Number Of Crises Research Articles

Hydroxyurea and Neurologic Follow-Up Including Transcranial Doppler Flow Velocities in Children with Sickle Cell Anemia.

Introduction: Progress in the management of sickle cell disease (SCD) has improved life expectancy. However, stroke remains one of the most serious complications of SCD. The purpose of this single-center longitudinal descriptive study is to demonstrate that hydroxyurea (HU), apart from lowering transcranial doppler flow (TCD) velocities, improves the clinical symptoms in SCD. Furthermore, starting the children at risk for stroke concomitantly on HU and short-term transfusion ameliorates rapidly the TCD velocities and clinical symptoms.Patients and Methods: Twenty-eight consecutive patients with a median age of 10.8 years (range 6.0–21.0 years) had biologic and clinical follow-up for a median of 9 years (range 2.5–18 y). A total of 27 patients were followed by TCD screening of the middle cerebral artery (MCA), anterior (ACA) and posterior cerebral arteries (PCA), carotid siphons (ICA) and basilar artery (BA). Twenty-one patients received hydroxyurea for a median of 5.9 years (range 4 months-9.5 years). HU was started for the following: 3 or more severe vaso-occlusive crises requiring hospitalization, abnormal MRI, TCD velocities of 200 cm/sec, and parental refusal to transfusion. Three patients had monthly red blood cell transfusion for 6 months concomitantly to HU. Myelotoxicity was controlled at two-week intervals for the first 3 months. Twenty-one patients under HU were retained for analysis. TCD velocities of a given patient were compared using the nonparametric Wilcoxon sum test.Results: All patients improved clinically under HU treatment with decrease in the number of crises. Concerning the neurologic findings of the patients, 13 with increased TCD velocities in the MCA (median190 cm/sec) showed decreases under HU (table).MCA flow velocities for 13 children with SCD, before and 3, 6, 12 and 24 months after starting therapyMCA flow velocity (cm/s)before3 months6 months12 months24 monthsmedian (range)190(156–246)172(128–232)172(149–244)158(121–222)164(150–228)P0.03NS0.030.03NS indicates not significant; P values indicate comparison between each month under HU and before treatment.Two patients with headaches accompanying increases in TCD velocities had disappearance of the headaches 1–2 months after starting treatment. One of these had concomitant monthly transfusions for 6 months. After the end of transfusions, she remained asymptomatic under HU. One patient with stroke, severe headaches and pathologic MRI before HU had very rapid and stable recovery of symptoms under HU and short-term transfusions. She is at present 15 months after the last transfusion asymptomatic under HU therapy. None of the other 28 patients manifested any neurologic symptom during the follow-up.DISCUSSION Our single-center longitudinal study, although limited in number, shows the benefits of HU on the neurologic outcome in pediatric SCD patients, and brings the observation that concomitant use of short-term transfusion prophylaxis and HU might produce a faster response in clinical and biologic parameters which will be stable over the years. Long-term follow-up will show if short-term transfusion prophylaxis is periodically necessary in these patients under HU.

Vanishing financial contagion?

While a number of crises in emerging markets generated widespread contagion in financial markets during the 1990s, more recent crises (notably, in Argentina) have been mostly contained within national borders. This has led some observers to wonder whether contagion might have become a feature of the past, with financial markets now better discriminating between emerging countries with good and bad fundamentals. Available data suggest that the main channels that contribute to transmitting financial crises across countries are – if anything – even stronger today than in the 1990s. Moreover, anticipation by international investors may help to explain the near-absence of contagion in the context of the Argentine crisis. This paper argues that a prudent working assumption is that financial contagion has not vanished.

