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Co-authored by Dr. Chethan Sathya, a freelance journalist and surgical resident at the University of Toronto



Dr. Martin Salia, a general surgeon who died from Ebola in November 2014, is pictured on the left operating at Kissy United Methodist Hospital in Freetown, Sierra Leone. Photo credit: United Methodist Church.

This article originally appeared here on ScientificAmerican.com.

Thaim Kamara is 60 years old and would like to retire this year. But he is one of only eight remaining surgeons in Sierra Leone, a west African country of about 6 million people. Kamara lost two friends to Ebola in 2014 -- Martin Salia and Thomas Rogers, fellow surgeons at Connaught Hospital in the capital, Freetown. In light of the dire circumstances, Kamara has postponed his plan to retire.

Although the rate of new Ebola infections in Sierra Leone, along with neighboring countries Guinea and Liberia, is finally falling, more than 800 health care personnel have been infected with Ebola in the hot zone and nearly 500 have died since the epidemic began, according to a January report by the World Health Organization. And the toll, along with the continuing deaths of health care workers will have devastating implications for the long-term health of these nations.

Salia's death in November was especially devastating for Sierra Leone. The talented surgeon was not only a precious commodity, he was an innovator. The 44-year-old was at the forefront of a campaign to revitalize surgery in that nation via a partnership with King's College London. Surgical care in Sierra Leone is now at a standstill, says Andy Leather, director of the King's Centre for Global Health at the college and a surgeon who worked with Salia in Freetown. There are nearly no elective or emergency surgeries in the country because of a lack of surgeons, he says. And some surgeons -- aware that their risk of contracting Ebola is 100 times higher than that for the general population -- are scared to operate.

Surgery is a critical element of any health care system, but it is often a forgotten one. WHO calls it the "neglected component" of health care and estimates that surgery can be used to treat 11 percent of the global disease burden. The standard of surgical care in Sierra Leone was lacking even before Ebola arrived, according to research by Surgeons OverSeas, a U.S. nonprofit that works to improve such care around the world. It found that 25 percent of deaths in Sierra Leone could be prevented with surgery and estimated that 1.5 million Sierra Leoneans need surgical consultations, mostly for burn injuries and wounds.

Decades of civil war devastated Sierra Leone's public health and medical infrastructure, leaving it vulnerable to epidemics like this one. A lack of health care workers exacerbated the problem. Although the U.S. has 245 doctors for every 100,000 people, Sierra Leone has around two. Of the eight remaining surgeons in the country, only one is below the age of 60.

Short-term solutions to the surgeon shortage include volunteer surgeons who practice in Sierra Leone for a few months at a time. They can help perform some of the vitally needed surgeries such as emergency operations and C-sections. "But that doesn't really help us in the long-term," Kamara says. "What we really need is to train surgeons, and that's not an easy affair because it takes many years."

Training time is not the only challenge. Retaining surgeons in Sierra Leone is an even bigger hurdle, says Anna Dare, a researcher at King's College who was working with Salia to study the state of surgical care in the nation. Brain drain, or the emigration of doctors from the developing to the developed world, is a concern for all countries in the Ebola hot zone. Emigration of doctors from sub-Saharan Africa to the U.S. increased by nearly 40 percent over the last decade. Salia was a rare example of the opposite: He trained overseas but returned to Sierra Leone to work in a local hospital. Before his death Salia was leading efforts to recruit and retain health care professionals, Dare says. "Medical students were starting to warm up to the idea of staying in Sierra Leone and working," she says. "However, now that everyone is dying, they all want to leave as soon as possible."

Even as health officials cautiously declare a decline in the rate of Ebola infections, the epidemic has exacted a new assault against health care workers in the region. Kamara, who has delayed his own retirement plans, worries about his sick mother who recently suffered a stroke and needs his help. "I want to retire soon," he says, "but I don't think I can. Some of the eight [remaining surgeons] have actually retired but they come back to work because we desperately need them."



An operating room at Connaught Hospital in Freetown, Sierra Leone. Two surgeons who worked at the hospital have died from Ebola. Photo credit: Anna Dare.

Nigeria's election commission on Saturday postponed presidential and legislative elections for six weeks due to security concerns.

The vote was scheduled to take place on Feb. 14, amid concerns that millions of voters would be disenfranchised by Boko Haram's brutal insurgency, as well as delays in distributing voter ID cards.

Election commission chairman Attahiru Jega said Saturday that the vote would be rescheduled for March 28 because security agencies were unable to guarantee safe elections while they focus on battling Boko Haram militants.

"We wish to call on all Nigerians to accept this in good faith to deepen democracy in our country Nigeria," he said.

