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The Responsibility to Rebuild

Panel experts and parliamentarians also discussed the difficult security situation in Libya in the wake of NATO’s Operation Unified Protector in 2011.  Several members noted that, while that operation may have protected Libyan civilians from an imminent regime-led massacre, the international community largely abandoned the country afterwards. The ensuing chaos has gravely complicated efforts to constitute legitimate state authority in that country. This failure has complicated security implications. Panellist Ethan Chorin, author of Exit The Colonel: The Hidden History of the Libyan Revolution, noted that: “While it was noble to uphold the new norm of the Responsibility to Protect, the international community would do well to now focus on its Responsibility to Rebuild.  Failing to do so will result in security challenges not only in Libya but in the Sahel, Europe, and the Middle East as well.”

A detailed report of the proceedings of the seminar is forthcoming and will be published on the website of the NATO Parliamentary Assembly.


Perim Associates












Perim Associates provides counsel to international law firms on Africa and Middle East disputes (expert testimony, due diligence, networks, business strategy, language-intensive research, polling and data analysis).  We are currently 10 senior experts (former diplomats, development professionals, economists, lawyers and businessmen), with an average of 30 years in the sub regions.  We provide proven development solutions to governments in rural healthcare, training and environmental and cultural conservation — particularly in conflict and post-conflict environments.  We have particularly strong knowledge of Libya, North & West Africa, Iran, the Gulf and The Horn.  For more information:   Member bios are posted to   — EDC

The Promise of Rural Health Innovation in Djibouti









This is the unlikely — and unfinished– story of a public-private partnership for development, linking the Gulf emirate of Dubai, the Red Sea State of Djibouti and the United States Agency for International Development (USAID).

In 1998 Ethiopia and Eritrea fought a brief but brutal war.  Ethiopia lost use of its former two main ports (Assab and Massawa) to Eritrea, and almost all of Ethiopia’s exports and imports (Ethiopia’s 2011 GDP was close to 40 billion dollars) shifted onto a thin road linking Ethiopia’s capital of Addis to the port of Djibouti. Dubai was at this time seeking a beachhead in Africa through which to export its combination of port management services, free trade zones, customs management and amenities.  Developments in Ethiopia, a precipitous drop in trade through neighboring Aden, Yemen due to the USS Cole Bombing in 2000, and Djibouti’s strategic location at the foot of the Red Sea, made Djibouti an inspired — and profitable–  bet.

A 2008 presentation in Djibouti by the late Gail Goodridge, then with Family Health International (FHI), converted me to the rather brilliant idea of using transport corridors as a vector for delivering social services to a number of disadvantaged populations.  Dr. Jeff Ashley, a veteran USAID hand, conceived several years before of the idea of using “augmented truck stops” along major transport corridors in Africa to get out the message about HIV/AIDS.

With Dubai catalyzing nearly $1.3 billion in investment in this state at the foot of the Red Sea — paying for the construction of the most technologically advanced port in East Africa, a luxury hotel, and roads, among other things–  both Dubai-led external investors and Djiboutian government were under pressure to show that this relationship was generating benefits for Djibouti’s urban and rural poor (Djibouti’s unemployment rate is over 50%, and the country’s population of 800,000 is under continued threat of famine and drought).

As the Corporate Social Responsibility point person for Dubai Ports (DP World) from 2008-2011, I oversaw a three-year campaign to broaden the ROADS remit to include the provision of primary healthcare services and small-scale commercial activities, enabled by advances in solar and satellite wireless technology.  We revamped the “truck stop” concept and persuaded Dubai Ports and its suppliers to invest in more permanent healthcare structures according to a “hub and spoke” model, which has since been successfully implemented in other countries in the Subcontinent.  After Djibouti, the next recipients were to be the Maputo Corridor in Mozambique, the port of Dakar, in Senegal (both of which were run by DP World).

The model, and the division of labor, looked robust:  Dubai Ports would pay for the hard infrastructure that USAID funding did not allow, and the contractors (in this case, FHI) would work with the Djiboutian government and local hospital to make sure local resources were trained to staff the facilities.