Oral Abstracts

Background: In 2005, the RCOG’s “Why Mothers Die” report showed that substandard care was a factor in nearly 70% of maternal deaths from direct causes, and nearly 40% of maternal deaths from indirect causes1. The failure of communication between medical and midwifery staff was an important dynamic in these grim statistics. Similarly in Queensland, a major review2 reported the cogent need for maternity carers to have ‘highly developed communication skills’, and for carer teams to have clearly defined roles and responsibilities. The review also noted that obstetricians and midwives appeared unable to find ‘a common ground for care provision’, and recommended that future carers ‘learn to work together’ through dedicated education and training. Aim: In response to the above, the multidisciplinary MaCRM program was developed and has successfully trained midwives and obstetricians using crisis resource management (CRM) principles. This presentation will describe the program and the results of recent evaluations by participants in both the short- and longer-term. Methods: Participants initially refresh their knowledge about a number of crises (e.g. maternal collapse, massive obstetric haemorrhage, shoulder dystocia and cord prolapse). The following day, participants work as a team to manage emergencies in 5 different scenarios. Scenario-based training encourages high-order thinking: learners and teachers have to deal with real-world situations and are forced to think critically about them, and to make informed decisions by correctly interpreting all parts of the scenario at hand3. CRM training enables groups from unrelated disciplines to act as a co-ordinated team, through emphasis on: clear/directed communication; the roles of leaders and followers; situational awareness; when to call for help; and using all available human and technical resources at hand. Evaluation of MaCRM has 3 elements: 1) a pre-program survey relating to participants’ level of experience, knowledge, and skills in the areas covered by MaCRM, and self-reported behavioural characteristics; 2) an immediate evaluation of the program at its completion, and 3) one month later, a repeat of the pre-program survey and semi-structured interview to determine what effect if any, MaCRM had on the handling of crises by participants. It is envisaged that a State-wide impact evaluation will be carried out when there is a sufficiently high number of participants for a difference in outcomes to be observed. Results:The learning objectives of the MaCRM programs to date have been met, as evidenced by both midwives and obstetricians indicating their use of CRM principles (e.g. better communication, teamwork, calling for help early) when dealing with emergencies, and a higher level of confidence in their ability to deal with these. Additionally, participants have benefited from the opportunity to refresh their skills (e.g. handling a breech, APH, PPH).Conclusions: The MaCRM program has enormous potential to save lives of mothers and babies through the up-skilling of both midwives and obstetricians, and especially through training them to work as an effective team in the face of any emergency in the birthing suite.

Successful management with C1-inhibitor concentrate of hereditary angioedema attacks during two successive pregnancies: a case report

[corrected] Hereditary angioedema (HAE) is a rare genetic disorder caused by a deficiency of the plasma protein C1 inhibitor (C1-INH). HAE is characterised by the onset of angioedema, which may develop in one or several organs, and may last from a few hours to several days. Oedema of the upper airway can be life-threatening. As a result of hormonal changes, some women experience more frequent angioedema attacks during pregnancy. During pregnancy, antifibrinolytic agents should only be used with caution, and attenuated androgens are contraindicated; therefore, replacement therapy with C1-INH concentrate represents one of few therapeutic options, but it is not widely documented. We report the first case study of the successful management with regular infusions of C1-INH concentrate, of two successive pregnancies in a patient with HAE. During the second half of the first pregnancy, C1-INH was administered on demand at home. For the second pregnancy, on demand treatment was intensified to prophylactic therapy, with once or twice weekly infusions from the middle of the second trimester in order to efficiently control the frequent attacks. This report illustrates that HAE can be successfully managed during pregnancy with C1-INH infusions at home. Since the number of crises may vary between pregnancies, the treatment regimen must be adapted to the patient's need.

Bone mass density in adults with sickle cell disease

Sickle cell disease (SCD) leads to many complications including osteoporosis and osteopenia. We studied the prevalence and predisposing factors of low bone mass density (BMD) in adults with SCD. In this retrospective study, dual X-ray absorptiometry bone scans were used to determine BMD in the lumbar spine, femoral neck and ultra distal radius of 103 patients (73 females, 30 males, aged 15-80 years). Chart reviews and a patient questionnaire were used to collect patient characteristics, disease course and severity, and low BMD risk factors. The 79.6% of patients (mean age 36.5 +/- 12.5 years) had an abnormal BMD, with a predilection for the lumbar spine (P = 0.001). Analysis by 3 (low BMD versus very low BMD versus normal) or by 2 groups (abnormal versus normal) showed that abnormal BMD was associated with lower body mass index (BMI) (P = 0.003), lower Hb level (P = 0.001) and higher ferritin (P = 0.003). Low BMD patients were more likely to be SS, SC or Sbeta(0)thal than Sbeta(+)thal (P = 0.022). Abnormal BMD was not related to age, sex, menarche, SCD complications, number of crises, iron overload, treatment with hydroxycarbamide or desferal, renal disease, smoking or alcohol. Patients treated with hydroxycarbamide for at least 6 months were more likely to have an abnormal BMD. In this SCD population, abnormal BMD seemed to be independent of sex, age and menopause, whereas BMI, ferritin level, Hb type and level appeared to play a major role.