Earlier Saturday, civil rights groups opposed to postponing elections protested in the Nigerian capital of Abuja, the Associated Press reported.

The vote comes at a critical moment for Nigeria. Boko Haram has stepped up its brutal campaign to establish an Islamic caliphate in the country's northeast. More than one million Nigerians have fled their homes amid the slaughter.

The conflict has increasingly spilled over into neighboring Cameroon, Chad and Niger, and this week the African Union pledged thousands of troops for a joint force to battle the Islamists.

CHICAGO (AP) — Six Bosnian immigrants accused of sending money and military equipment to extremist groups in Syria used Facebook, PayPal and other readily available services to communicate and transfer funds, according to a federal indictment.

All are charged with conspiring to provide and providing material support to groups designated by the U.S. as foreign terrorist organizations, including the Islamic State group and an al-Qaida-affiliated rebel group known as the Nusra Front. The indictment unsealed Friday in U.S. District Court in St. Louis alleges they plotted by phone, Facebook and email; shared videos and photos related to their plans on social media sites; sent money via PayPal and Western Union; and shipped boxes of military gear through the U.S. Postal Service.

The defendants are accused of donating money themselves and, in some cases, collecting funds from others in the U.S. and sending the donations overseas. It says two of the defendants, a husband and wife in St. Louis, used some of the money to buy U.S. military uniforms, firearms accessories, tactical gear and other equipment from local businesses and ship it to intermediaries in Turkey and Saudi Arabia who forwarded the supplies to fighters in Syria and Iraq.

One of the suspects, Mediha Medy Salkicevic, a 34-year-old mother of four from the Chicago suburb of Schiller Park, appeared Saturday in federal court in Chicago. Wearing an orange jail uniform, she spoke only to confirm that she understood the charges. She appeared calm and smiled occasionally while consulting with her attorney.

Speaking to reporters afterward, defense attorney Andrea Gambino stressed that Salkicevic is considered innocent until proven guilty.

The indictment says the suspects used "coded language" in their communications over email and social media, using terms like "the beach" for places in Iraq and Syria.

But it says they also used terms such as brothers, lions, mujahids and shaheeds, or holy warriors and martyrs. Such language is commonly used among Islamic extremist groups and would seem likely to draw law enforcement scrutiny if posted openly on the Internet.

But terrorism financing expert Loretta Napoleoni said it's a clever tactic to use such usual channels for communicating and sending money as long as the amounts are small, noting that so many people use them that it's easy to "go below the radar."

"That's the easiest way to send money. ... And frankly using the U.S. Postal Service is also a very good way not to be caught," said Napoleoni, author of "The Islamist Phoenix." ''There is so much stuff going through."

The FBI arrested Salkicevic on Friday. If convicted, she could face up to 15 years in prison and a fine of up to $50,000 on each charge. The case will be tried in Missouri, where several other defendants were arrested. A bond hearing Monday will determine whether Salkicevic travels there on her own or in custody.

The indictment alleges the conspiracy began no later than May 2013.

All six people who are charged are natives of Bosnia who were living in the U.S. legally. Three are naturalized citizens; the other three had either refugee or legal resident status, according to the U.S. attorney's office.

Besides Salkicevic, the indictment names Ramiz Zijad Hodzic, 40, his wife, Sedina Unkic Hodzic, 35, and Armin Harcevic, 37, all of St. Louis County; Nihad Rosic, 26, of Utica, New York; and Jasminka Ramic, 42 of Rockford, Illinois.

Salkicevic is accused of sending several thousand dollars to Ramiz Hodzic in St. Louis via PayPal.

According to the indictment, Hodzic sent her a photo of two sniper rifle scopes being shipped and that Salkicevic replied by saying she hoped they would be put to good use.

Salkicevic has four children and is employed, but her attorney declined to give reporters any other information about her.

Five of the defendants have been arrested; Ramic is overseas, but the Justice Department declined to say where.

Online court records do not list defense attorneys for any of the defendants.

The property manager at the complex where the Hodzics live told the St. Louis Post-Dispatch that the couple had been living there for 1½ years with their three children. Larry Sorth and his wife, Joyce, said they were surprised by the arrests and that the couple was friendly.

"She was very sweet, to tell you the truth," Joyce Sorth said of Sedina Hodzic.