During stage I, the base camp at a truck stop called “PK12” (for its distance twelve kilometers from the city center), essentially two shipping containers welded one on top of the other and furnished, was outfitted with solar panels (electricity was prohibitively expensive, so the facility was dark 9 hours a day) and a VSAT internet connection, so visiting truckers could Skype their relatives, and pull up a variety of health-related information, some in the form of software donated by DP World suppliers. Planned small-scale commercial activities included mobile phone charging stations and a small canteen.

Meanwhile, we set about designing a prefab clinic (manufactured by Italy’s Edil Euganea)  which included exam rooms, a lab, a canteen, an audio-visual room, easily sanitizable surfaces and separate entrances for male and female visitors (in deference to the country’s conservative mores). Importantly, we thought hard about what would make the clinic more attractive to its users.  We designed the facility, within budget, to accommodate 30,000 individual visits a year.  With the ‘hub clinic’ was built, the existing, upgraded ‘SafeTStop’ was to be moved up the highway to Dikhil, closer to the northern border.  Connectivity between the two posts, and other posts over the border in Ethiopia, would serve as the skeleton of a widening network of services, where a mobile patient’s records would be available throughout the network.

Thus, a USAID “Global Development Alliance” (GDA) linking Dubai Ports, the Djiboutian government, and the United States was launched in 2009, formally, in a ceremony attended by the Djiboutian Minister of Health, Senior DP World executives, and representatives from USAID and FHI, and touted as the “First Ever U.S.-Djibouti Public-Private Partnership” (the USAID link has since been taken down).  A Dubai and Kenya based company, Intersat/ SPARC, installed the solar panels.

Here’s where things started to go awry:  Dubai’s increasing preoccupation with the fallout of the 2008 financial crisis, a tussle with Djibouti over an exiled ex-Djibouitan official, and an odd drop-off of interest by contractors employed by USAID, left the upgraded unit operating much as it had previously been, and the new clinic sitting unassembled for the better part of two years.

No longer working for Dubai Ports, I and a group of colleagues worked with Edil Euganea and other entities over the course of 18 months to assure the new prefab unit was not sold for scrap for delinquent payment (it came close), and lobbied with USAID and senior government officials to make sure programming and training was not suspended or abandoned.

Now, in mid 2013, a somewhat promising thaw in Dubai-Djibouti relations has brought the clinic concept back to life:  Dubai unsealed the containers and the 2000 sq ft unit — the one pictured above– was assembled in less than two weeks by, using a combination of Djiboutian, Italian and Dubai labor.

Certainly better late than never, but what of the original plan?  Will the new clinic be staffed by purpose-trained Djiboutians in a collaboration between American and Djiboutian medical personnel?  Will the original PK12 structure be moved up the corridor to the town of Dikhil to establish the second node?  Who will make sure the clinic and the outpost are working properly?

The success of this venture is all the more critical, as every one of the stakeholders– Dubai, Djibouti, the U.S. government, the Ethiopian transport workers– has a stake in the outcome.


The California-Libya Connection

Despite being almost 7,000 miles apart, California and Libya have an interesting history, a similar climate, and a relationship that’s worth watching.

At independence in 1951, Libya was one of the poorest countries in the world, exporting scrap metal and dates. After the discovery of oil in commercial quantities in 1958, Libya began sending promising graduates to the United States to acquire skills needed to manage the country’s natural resources. Future petroleum engineers went to ‘oil schools’ like Oklahoma, Kansas and Texas A&M, while those focused on agriculture and water (a critical issue in a country that is over 90% desert), attended Federal land-grant universities such as U.C. Davis and Berkeley. Libya’s most prominent hydrologist studied at Davis in the 1970s (perhaps it is no coincidence that California artichokes grow beautifully in Libyan soil).

As Gaddafi’s policies became more erratic and violent, nearly two decades of bilateral and U.N. sanctions reduced Libya’s contact with the West. During the rapprochement with Libya in the late 90s and early 2000s educational links began to re-form, if tentatively. The 2011 ‘Libyan Spring’ spawned literally hundreds of local civic organizations, and prompted a large number of the Libyan diaspora– many from Texas and California– to return to help create a new, more open state.

This year, one might say the Libyans have returned to California. Two out of a record six Libyan candidates were chosen to participate in the prestigious U.C. Berkeley-Beahrs Environmental Leadership Program (ELP). The ELP, in its 15th year, is designed specifically to boost the effectiveness of promising mid-career professionals from developing countries, through modules on resource management, global warming, food security, etc. and workshops on negotiation and organizational management. Two past ELP participants have won the Goldman Prize (Environmental Sciences’ analog to the Nobel).