Hematological and Clinical Findings Predictive of Mortality in Italian Patients with Sickle-Cell Disease: A Case-Control Study.

Background: the number of cases with Sickle-Cell Disease (SCD) registered in Italy at 2000 was 928. Six-hundred-twenty-two (67%) of these were with Sickle-Cell/βthalassemia. Moreover, while the main causes of death in Afro-American patients with SCD is well known, we do not have many informations in Italian subjects. For this reason, we carried ahead a case-control study in this group of patients.Aim of the study: the evaluation of the main hematological and clinical parameters predictive of mortality.Materials and Methods: clinical and hematological findings of 14 SCD died patients were compared with a SCD alive control population homogeneous for age, sex, phenotype and number of painful crises per year. Two alive control subjects were studied for each died patient.Results: the main causes of death were: Acute Chest Syndromes (ACS) (n°6), Cardiovascular Diseases (n°3),Hepatic Failure (n°1),Hodgkin Lymphoma (n°1), Stroke (n°1), Lung Cancer (n°1), Surgery Complication (n°1). The main correlated hematological findings with mortality were Hb (gr/dl) levels (p=<.05), WBC count (103 / ml) (p= <.05), ferritin levels (ng/ml) (p=<.01). The main correlated clinical features were: the number of crises >3/year (Odd Ratio= 1.64; p= <.01), previous stroke (Odd Ratio= 1.53; p= <.01), HU treatment (Odd Ratio=<.01; p=<.01), leg ulcers (Odd Ratio=1.46;p=<.01).Conclusions: these data suggest that the main causes of death in Italian patients with SCD are similar to those reported for Afro-American subjects (M.H. Steinberg, JAMA, April 2, Vol. 289, N°13, 1645–1651). Particularly, the lack of HU treatment, anemia, high ferritin levels, number of crises per year and previous stroke are the most important predictive factors of mortality.

Crisis management best practice – where do we start from?

In the last few years a number of crises have hit the headlines. These range from September 11th through Hurricane Katrina to major breakdowns of critical infrastructure facilities such as the electricity supply in New York and the Tsunami in Asia at the end of 2004. As a result, all governments and businesses worldwide have been warned to prepare for major disasters, formulate plans and pro-actively look at crisis management. The question is whether your organization has taken this warning seriously and, if not or if you are in doubt, where you can start from in terms of security and continuity best practice so as to be in position to manage crisis situations.

