THE WEST BLOCK
Episode 18, Season 13
Sunday, January 14, 2024

Host: Eric Sorensen

Guests:
Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations

Health Panel:
Dr. Kathleen Ross, CMA President—Coquitlam, BC
Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown

Location:
Ottawa Studio

Eric Sorensen: Increasing tension in the Middle East after a U.S. led coalition strikes Houthi targets in Yemen.

I’m Eric Sorensen, sitting in for Mercedes Stephenson. Welcome to The West Block.

The strikes are intended to stop Houthi attacks on ships in the Red Sea, but could they escalate a wider regional conflict? We speak to a former U.S. state department official about the risks as the White House grapples with the war between Israel and Hamas.

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Plus, emergency departments are overwhelmed again this winter. With long wait times and not enough beds, a crisis is plaguing Canada’s health care system and it’s getting worse. We speak to two doctors with a roadmap for policy makers.

And, remembering former NDP Leader Ed Broadbent.

Prime Minister Justin Trudeau: “His service to this country was always focused on strengthening communities, on bringing people together.”

Eric Sorensen: Fears of escalation in the Middle East are rising after strikes by the U.S. and U.K. on Houthi targets in Yemen. The strikes supported by U.S. allies, including Canada, are aimed at stopping Houthi attacks on shipping vessels in the Red Sea. It comes at a delicate time for the White House, as the U.S. secretary of state just wrapped up his latest visit to the region for talks on how to end the conflict and what happens to Gaza when it’s over.

Antony Blinken, U.S. Secretary of State—Cairo, Thursday: “We also had conversations about the day after the conflict ends, doing the work necessary to prepare for that, as well as for long-term, enduring security.”

Eric Sorensen: So, do the air strikes undermine the White House peace plan, or do they risk a wider conflict in the Middle East?

Joining me now is Frank Lowenstein, a former U.S. envoy for Israeli-Palestinian Negotiations.

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Thank you again, Mr. Lowenstein for being with us. The U.K. and the U.S. are combatants now in the region, with the attack on the Iranian sponsored Houthis. What are the risks would you say now of a still wider conflict?

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Well so I think that the risk of escalation in Yemen is relatively limited, that there’s only so much more the Houthis can really do beyond what they’ve been doing right now. And we had a similar situation in 2016 and we launched a pretty serious attack on their military targets and they stood down after that. My guess is that they won’t do that now, but I don’t see that as being a front that has a lot of potential to explode. I think the administration is much more concerned about the Lebanon border and the potential for Hezbollah to be getting more involved in that war. And then also the West Bank, which is in a very delicate situation right now, and I think Blinken and those folks are very concerned that that whole situation may collapse. So yes, it’s of concern, certainly, what’s going on in Yemen and we did really everything we could to avoid it. But it is important to understand that if the Houthis were determined to get a response out of the United States and our allies, they were going to be able to do that. So we tried as hard as we could to avoid it and now I think the process is just one of containing it as much as we can.

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Eric Sorensen: You know Antony Blinken’s diplomacy; he’s been to the region now four times. What has it achieved? Like Israel is not curbing its attacks on Gaza. It is not backing away from being in Gaza, possibly controlling it for a very long time.

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Right. Well one of the things that I learned when I was in the state department was sometimes you get measured on the bad things that didn’t happen, and I think what the secretary would probably say is that we’ve avoided war with Lebanon, with Hezbollah and Lebanon. We’ve kept the West Bank from disintegrating entirely. So I think he would view his efforts as being successful on those core objectives. That being said, he’s in a very, very difficult spot with respect to what the Arab world wants in order to engage in the reconstruction of Gaza, and ultimately in the case of Saudi Arabia, normalizing relations with Israel. And that is a path to a two-state solution, and I think he presented that to the Israelis yesterday with the Saudi potential for normalization being at the top of the list and I think he really expected a more forward leaning response out of the Israelis. Their reaction was something along the line of look, we’re just not ready to talk about any of that stuff right now, and it really puts Blinken and the U.S. in a very difficult situation because we can’t move forward with the next stages of this conflict, getting Arab world involved in a peacekeeping force and reconstruction if they don’t see that path to a two-state solution, and right now that’s basically an impossible task when it comes to the Israelis.