ANKARA/NEW YORK, Feb 7 (Reuters) - Iran's foreign minister has warned the United States that failure to agree a nuclear deal would likely herald the political demise of pragmatist President Hassan Rouhani, Iranian officials said, raising the stakes as the decade-old stand-off nears its end-game.
Mohammad Javad Zarif pressed the concern with U.S. Secretary of State John Kerry at several meetings in recent weeks, according to three senior Iranian officials, who said Iran had also raised the issue with other Western powers. Zarif's warning has not been previously reported.
In a statement posted on the Iranian Foreign Ministry's website, Zarif later denied discussing domestic issues with Western officials.
Western officials acknowledged the move may be just a negotiating tactic to persuade them to give more ground, but said they shared the view that Rouhani's political clout would be heavily damaged by the failure of talks.
The warning that a breakdown in talks would empower Iran's conservative hardliners comes as the 12-year-old stand-off reaches a crucial phase, with a March deadline to reach a political agreement ahead of a final deal by June 30.
The agreement aims to end sanctions in exchange for curbs on Tehran's nuclear program, though hard-to-bridge differences remain, particularly on the timing of the relief on economic sanctions and the duration of the deal.
Both U.S. President Barack Obama and Rouhani, who Iranian officials say has staked his career on the deal, are facing stiff domestic opposition to an agreement, narrowing the scope for compromise.
The Iranian officials who spoke to Reuters said Zarif had raised the concern over Rohani's fate with Kerry. The two men have met repeatedly in recent weeks in an attempt to break the impasse, most recently on Friday when they talked for over an hour on the sidelines of the Munich Security Conference .
"As Rouhani is on the frontline, naturally he will be more harmed," said one of the officials, who has direct knowledge of Zarif's discussions with Kerry.
Other Western officials said the Iranian delegation had raised the same concern in talks recently. If the talks fail, Rouhani would likely be sidelined and his influence dramatically reduced, giving hardliners like Iran's Revolutionary Guard Corps an upper hand, Iranian officials and Western analysts say.
However, a senior U.S. official denied that Zarif had issued any such warning about Rouhani.
"We'll leave assessment of Iranian politics to the Iranians but this rumor is untrue," the official told Reuters on condition of anonymity.
The Iranian Foreign Ministry website quoted Zarif as saying: "Domestic issues were never raised with foreign officials during any of the meetings."

CONFLICTS
A comprehensive nuclear deal is seen as crucial to reducing the risk of a wider Middle East war, at a time when Iran is deeply involved in conflicts in Syria and Iraq. After nearly a year of talks, negotiators failed for the second time in November to meet a self-imposed deadline for an agreement.
Iran rejects allegations it is developing the capability to produce atomic weapons. But it has refused to halt uranium enrichment and other sensitive atomic work, leading to U.S., European Union and U.N. sanctions that have hobbled its economy.
One of the Iranian officials, who also had direct access to the talks, said the Americans were talking in terms of years for the sanctions relief while Iran wanted curbs on oil and banking to be lifted within six months.
Rouhani was elected in 2013 on promises of ending Western sanctions, improving the economy and reducing Iran's diplomatic isolation.
But he faces a worsening power struggle with Supreme Leader Ayatollah Ali Khamenei, who has said Iran should immunize itself against sanctions, suggesting he is prepared to live with them. Khamenei has the final word on any deal.
Rouhani has said Iran needs to end its isolation to help its economy, which has also been hit hard by plunging oil prices.
Both Israel and Saudi Arabia are suspicious of the U.S. decision to engage with Iran on the nuclear issue. Israel has threatened to use military force against Iranian nuclear sites if diplomacy fails to contain the threat it feels Tehran poses.
The United States, officials familiar with the talks say, has already compromised on the issue of how many centrifuges Iran would be allowed to operate.
Obama could temporarily suspend many of the harshest unilateral U.S. sanctions against Iran but permanent removal would have to be approved by the Republican-controlled Congress, where there is little appetite for sanctions relief.
The Senate is finalizing a bill for tougher sanctions if there is no final nuclear deal by June 30. Obama has vowed to veto any new Iran sanctions bill.
Another Western official said Rouhani appeared to have underestimated the resolve of Washington and Europe to demand limitations on Iranian nuclear activities for a decade or more in exchange for sanctions relief.
"Rouhani thought that by speaking nicely and not calling for Israel's destruction, Western powers would rush to sign a deal, any deal, with Iran," the official said. "He miscalculated. The Western powers may also want an agreement but they're also constrained by Congress, Israel and Saudi." (Additional reporting by Dan Williams in Jerusalem and John Irish in Paris; Editing by Stuart Grudgings and Gareth Jones)

To whom it may concern, and it concerns hundreds of millions ...


Two weeks ago, the Greek people cast a decisive vote that reflects a number of desires that can be summed up in one word: dignity.


Ultimately, the Greek people chose this government not out of desperation but out of optimism; out of a belief that they can put the challenges of recent years behind them if...