Khaled Ben Halim, one of the 2013 ELP Libya contingent, relocated to Tripoli from Texas during the revolution with the single-minded goal of protecting animals from abuse; “conservation and animal welfare is usually last on the list of concerns during war,” Ben Halim rues, “but these constituencies also need advocates, and I felt that was the contribution I was best able to make.” Ben Halim has been instrumental, among other things, in a campaign to rehabilitate the Tripoli Zoo, whose collection of hippos, oryx and other African fauna barely survived the revolution, due to the efforts of volunteers. On the sidelines of ELP, Ben Halim hopes to create a relationship with the U.C. Davis School of Veterinary Medicine.  Rida Sherif, a final-year forestry Ph.D. candidate at the University of Mississippi, is concerned with the impact of improved forest management on desertification. ELP participants from the state of Mali, itself severely impacted by the revolution in its neighbor to the North, improve access to education through feeding programs.

Professor David Zilberman, ELP program co-director, says that “sustaining natural resources in post conflict nations is a major priority for the College of Natural Resources, and we are very eager to support Libya’s future environmental leaders.”

My experiences at Berkeley (Ph.D., Agricultural and Resource Economics), and as one of the first U.S. diplomats in Tripoli from 2004-2006, shaped much of what I’ve done since, including co-founding the Avicenna Group, which has specialized in building relationships between U.S. and Libyan institutions, particularly in the area of acute care and emergency medicine.

Ambassador Christopher Stevens, whose ties to California and U.C. Berkeley were widely reported, served sequential assignments in Libya as Deputy Chief of Mission, U.S. Envoy to Benghazi, and then, Chief of Mission in Libya.  Stevens was critical in generating U.S. support for Libya during and after the 2011 revolution, until his tragic death last year in the attack on the U.S. Mission in Benghazi at the hands of extremists– an act that had more consequences on Libya’s trajectory than many would care to admit.

Anne O’Leary, who retired recently from the Foreign Service, was the first permanently assigned Public Affairs Officer (PAO) in Tripoli, and in that capacity, created a framework for future US-Libya student exchanges. O’Leary grew up in the Bay Area, and was ‘Diplomat in Residence’ at U.C. Berkeley from 2007-2008. One of her successors, Mietek Boduszynski–you guessed it, another Berkeley Ph.D.– has been responsible for keeping U.S.-Libya educational relationships running, through the current turmoil.

After the September, 2012 attack on the U.S. Mission, the Avicenna Group shifted its focus to the problem of how to provide technical assistance when a sustained in-country presence is either not possible, or very difficult. The organization, with support from American and Libyan donors, has been working closely with ELP, and the Blum Center for Developing Economies to engage advanced graduate students in Engineering and Public Health, for example, to address a series of practical questions such as “how to design an ambulance dispatch system in a city without physical addresses”, “how to train novice medics in the field via Internet-based courses.”

In parallel, Avicenna has been working with faculty at the University of San Francisco (UCSF)-Global Health Sciences, and the U.C. Berkeley School of Optometry, to scope projects in, for example, retinal scanning for diabetes (assisted by a Libyan Ph.D. candidate), hospital administration, planning for acute and emergency care, and sustainable design. California-based firms with international interests, like the Berkeley Research Group, a law and economics consultancy, have helped underwrite the costs of ELP’s Libya outreach.

Recent exchanges have also been cultural: several in Libya and California helped bring noted Libyan artist Mohammed Binlamin to Davis in early April, to participate in a Stevens memorial exhibition, hosted by the John Natsoulas Gallery. Binlamin spent several days in Berkeley, visiting with local artists and touring a local foundry and galleries, with the goal of bringing California-based artists to Libya.

Collectively, the Libya-California links are multi-faceted, decreasingly random, and neither permanent nor fail-proof– but with attention, they have the potential to contribute to a more stable Libya, a more creative U.S.-Libya bilateral relationship and new approaches to the provision of meaningful, cost-effective assistance to post-conflict states.