Beating the odds

Beyond the shadows of Montreal is a small, rural Mohawk community known as Kanesatake (Oka), which has a population of approximately 1500 Mohawks. Residents of Kanesatake have experienced a number of crises in recent years, with negative consequences for the entire community and especially children and youth. The present article provides an overview of the dynamics of two crises faced by the Kanesatake community, detailing the specific impacts on children and young people before moving on to describe health centre interventions that were designed to support community members in processing the trauma. In 1990, Kanesatake was at the heart of the ‘Oka Crisis’, in which Mohawk residents set up barriers to prevent the expansion of a golf course onto their sacred grounds – the cemetery. The Quebec Provincial Police (Surete du Quebec [SQ]) and the Canadian army were sent in to dismantle the Mohawk barricades. Unfortunately, violence broke out, resulting in the death of a police officer. Many people believe that the ensuing 78-day stand-off was the beginning of many difficulties for the community. These events have had a harmful impact on the community, its members and the surrounding communities. Although the Oka Crisis did protect and preserve our sacred lands, it had some unsettling effects on the community that continue to affect us to this day. On January 12, 2004, our most recent high-profile community crisis involved, yet again, damaging national publicity as a result of political warfare and an ‘invasion’ by over 100 policemen from other Native communities to assist our Native police force. At the time, the community was not told why these extra police were brought in. There were rumours that the police officers were there to raid contraband cigarette vendors. No one knew for sure what was happening and it was a very confusing and tense time. The situation escalated with the burning of the Grand Chief’s home and the takeover of the police station by some community members. After a 24 h stand-off between the Native police force and some community members, the police were escorted out of the community. The community was left without security, which created more instability and affected the community and the surrounding areas. These two crises compounded the historical trauma brought on by colonialism, residential schools and dislocation. This prolonged and extreme trauma, and the resilience of the people who survived it, is rarely acknowledged in Canadian society. Suffering is not unique to First Nations peoples, nor is resilience, but perhaps what sets First Nations apart is the fact that most Canadians do not even acknowledge the depth of the trauma or the strength that was needed to survive. Too often, their views of Native people are formed by flashes on the television screen instead of through respectful relationships – and so it was with our community. We entered into the national consciousness at a time of crisis, and for most Canadians, we became defined by that moment, but we were here before and our children will be here after. The present article is as much about calling attention to the need for community post-traumatic interventions as it is about affirming our entire humanity as a proud people working for a better future for our children – not just an event.

Efectividad de una intervención rehabilitadora, realizada en atención primaria, en la evolución de los pacientes con EPOC

The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. Pragmatic cluster-randomised clinical trial. Clinics of 16 PC teams in various health areas of the Community of Madrid. 476 patients with light-moderate COPD, who sign their informed consent. Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

Troubles du comportement alimentaire chez l'adulte

Adults' disorders of the feeding behaviour encompass anorexia, bulimia nervosa, and various atypical forms of nutritional disorders. Following a clinical review of anorexia and bulimia, the authors describe the so-called binge eating disorder in which the nutritional behaviour is assessed by the number of days of overfeeding rather than by the number of crises per week, over a period lasting 6 months at least. This disorder is 2- to 3-fold more frequent than bulimia nervosa. The night eating syndrome often induces obesity. Potomania, merycism, and pica are also described. Establishing the prognosis is always difficult. Published studies show important variations. Therapeutic follow-up studies show frequent relapses during the first year following a hospitalization. Poor prognosis corresponds to a long pre-treatment duration of the disorder and to a persistent anorexic behaviour. Epidemiologic data confirm the seriousness of such disorders, with a significant mortality rate associated to prolonged disease. The authors analyze the aetiopathogenesis of these disorders and their relationships with other psychiatric affections (depressive disorders, anxiety, personality disorders); addictions; biological perturbations; genetic factors; and the social and educational context. The cognitive-behavioural model and the psychodynamic theories are presented. The authors recommend approaching the ambivalence inherent in nutritional disorders by a series of specific interviews and a special attention to the singularity of each case and to the risk of negative reinforcement related to the measures of strict isolation. The family should be integrated in the therapeutic program. Resuscitation measures must be adapted. Precise and relevant criteria for hospitalization are presented, a definition of the therapeutic goals is recommended, together with the establishment of a care contract, and dietary and behavioural measures aimed at modifying both the relationships of the patient with feeding and weight gain. Group therapies are emphasized.

Estudio de la influencia del consumo de lácteos fermentados en una población de pacientes alérgicos

Prevalence of allergic diseases has been increased in last years; new alternative therapies have been employed. Beneficial effects of probiotics have been described in some pathologies such as tumors, diarrhea, and allergic disease. The aim of our work was to describe nutritional status and influence of probiotic consumption in allergic population. 44 allergic patients were selected, in all patients were recorded; sex, age, place of residence, anthropometric evaluation, dietary questionnaire and allergic variables (rush, blood levels of Ig E, and number of crisis in a year). 18 patients (40.9%) were females and 26 (59.1%) males with an average age of 24.5 (10.3) years. Most of patients (20.5%) are located in percentile P25-50, showing a good nutritional status. 16 patients consumed probiotics (27.1%), with an average of consumption per week 1.79 (3.16) and an average amount per week (mg-ml) (593.4 (461.9). The number of crisis year was 1.44 (1.8), average value of Ig E was 35.68 (31.93) UI/L and rush 10.09 (2.8) mm. Patients with a consumption of probiotics higher than 593 mg/week showed a IOW rush diameter (10.12(0.8) mm vs 8.85 (1.1) mm; p < 0.05), without statistical differences in other variables. Consumption of probiotics in allergic patients could be beneficial. Further studies with more patients and intervention designs will be necessary to analyze this relations.