If, given a chance.


Greeks simply don't feel they're getting that chance right now, with good reason.


With all of the talk of GDP growth, primary surpluses, and repayment schedules, what is being lost is the continuing human cost of austerity.


Unemployment in Greece right now is 25.8 percent. As a point of comparison, that is higher than the highest unemployment ever reached in the United States at the height of the Great Depression. Youth unemployment is even higher -- over 50 percent. My family is incredibly lucky to live comfortably, but too many Greek families can no longer put food on the table, much less help the future of their children. One study shows that Greece suffers a suicide a day due to austerity.


For too long, Greece has been unfairly singled out. Nations around the world run afoul of financial obligations, but we are called to account. People around the world work less hard then Greeks, but we are stereotyped as lazy.


I know and I have seen a different Greece. The Greece I saw leading up to the Athens Olympics was a Greece that was willing to sacrifice and willing to meet and exceed international standards. As a sponsor of students at the Clinton Global Initiative University -- I've seen firsthand the energy and potential of Greece's young people. And as the founding sponsor of the Clinton Global Initiative Mediterranean meeting, I look forward to bringing leaders to Athens this June to work on solutions to many of Greece's, and the region's, challenges.


Inspiring movements and capturing potential requires time, and it requires leadership.


When I served in the Greek Parliament, I was a member of a center-right party. Our new Prime Minister represents the left. You might think that I would reflexively oppose him, but I believe he represents the new leadership Greece needs. Now what he needs, is time.


The Prime Minister-elect had yet to be sworn in before he was subjected to an unprecedented attack from leaders throughout Europe. The media immediately started splashing front pages with dated headlines that told the story of our past, as if it was necessarily the story of our future.


The Greek people voted overwhelmingly for a new start. But Prime Minister Tsipras cannot deliver that new start alone. He needs help from World leaders and Europe's other leaders and the involved Eurozone officials, easing up the strict -- non-workable rules imposed -- on the Greek people.


And I believe if World and European leaders help Prime Minister Tsipras deliver dignity to the Greek people, the Greek people will deliver for themselves -- and the world.

GUATEMALA CITY (AP) — A national disaster preparedness official in Guatemala says the Fire Volcano has exploded, spewing incandescent rock and ash that dusted surrounding communities.

Spokesman David de Leon says authorities put the southern Guatemala area on alert, though no evacuations have been made so far. Karina Lopez, a resident of nearby Antigua, said Saturday that ash mixed with a drizzle to reduce visibility and that the rumblings continued.

The National Coordinator for Disaster Reduction issued instructions urging people to take shelter, wear masks, cover water tanks and be aware of evacuation routes. Firefighters were standing by.

The volcano sits on the border of the Guatemalan states of Escuintla, Sacatepequez and Chimaltenango. It has a height of 3,763 meters (12,346 feet) above sea level.

LONDON--In the fall of 2012, aboard a retired aircraft carrier permanently docked on the west side of Manhattan, I listened as then-United States Secretary of Defense, Leon Panetta, delivered one of the most chilling speeches I have ever heard. To a roomful of leading CEOs and military leaders, Panetta spoke about the new cyber threats faced by civilized society and the many ways in which America's adversaries could use computer networks to spread panic, paralyze the country and inflict mass casualties.

"Let me explain how this could unfold," he said. "An aggressor nation or extremist group could use these kinds of cyber tools to gain control of critical switches. They could, for example, derail passenger trains or even more dangerous, trains loaded with lethal chemicals. They could contaminate the water supply in major cities or shut down the power grid across large parts of the country."

"The most destructive scenarios," he continued, "involve cyber actors launching several attacks on our critical infrastructure at one time, in combination with a physical attack on our country . . . The collective result of these kinds of attacks could be a cyber Pearl Harbor; an attack that would cause physical destruction and loss of life. In fact, it would paralyze and shock the nation and create a new, profound sense of vulnerability."

Those words echoed again for me with today's news that a mammoth breach of data occurred last month at America's second-largest health insurer, Anthem. The attack, which authorities have linked to Chinese hackers, reportedly pilfered the birthdays, Social Security numbers, email addresses and home addresses of 80 million customers and employees. This comes on the heels of a series of cybercrimes that have recently ricocheted through headlines - from the vicious attack that sought to destroy Sony's computer network to the more benign hacking of the YouTube and Twitter accounts of the U.S Central Command by somebody claiming links to the Islamic State.