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Eric Sorensen: is there a significant rift between Joe Biden and the White House and Benjamin Netanyahu and the Israeli government?

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Well I wouldn’t say it’s significant, and it’s largely been behind the scenes right now. I know there have been some very tough conversations with the Israelis that we have been engaging in, you know, outside of the public eye. And I think what we’ve really been focused on there is the humanitarian situation in Gaza. I think the military campaign; we would like to see them engage in a much more targeted approach. I think we’ve made that very clear. The Israelis are not doing that as much as we would like, but they’ve made some progress in that direction. Where we’re really nowhere is on the humanitarian assistance. I mean as you all well know, there’s 2 million people in Gaza who don’t have food and water and fuel. Many of them are at risk of famine and disease. So you could be looking at, you know, casualties on a scale that would dwarf what we’ve seen so far in the military conflict, unless Israel changes its position significantly with respect to allowing humanitarian assistance. And I think on that front, one of the things Blinken would really have stressed is the possibility of a two-week pause in return for the exchange of some hostages, and also the opportunity to give the people of Gaza, you know, much more humanitarian assistance than they’ve gotten right now. So I think that’s the main focus for Blinken is on this sort of shorter term what can we do to prevent this situation from really spiralling out of control on the ground in Gaza, and then work towards the next stages after we’ve gotten that done.

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Eric Sorensen: It’s what makes me wonder if there isn’t more of a rift that’s kind of—that can just widen quickly here because, you know, I mean President Biden throughout his career has been a staunch supporter of Israel, but could this war at this moment imperil Joe Biden and his political future at home in an election year?

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: It’s a great question and there’s no doubt about it. It is having a negative impact on the president’s polling numbers. Again, they don’t seem to be too concerned about that right now. I think there’s a long way to go between now and the election. But I think over time, you will see us taking an increasingly tough line. There’ll be an increasingly obvious public rift between us and the Israelis when it comes to this humanitarian situation. I really can’t stress that enough, how unbelievably dangerous that is and what an impossible situation a lot of perfectly innocent people in Gaza have been put in. And given that we are so invested in this war, we are by extension to blame for that disaster. So I think we’re really going to be pushing the Israelis on that as much as we can and hoping that they’re really going to change course, you know, at a fundamental way on that front. Otherwise, you could be looking at a big breach between the U.S. and Israelis, publicly.

Eric Sorensen: You now immediately after the Hamas attack in October you were on this program with Mercedes Stephenson and you said there will be a long and brutal war, and here we are. Do you see from now at this point that it just carries on or is there an end to it?

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Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Yeah, it’s going to carry on. I don’t think there’s any question about that. The Israelis have said that there’s months left in this campaign. If you look at where—by their own account, they’ve killed maybe a third to half of Hamas fighters. Their still very much dug in around Khan Younis in Southern Gaza and there—the Israelis are saying nobody can go back to Northern Gaza because there’s still a, you know, a large contingent of Hamas militants in tunnels and otherwise hiding there. So the military campaign is nowhere near having achieved its objectives, and so the Israelis have no intention of backing down. I don’t think this talk of a day after is really accurate. I think that there’s different phases that this campaign is going to go through. But any talk of brining the Palestinian authority into Gaza or figuring out how governance is going to work there is premature because we have probably three or four months at least of fairly intensive military fighting there and at that point, you can start thinking about what comes next. But the Israelis have made clear this is a campaign that’s going to take a long time and they intend to be full occupiers of Gaza for as far as the eye can see. Not permanently, but as long as it takes to achieve their military objectives, which can be, you know, months at best.


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Eric Sorensen: So this renewed talk of a two-state solution, is that something that you can see the conditions being bringing that about in some way out of this war or are we further away from that than ever?