MS ANTWERPEN: Emergency Management Training for Low-Risk Environments

Emergency management training programs have been developed mostly for trainees from high-risk environments such as aviation or the chemical industry. This article describes a training program for staff members from low-risk environments such as hospitals or hotels, where the awareness of potential dangers is usually low and emergency plans are often outdated or missing. The goal is to equip members of such organizations with some basic competencies necessary for effective functioning in the context of an emergency management team. The training is based on learning by doing, guided reflection, and instruction. The main training tool is a dynamic and interactive computer simulation of a passenger cruiser called MS ANTWERPEN. Participants enact different roles of this ship’s leading crew and are confronted with a number of crises and emergencies. Results of a pilot evaluation study with staff members from a large hospital confirm the expectations regarding the effectiveness of the approach.

The older sickle cell patient.

The lifespan of sickle cell patients has increased substantially. We chose to compare the attributes of older sickle cell patients with younger ones within the confines of a single institutional study serving the local Bronx population. Laboratory and clinical assessments from 40 patients with sickle cell disease over 40 years of age were compared to 40 patients under 30 years of age. When the older group was compared to the younger group, hemoglobin, indirect bilirubin, and platelet counts were significantly lower. Creatinine clearances were lower and BUN levels were higher in the older group. Although the prevalence of radiographically measured cardiomegaly was significantly higher in the older group, systolic and diastolic blood pressures remained unchanged. The number of crises and number of admissions were higher in the younger group than in the older, but there was wide variation, and no significant differences could be detected; days spent in hospital over the previous 2 years did not differ. No statistically significant differences were observed for absolute reticulocyte count, MCV, % HbF, white cell count, liver function tests, or oxygen saturation. Comparing genders within age groups, younger males had higher hemoglobin levels and absolute reticulocyte counts than younger females, while only the older females had higher HbF levels than the corresponding males. Lower levels of hemoglobin associated with older age may reflect decreased hematopoietic potential that may in part be due to decreased renal function. Lower platelet counts in older sickle cell patients may be a consequence of this decreased hematopoietic potential but may also represent a secondary survival benefit effect in sickle cell anemia.

Tongue-Tied in Singapore: A Language Policy for Tamil?

The Tamil situation in Singapore is one that lends itself ideally to the study of minority-language maintenance. The Tamil community is small. Tamils constitute only 4% of the population, whereas Indians constitute around 7%. The history and demographics of the Tamil community are well known. The Singapore educational system supports a well-developed and comprehensive bilingual education program for its three major linguistic communities on an egalitarian basis, so Tamil is a sort of "test case" for how well a small language community can survive in a multilingual society where larger groups are doing well. But Tamil is acknowledged by many to be facing a number of crises. Tamil as a home language is not being maintained by the better educated, and Indian education in Singapore is also not living up to the expectations many people have for it. Educated people who love Tamil are upset that Tamil is becoming thought of as a "coolie language" and regret this very much. Because Tamil is a language characterized by extreme diglossia, there is the additional pedagogical problem of trying to maintain a language with 2 variants but with a strong cultural bias on the part of the educational establishment for maintaining the literary dialect to the detriment of the spoken one. This article examines these attempts to maintain a highly diglossic language in emigration and concludes that the well-meaning bilingual education system actually produces a situation of subtractive bilingualism.