While Panetta's fears have thankfully not yet been realized, it's time to acknowledge that cyberwar is a greater threat to the U.S. today than more traditional forms of terrorism. If the first 15 years of the 21st Century were defined by the so-called Axis of Evil--the phrase George W. Bush applied to Iraq, Iran, and North Korea in the days after 9/11 for their support of terrorists--the next 15 years will likely be defined by the Access of Evil, as state and non-state cyberterrorists use technology to bypass our defenses in ways that damage businesses, lives, and nations.

There is little question about the charter members of this club. As Texas Congressman Michael McCaul, the chairman of the House Committee on Homeland Security, recently put it, "Russia, China, North Korea and Iran are increasingly hacking into U.S. companies and government networks for espionage purposes or financial gain."

So, what does this Access of Evil look like?

Russia has been tied to state-sponsored cyber-attacks as far back as 2007, when Kremlin-linked hackers disabled the government websites of Georgia and Estonia. Last fall, Western governments accused Moscow of sponsoring cyber-attacks that sought to infiltrate the White House, the German government, the North Atlantic Treaty Organization (NATO), the Ukrainian government, telecom companies and universities. More troubling were reports that Russia, angry over Western sanctions for its illegal invasion of Ukraine, had gained access to some of the industrial-control software that drives part of America's critical national infrastructure. For good measure, last July's cyber-attack on J.P. Morgan--which saw hackers steal personal information from 83 million account-holders--was also traced back to Russia.

China is strongly believed to have funded a program starting in 2006 (dubbed Operation Shady Rat) that saw its hackers steal information from more than 70 national governments, global corporations and nonprofit organizations. In 2012, the Pentagon accused China of attacking U.S. government computers to extract sensitive information. Last May, a U.S. grand jury indicted five hackers associated with the Chinese military for stealing information from six American companies in the nuclear and solar power industries and passing it along to competitors in China. Today's Anthem news is just more of the same.

Meanwhile, North Korea has reportedly carried out six major cyber attacks on South Korea since 2009, costing that nation nearly $1 billion. Warning bells were raised last September when Hewlett-Packard issued a cyber threat report alleging that Pyongyang was significantly expanding its cyber warfare capabilities. Those fears were realized in December, when both the Federal Bureau of Investigation and the U.S. Department of Homeland Security linked the attack on Sony Pictures Entertainment back to Pyongyang. Further stoking fears, last month, Seoul alleged that Kim's hacker army was now 6,000 strong and planning new digital mayhem.

Iran, by contrast, was first associated with cybercrime as a victim. In 2012, Iran's nuclear program was the target of a massive cyber-attack -allegedly spearheaded by Israel and the U.S. - that infected the software running hundreds of centrifuges as they spun uranium into nuclear material, causing them to lose control and fail. Iran reportedly retaliated by backing a massive attack that disabled three-quarters of the computers at Saudi Arabia's national oil company. By early 2013, having invested billions to improve its online arsenal, Iran declared itself the "fourth biggest cyber power among the world's cyber armies." A remarkably sophisticated Iran-linked attack on the websites of major U.S. banks, combined with the news that Iran had successfully infiltrated the U.S. Navy's network, raised alarm bells and led the U.S. Army War College's Strategic Studies Institute to declare that "Iran as a cyber power is the elephant in the room that everyone is finally beginning to notice."

And this is just the start--according to intelligence reports, more than 140 countries have some kind of cyber weapon development program. For small nations in particular like North Korea, which has just 24 million people, cyber warfare is the great equalizer, enabling them to take on larger nations and wreak havoc in ways that aren't possible with conventional warfare.

Of course, with the leak of thousands of classified documents by former U.S. government contractor Edward Snowden in 2013 and their revelations of secretive global surveillance programs run by the U.S. National Security Agency, every member of the Access of Evil has charged the U.S. government with hypocrisy. That's understandable. But I'd argue that there is a world of difference between using technology as a cyber ear--to monitor global networks in order to root out terrorist cells and advance global security--and using it as a cyber weapon to steal, disrupt and destroy the hard work of others for one's own benefit.

Thus far, the damage of this ongoing cyberwar has been largely commercial, costing the world economy an estimated $575 billion a year. Last year, a range of U.S. companies--from Target to Home Depot to EBay--were added to a list of more than 75 American corporations that have suffered attacks resulting in a million records or more being compromised or publicly disclosed. We now have a decade's worth of stories like the one recounted in Fortune last fall, of an American biomedical company that went through a five-year process to introduce a new innovation to market--only to see a Chinese competitor infiltrate its mainframe, steal its design, and rush the same exact product to market in less than half the time.

