performs an ultrasound and declares us as either a boy or girl our lives are immediately shaped and planned, for the most part, we seem to follow our gender paths quite naturally. Unlike some we do not struggle to pretend to be a gender that that does not fit and feels unnatural. We are not in despair at not having a body that matches our mind. For society to demand that we adhere to a gender confronts the notion of hierarchy in gender and claims we each have one true sex. [10]

Should sex reassignment surgery be covered by the government? By Matt Turnbull

By Matt Turnbull

In an ideal world, it would be possible to provide sex reassignment surgeries to anyone who wanted them.  However, in our current situation there are already ludicrously long wait times for surgeries pertaining to life-threatening illnesses and other necessary procedures, as well as shortages of surgeons and hospital beds, especially in certain areas of the country.  It is crucial that these issues are dealt with before we can even consider adding less directly life threatening surgeries to the healthcare umbrella.

The OHIP Schedule of Benefits, which essentially details what is covered by OHIP, specifically states that insured procedures must be “medically necessary”.  It gives as an example of an uninsured procedure “... a service that is solely for the purpose of altering or restoring appearance.” [1]  So it must be shown that sexual reassignment surgery is a medical necessity, and not merely a cosmetic change.  There must be some kind of mental stress or life impairment caused that would be fixed by surgery.   

Interestingly, the Schedule also states that for reconstructive surgeries, “Although surgery solely to restore appearance may be included in this definition under certain limited conditions, emotional, psychological or psychiatric grounds normally are not considered sufficient additional reason for coverage of that surgery.” [2]  So even if there’s significant psychological stress due to being transgendered, for most appearance-altering surgeries that’s not enough to get coverage.  Currently, the only procedures covered relating to psychiatric difficulties are electroconvulsive therapy and some neurological assessment tests.  Psychological assessment is excluded, even though some psychiatric consultations are included in the Schedule. [3]

This isn’t at all to say that there is something psychologically “wrong” with transgendered persons.  It is merely to highlight that stress issues and other life-impairing problems which are not physical in nature are not necessarily covered by government health care.  There is a much stronger focus on physiological problems which directly affect physical livelihood. 

It would be foolish to assume that all the surgeries covered by OHIP are absolutely necessary to stay alive.  It is true that some relate to improving a standard of living caused by an ongoing difficulty, and in some cases reversing the effects of a voluntary behaviour.  However, just because certain surgeries don’t fall within the purview of this article doesn’t mean they shouldn’t also be reviewed based on their medical necessity when there are other more directly life-threatening surgeries being delayed.   

Of 15 types of major surgery, two have actually had a significantly increased wait time, and two have shown no significant change, despite programs in place to decrease Ontario’s famously poor wait times.  As of September 2009 figures, general surgery still has a wait time of 107 days, ophthalmic (eye) surgery has a 115 day wait, and it can take 112 days to get an MRI.  Even cancer surgery has a 65 day wait period according to the most recent figures – and that’s decreased from 81. [4][5] Why add another surgery to our overtaxed medical system when wait times are already long, hospitals are overcrowded, and surgeons are in short supply?  Is this really an equivalent medical concern to heart bypass or eye surgery, where wait times have significantly increased despite our efforts?  Medical time and resources should be going towards essential and life-threatening treatments, especially if the money is being supplied by taxpayers and donors.  

It’s always possible to undertake the surgery voluntarily.  This may be expensive, but if the cognitive dissonance caused by being transgendered is so high, wouldn’t it be worth the cost?  In order for the surgery to be paid for by the government, it would have to be shown that it caused such a high degree of stress and disruption that it strongly impacted an individual’s personal life, likely to the extent that they couldn’t function properly in their daily life and workplace and thereby gain the means to pay for it themselves.

Some public and private insurance companies, as well as some employment benefits insurance plans, are now including sex reassignment surgeries as part of their coverage.  Examples include the City and County of San Francisco, and IBM, and insurance carriers like Aetna and Cigna. [6] There have also been significant steps towards reforming the view of transgender issues and ensuring that equal and fair insurance deals and surgical treatments are given to transgendered persons. [2] This is fortunate not only because it represents a more inclusive and knowledgeable approach towards transgender issues, but also because it provides an opportunity for these surgeries to be offered without overtaxing the public medical system.  These private means of securing sex reassignment surgeries, or at least subsidies for them, should be encouraged and broadened across more socioeconomic strata and employment types to provide wider and more equitable access without detracting from our limited public health resources.

Not committing taxpayer dollars transgendered surgeries when it is intended for patients in medical need isn’t a form of condemnation so much as a lack of facilitation – and they are different.  Even when not covered by the government the means are costly, but available.  It would be nice to be able to provide the surgeries and the services but in the current state of Canadian medicare resources are better spent taking care of patients with health-threatening issues, reducing wait times for necessary surgeries, and building infrastructure, especially in underserviced areas.  And maybe one day we will have the surgeons and resources to provide sexual reassignment surgeries under OHIP but until then, more directly threatening medical needs must come first.