Dimensions and dynamics of microfinance membership overlap – a micro study from Bangladesh

The microfinance market of Bangladesh is getting rapidly crowded. In certain areas there is also quite high incidence of households taking loans from a number of microfinance providers. Why is this happening? How does it affect the providers? What should be done? These are some of the questions that this paper begins to address based on data collected from BRAC's operations in Tangail. We find that a number of crises often gives rise to an urgent need for lump sums of cash, and this is why households often need access to several loan sources. Though repayment irregularity is found to be on the increase, somehow it is being managed from turning into a major default problem, suggesting a level of in-built resilience of the system. This needs further research. In terms of what should be done, we chalk a broad agenda consisting of better information-sharing mechanisms and developing better risk-responsive financial products. In this sense, the phenomenon of multiple microfinance membership is as much an opportunity as it is a challenge.

Are Hong Kong companies prepared for crisis?

Since its handover from the UK to the People’s Republic of China on 30 June 1997, Hong Kong has been struck by a number of crises. This paper reports the results of an empirical investigation of how Hong Kong companies prepare for crisis. The research design was based on a replication and extension of a study originally conducted in the USA. Analysis of data collected through a survey of senior executives revealed that 21 Hong Kong companies had a crisis management plan (CMP). The rationale for crisis planning, and characteristics of structural components of the CMP, including both the crisis management team and crisis communication plan, are discussed.

Sludge, stones and sickle cell anaemia

A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.

Turning down the heat: Influences on conflict management in enduring rivalries

Enduring rivalries represent the most difficult challenges for policy makers seeking to promote international peace and security. Once in place, enduring rivalries account for a disproportionate number of crises, militarized disputes, as well as wars, and include conflicts that are more likely to escalate than those falling in other conflict contexts. Unfortunately, we know very little about conflict management in enduring rivalries from either a theoretical or policy perspective. This study seeks to account for why some rivalries are successfully managed while others persist at high and unabated levels of conflict In addressing these concerns, we explore 35 enduring rivalries over the period 1945–1992. We find that although enduring rivalries are quite resistant to influences that produce changes in their dynamics, both endogenous and contextual influences can exercise a significant impact upon the prospects for conflict management between enduring rivals.

Splenic size determination in sickle cell anaemia: an ultrasonographic study.

To examine the generally accepted concept of autosplenectomy in patients with sickle cell anaemia, and determine the relationship between age, the steady state PCV and splenic size. Case-control study. Sickle Cell Clinic, University of Ilorin Teaching Hospital, Ilorin, Nigeria. Sickle cell anaemia patients aged three to 47 years, while the controls included age and sex matched patients attending the General Outpatient Department for minor ailments. Longitudinal and coronal sizes of the spleen were measured antemortem, by ultrasonographic method, in 98 adult sickle cell anaemia patients and 48 control subjects and compared. The splenic size was correlated with age and PCV among sickle cell anaemia patients. Determination of longitudinal and coronal sizes of the spleen, comparison of mean splenic sizes of patients with those of controls by Student's t test, and correlation of age and PCV with splenic sizes. Both mean longitudinal and coronal diameters, and surface area were found to be higher in the sickle cell anaemia patients compared to the controls. While the longitudinal diameter increased with age continuously, the coronal diameter decreased after the age of 30 years. There were no significant correlations between the splenic sizes and PCV and number of crises per year. The general belief that sickle cell anaemia patients suffer anatomical autosplenectomy was not confirmed. This could be due to the effect of malaria and improved clinical care.

An Institutional Framework for Facilitating Cooperation in the Euphrates-Tigris River Basin

AbstractSince the initiation of major development projects, riparians of the Euphrates-Tigris river system, namely Turkey, Syria and Iraq, have begun utilizing those water resources under conditions of complex interdependence. A number of crises have occurred in the basin due to the lack of regularized consultation mechanisms among the riparians. Nevertheless, there have been notable efforts to build up a negotiation framework for data sharing and project coordination. The article describes the negotiation mechanisms and processes between Turkey, Syria and Iraq, as well as the bottlenecks and opportunities that exist over utilizing the waters of the Euphrates and Tigris rivers. Negotiations over the water issues involved, both at the technical level and higher levels, have been suspended since the mid-1990s. The article asserts that there is a need to revitalize these negotiations. A clear understanding of the respective rights and obligations of the three riparians as well as an objective definition of such needs are prerequisites for sustaining the negotiation process. The article concludes by elaborating on the modalities of institution building that would facilitate negotiations over the use of the waters of the Euphrates-Tigris river system.