While we have been spared the kinds of attacks that Panetta spoke about, a leading expert on cybersecurity warned The Times of London that such attacks are "very close." And the worst part, said Eugene Kaspersky, who advises organizations ranging from Interpol to the British government, is that "States are scared. They're absolutely not ready for this challenge (and) they don't yet have the strategy in place" to stop attacks on national infrastructures. Indeed, numerous organizations have warned that the U.S. electrical power grid in particular is nearly defenseless against cyber attacks. With extremist organizations like ISIS already using social media in sophisticated ways to attract recruits, cyberwar could be the next battlefield.

For 40 years, Americans have asked: what is the next moonshot? What big, audacious goal could this generation set that is as grandly ambitious as President John F. Kennedy's 1961 challenge that America should land on the moon within a decade? I think it is this: to bring together our best public and private minds, our best companies and not-for-profit organizations, our best innovators and entrepreneurs, and find a way to ensure that the technology lifting our economy and our world to new heights today doesn't also become the means and tools of our destruction.

I've lived through one Pearl Harbor in my lifetime. We can't afford another one.

Stanley Weiss, a global mining executive and founder of Washington-based Business Executives for National Security, has been widely published on domestic and international issues for three decades.

There are ideas and calls in the US arena for stronger, firmer, and more decisive measures to implement the policy declared by US President Barack Obama to eliminate ISIS, as part of a comprehensive and calculated strategy away from arbitrariness and hesitation. Many high-level military officials who previously served in senior posts have started talking publicly about the "failure" of the United States to defeat al-Qaeda, ISIS, the Taliban in Afghanistan and Pakistan, and other radical Islamists because of the policies and decisions of the executive branch, particularly under Obama. Some are talking about the need for an Arab version of NATO, stressing the crucial importance of an actual US partnership with such an alliance, as this would serve the US interest. Otherwise -- as one such military voice cautioned -- the threat of ISIS, al-Qaeda, and radical Islamists is coming to the US homeland. John McCain, Republican senator and Chairman of the Armed Services Committee in the Senate, says eliminating ISIS is contingent upon the Obama administration adopting a clear position against Syrian President Bashar al-Assad and his Iranian allies. He says that in the short term, there is no other option but to create no-fly zones in Syria while significantly stepping up air strikes with the participation of special forces on the ground, which would bolster those fighting ISIS and the regime in Damascus. In the long run, McCain believes it is necessary to create an Arab force in Syria and Iraq with broad US participation in the air and limited participation on the ground, with the goal of supporting the Arab force. He explains that any Iranian participation in the war on ISIS in Syria is unacceptable because of what he calls the unholy alliance between Iran and Syria, saying that any US consent of this would be immoral. But what is absent from the US discourse on how to defeat ISIS is the need for a quasi-preemptive strategy in Yemen and Libya, which are becoming a fertile ground for the growth of Islamic radicalism in all forms. What is present so far is the continued reluctance to lead in earnest, not only because of the attitudes, personality, and thinking of President Obama, but also because of the inherent inconsistency in the US public opinion and character.

The Arab public opinion is no less inconsistent or lazy than the US and European public opinion, albeit it is sharper. The whole world has now seen the appalling yet calculated barbarism in the high quality, high definition video footage of ISIS's immolation of the captured young Jordanian pilot Moath al-Kasasbeh. Jordan and the Arab and Muslim countries are riding a wave of anger and outrage at the horrific crime and the baseness of ISIS, which poses an existential threat to the Arab nations.

But it is not enough to be angry. The Arab and Muslim worlds must rise up against ISIS. Those who consider the group a natural response to Iranian encroachment in the Arab region and those who see ISIS as an instrument of responding to Shiite exclusion of Sunnis in Iraq must desist. Otherwise, this will only be an investment in burning the Arab spirit and Islamic principles.

The above requires regional and international policies that would accompany it in order for it to succeed or even happen. In this context, it is vital to repair the US-led international anti-ISIS coalition, where Obama must stop avoiding international decisions, gaffes, hesitation, and shirking what the circumstances require him to do.

President Obama said the barbaric execution would "redouble the vigilance and determination on the part of global coalition to make sure that they [ISIS] are degraded and ultimately defeated." But one question is this: How will the US president translate this pledge into action as the leader of the coalition? The poles of the coalition are reproachful of Obama because of his political attitudes that are averse to clarity and devoid of strategy, such as by insisting on the need for Bashar al-Assad to step down without having a roadmap or practical preparations for implementing this. They are also reproachful because of the lack of US military preparations in the framework of the coalition.

The UAE suspended its air operations against ISIS, urging the United States to provide better protection for pilots in the event their planes are downed by moving US search and rescue equipment from Kuwait to northern Iraq. The UAE is right to do so.