Anti-Killer Apps & The Arab Revolutions

It is not surprising that the power of technology available to support post-conflict humanitarian action vastly surpasses the ability of governments, multilateral organizations and commercial enterprises to deploy it optimally. It is usually the smaller, nimbler, locally-rooted organizations that are usually best able to respond to local crises. Yet by their very nature, these organizations must be discovered and empowered if they are to act on a larger scale. It is here that politics comes into play.

Take ‘medicine and the Arab Spring’: There are a number of regionally-focused medical organizations, projects and technologies that could have a substantial impact in reducing human suffering in the field, and yet are healing at levels far below capacity, mainly because the smaller and the larger organizations are not speaking to one another as optimally as they might. A few examples from personal exposure as Co-Founder of the Avicenna Group, which has been working to boost medical capacity in post conflict regions (Libya, particularly), since 2011.

Mobile Ultrasound in Syria:  Pushed to its Limits

Within the Syria crisis, which has claimed by some estimates more than 100,000 lives, a U.S.-based organization called SAMS, the Syrian-American Medical Society, has spearheaded a series of truly inspiring humanitarian efforts. SAMS’ staff, most of which are senior American physicians, undertake regular, extended tours in country as trauma surgeons and advisors, in the most extreme of conditions.

One new technology in particular has proven hugely useful in the field. The VSCAN, a portable ultrasound scanner manufactured by General Electric, has been a diagnostic boon to the various field medics and hospitals — in ways that the manufacturer probably never envisioned. Indeed, General Electric corporate was unaware until recently that their products were playing such a prominent role in treating Syrian war wounded.

Severe conditions breed innovation, not only in technology, but also process: SAMS purchased 40 both rehabilitated and pared-down VSCANS, transported them to the Turkish-Syrian border and from there, into Syria, where they have saved many lives. The small size, versatile nature and ease of use of the VSCAN often makes it the only diagnostic tool within reach, both literally and in terms of cost (the units start at about 8000 dollars). In the cities of Homs and Aleppo (high-casualty centers for the Syrian opposition), for example, single-digit units are serving populations of 1-2 million.

SAMS is not just putting this technology to use, it took the lead to successfully lobby for an amendment to Anti-Assad sanctions that would allow legal delivery of VSCANs into the battle theatre. SAMS estimates that it needs another 40 of these units to reach the limits of its own capacity to assist.

The current push is to get more VSCANS into Syria, Turkey and Libya, to extend their use with power-enhancing accessories (the field life of device’s batteries is a large constraint). There is an effort underway to bundle VSCANs with expert-made diagnostic videos featuring the VSCAN, and to create detailed logs as to how the VSCANS are being used. The resulting ‘how to’ videos and logs would be made available free of charge to train medics and crisis planners outside of the region in use of the VSCAN and associated tools– all of which would benefit the suffering Syrians, of course, but also future trauma victims worldwide. From the manufacturers’ perspective, it could also be expected to create a much larger commercial market for these tools inside and outside of Syria.

‘1-1-1’ in Benghazi, Libya

Benghazi is a city largely without addresses, and without ambulances. When citizens in this city of 800,000 need urgent assistance, they count on friends and relatives to take them to one of the city’s six hospitals. The capacity of these hospitals varies greatly from week to week, and day to day. God help those heart attack, bombing victims or pregnant mothers with complications if they’re taken to one of those clinics that’s closed.

Benghazi officials tried to address this problem the low-tech way, by erecting a large billboard downtown, on which that day’s ‘open clinics’ are listed. Yet a relatively simple, technology-driven override exists:

A group of graduate students at U.C. Berkeley, assisted by a Bay Area technology firm, spent last semester building a prototype cell-phone-based app that allows the driver or the victim to use his/her GSM phone text a 3-digit number (say 1-1-1), to receive a return text message listing the closest open hospitals — obviating a trip to the “oracle-billboard.” A mapping enhancement developed by StampStreet, may in the near future enable victims to create their own ‘pickup’ addresses and maps, in a city with few valid addresses and little reliable mapping data (try looking up Benghazi on Googlemaps). The main local requirement for all of this is reliable human updating of facility status via independent, secure web connections, and a robust public awareness campaign. Estimates are that hundreds of lives have been lost because of this information breakdown. Undoubtedly many more will be if the situation continues for long.

The above are just two cases in which a small infusion of capital, and a bit more coordination within the local and international communities could have a large impact. There are many more. Every day counts.