Jordan will need more and more after King Abdullah II ordered the death sentences against Sajida Rishawi to be implemented. ISIS had demanded Rishawi's release in return for the pilot Kasasbeh, at a time when it had already burned him alive a month ago.

In the beginning, some Jordanian tribes, when Jordan declared its intention to do a prisoner swap, called publicly for Jordan to withdraw from the international anti-ISIS coalition saying this was not Jordan's war. After the video was posted, the Jordanian tribes including that of Kasasbeh's father began calling for revenge and supported the decision of King Abdullah to expedite the death sentences involving convicted jihadists and to remain in the coalition.

It is likely that ISIS would step up its revenge and escalate against Jordan. For its part, Jordan will likely resume its air sorties as part of the coalition's air campaign against ISIS, after having suspended its operations following the capture of the Jordanian pilot. This will require the members of the coalition, especially the United States, to implement practical and advances measures to protect Jordan. Here, Japan may be the first country to step up support for Jordan, after ISIS executed a Japanese journalist. ISIS had linked his release to the release of Sajida Rishawi, a demand Jordan agreed to but in return for the release of both the Japanese and Jordanian hostage and demanded proof of life. The deal was unsuccessful.

It is therefore expected that a serious and comprehensive review of the work of the international coalition would take place, in the aftermath of the beheadings and immolation exhibited by ISIS this week. It is now clear that air strikes alone will not bring about the full defeat of ISIS, and that there is no alternative to a clearer and broader political and military strategy in the air and on the ground.

The Arab and international popular climate is now more open to more stringent measures to stop the horrendous crimes perpetrated by ISIS, which has moved from beheading to burning people alive. This is a deliberate escalation by ISIS meant to invite denunciation while attracting volunteers for its ranks, and to provoke the United States into broader participation in the war against it possibly. This would be especially the case if ISIS decides to kill the American woman it holds hostage, and indeed, the execution of a young American woman in her 20s would have a huge impact on US decision makers and the nature of US measures.

The beheading of the Japanese journalist and immolation of the Jordanian pilot constitute the most blatant challenge for the members of the coalition and the American political and military diffidence. The talk being circulated about a response is not limited to escalating the military operations of the coalition, but also includes prospects for possible -- or impossible -- accords between the United States and Russia on the Syrian arena. It also includes the Iranian regional and nuclear dimension in the US calculations, bearing in mind that Iran is playing a direct military role in Syria alongside the regime to keep Assad in power, while the regime in Damascus is marketing itself as a natural ally for the coalition in its bid to defeat ISIS.

From the Arab side, the members of the coalition, the Gulf countries and Jordan, in addition to Egypt, are in remarkable accord and have important joint positions. This could form a nucleus for that "Arab force" that has to be considered as a serious option sooner or later.

On the international level, the equation between the United States and Russia has returned to regional and international considerations. On the surface at least, fighting ISIS in Syria seems to be something both the United States and Russia agree on, as both countries consider the organization their enemy. As for the necessary measures in the broader strategy that requires abandoning Bashar al-Assad to mobilize an upsurge against ISIS, these are hitting the wall of the American-Russian relationship and the requirements of accord between them.

The question today is what does Russia, which is in a standoff with the West in Ukraine, want? Russia has accused the United States and Saudi Arabia of "starving" the Russian people by driving oil prices down. What are the demands of President Vladimir Putin, who is well aware of the risk ISIS poses to him on his home soil and immediate vicinity? Is he ready to adapt with what is needed in Syria in relation to Assad's fate, to allow the international coalition to defeat ISIS? Or is he still insisting on clinging to the Syrian president under any circumstances and at any price?

What is the price Vladimir Putin wants? Accords and trade-offs? Or are his goals strictly confined to strategic and nationalistic calculations? Meanwhile, will oil prices and their damaging effect on Russia force it to reconsider and seek different kinds of negotiations and trade-offs?

This will depend on the extent of the existential threat felt by Russia. So far, the United States, Russia, and the European countries do not see ISIS as an existential threat. For this reason, they may drag their feet. If this happens, ISIS might respond in kind, considering this a signal for it to restrict its destructive and barbaric activities to the Arab region.

For this reason, the voices rising in the American arena to caution against repercussions for the US homeland should the hesitant and reluctant policies continue are sounding the alarm about the threat that the popular majority wants to be dealt with, while the US administration wants to mitigate until the nuclear negotiations with Iran are concluded.

For this reason as well, retired military figures and others in Congress consider the leniency with Iran's nuclear and regional ambitions as a threat to the stability of the Middle East and US interests. This is a taste of what is to come should nuclear negotiations fail with Iran.

These voices are reminding people that the United States has the option of imposing an economic blockade on Iran, should the nuclear talks fail. It also has the ability to thwart Iranian intervention in Syria -- whether direct or through groups like Hezbollah -- and trim Iran regional ambitions.

The coming phase will be difficult for the Arab region. But it will not be a phase in which Islamic radicalism in its multiple sectarian flavors will triumph.

Translated from Arabic by Karim Traboulsi

DELHI, India — On a recent Sunday afternoon in the tightly packed slum of Narela at the edge of Delhi, a group of children sat on a bright green rug amid broken tiles, bricks and bits of wood, engrossed in an animated discussion about their neighborhood.

Hens and goats roamed around. Older women in the traditional Indian sari sauntered past. Plastic buckets, used to fetch water from the nearby standpost, lay stacked in a corner. A small child shrieked, trying to clamber aboard a push-cart. The children, roughly between the ages of 7 to 16, talked of the need for toilets, clean water, parks and street lights. The weekly meeting of their child club, known as Mannat, was in progress.

A visitor might ask why children would like to spend part of their weekend in a meeting instead of playing. One answer is because they don't have a playground nor any of the recreation facilities that more affluent children in India's cities take for granted.

Female genital mutilation is on the rise in the U.S., and a number of doctors here are ramping up their efforts to reverse the damage the practice causes with a relatively new restorative surgery.

Friday marks the U.N.'s International Day of Zero Toleration to Female Genital Mutilation, and a new report found that the risks for girls and women in the U.S. has more than doubled since 2000. But there is renewed hope for females who have been cut as more physicians are offering clitoroplasty, which restores clitoral function.

While reconstructive surgery has long been available, about 10 years ago, French physician Dr. Pierre Foldes pioneered a procedure, which rebuilds the damaged area and rejuvenates the nerve networks so that patients can regain sensitivity and in some cases, attain orgasm, according to the U.N.

"It can certainly improve women's pleasure and lessen their pain," Foldes said in a statement in 2012 after studying the results of 3,000 such surgeries. "It also allows mutilated women to recover their identity."

During the one-year follow-up, most patients reported experiencing less pain or at least no worsening pain, and 81 percent said their sex lives had improved, according to a study published in The Lancet.

While the surgery proved effective, Foldes also noted at the time that it was cost prohibitive and needed to become more readily available for the girls and women who are eager to get it.

More than 130 girls and women worldwide have undergone FGM, which involves partial or total removal of the external female genitalia and has no medical benefit. The number of women and girls who are at risk in the U.S. has more than doubled to half a million over the past 15 years, according to a study released on Friday by the Population Reference Bureau.

The nonprofit attributes the concerning increase to a rise in immigration from African countries.

FGM poses a slew of health risks, including causing damage to adjacent organs, recurring urinary tract infections, birth complications, the formation of dermoid cysts and, in some cases, can lead to death.

Girls are typically cut before the onset of puberty, with the goal of making them remain virgins before marriage and faithful to their husbands once they wed, according to UNICEF.

In 2012, the United Nations General Assembly called on all countries to eliminate the practice. But in countries where it's widely practiced, FGM shows no sign of slowing down.

In Egypt and Somalia, for example, more than 90 percent of the female population is affected by the tradition.

Realizing the overwhelming need of women who have undergone FGM, Dr. Marci Bowers, a renowned expert in transgender surgery, according to the BBC, now devotes a portion of her practice in California to performing clitoroplasty.

She trained with Foldes in France and did her first clitoral repair surgery in the U.S. in 2009. Since then, she's done about 100 such procedures, according to The Washington Post.

Bowers was the subject of a Vice documentary, "The Cut That Heals," which was released on Friday.

Ayan, a 32-year-old nurse who was cut in Somalia when she was 6, is a patient of Bowers and was featured in the film. She fled for the United States in the '90s and had been too "ashamed" to see an OB-GYN before she met Bowers.

Before the surgery, she told Vice she felt "OK" about her body, barring the "particular issue she wants reversed."

Ayan said she is a virgin and plans on remaining so until she gets married. But she doesn't need the pain and the scars from the FGM procedure to be "reminded to be pure."

Bowers performs the procedure, which takes less than an hour, for free. Patients just have to pay the operating room and anesthesia fees, according to her website.

But she says the surgery is about much more than just enabling women to feel sexual pleasure.

"The number one reason is restoration of identity," she told The Washington Post. "They want their body back and to feel more normal. It's about not being different any more."

Six weeks after the surgery, Ayan wrote in an essay for Vice that her menstrual cramps had already eased up and that she's "healing beautifully."

"I was immediately overcome by a feeling of completeness," she wrote. "It was an unfamiliar feeling."