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Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Well it’s a really good question. Right now, we’re further away than that than ever. But there’s been a line of reasoning here in the United States that this situation had to get a lot worse before it had any chance of really getting better. And so maybe there is opportunity that comes out of this. Maybe the Israelis will take a step back when they get done with this campaign and ask themselves: is this a sustainable way for us to live? And hopefully they’ll see the light and say okay, we have to do some things different here in order to get Saudi normalization, in order to get support for reconstruction. In order to keep the United States on side, they have to change course, but that’s going to take a different government. To be very clear about it, Prime Minister Netanyahu will do nothing to advance the two-state solution, right? His coalition is so far to the right; they’re still talking about settling Gaza Strip and really getting the Palestinians there out to other countries. So their mentality there is nowhere near conducive to a two-state solution and I don’t think that’s going to change as long as Prime Minister Netanyahu is in power.

Eric Sorensen: If it’s worth looking that far ahead, what do you see happening the day after the war is over? Who rebuilds? Who’s in charge?

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: So I think that really depends a lot on how the Israelis conduct the rest of this military campaign. If you’re looking at, you know, tens of thousands of more casualties, more likely as a result of disease and famine than directly, you know, as a result of Israeli military strikes, but if that is the case, they may have burned so many bridges in the Middle East at that point that none of the other countries are willing to help them with reconstruction. So I think one of the things Blinken has been stressing is hey, you’ve got to start thinking about the next step now. Maybe it’s six months away or whatever, but in any event, you need to start behaving now in a way that’s going to allow for some possibilities for peace in the future and in any event, for the Arab world to come in and provide tens of billions of dollars for reconstruction, which is absolutely necessary. But yeah, right now it looks like we’ve taken a big step back, but it may be possible with different leadership, really on both sides that this could open up opportunities down the road.

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Eric Sorensen: We only have a few seconds left. Does Netanyahu survive out of this?

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Ah, I’ve learned never to count out Prime Minister Netanyahu. He rises like the phoenix over and over and over again. His situation is worse than it’s ever been and he’s really beholding to an extreme right wing coalition, which is not going to work when it comes to, you know, their longer term goals in Gaza and our longer term goals in Gaza. So I think this is all going to come to a head in the next few months, whether it be he makes it out of that or not is really anyone’s guess.

Eric Sorensen: Mr. Lowenstein, really good to talk to you. We always get lots out of it. Thank you very much.

Frank Lowenstein, Former U.S. Special Envoy for Israeli-Palestinian Negotiations: Thanks for having me.

Eric Sorensen: Up next, long wait times and overwhelmed ERs. Why doctors are calling for urgent action to address the crisis in health care.

Dr. Trevor Jain, Canadian Association of Emergency Physicians: “Well the situations from coast to coast to coast, they’re horrific and inhumane. We have a large number of Canadians that are waiting in emergency departments with serious illnesses, up to 10, 12, 15—we even heard up to 32 hours in one emergency department in Canada.”

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Eric Sorensen: Once again, emergency departments are overwhelmed with patients who are waiting many hours for care. Some of the causes are familiar: not enough staff, not enough beds, and the surge that comes from a lot of people getting sick this time of year. What’s different this time? Well, ER doctors say the situation is the worst they’ve ever seen, and they want real action to fix the crisis plaguing Canada’s health care system.

For more on this, we’re joined by Dr. Kathleen Ross. She’s a family physician and the President of the Canadian Medical Association. And Dr. Trevor Jain, an ER doctor with the Canadian Association of Emergency Physicians.

So let me start with you Dr. Jain. First of all, describe the situation in your emergency room.

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: Well the situations from coast to coast to coast, they’re horrific and inhumane. We have a large number of Canadians that are waiting in emergency departments with serious illnesses, up to 10, 12, 15—we even heard up to 32 hours in one emergency department in Canada. I mean the last 20 years, the emergency department’s become all things for everybody for all the time, because we’re always open and the system’s starting to reflect that crisis.

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Eric Sorensen: Dr. Ross, you’re in B.C. You’re talking to doctors across the country. Is what Dr. Jain describes isolated?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: Unfortunately this isn’t an isolated issue anymore and we’re seeing these challenges from coast to coast to coast, in urban centres and rural centres. We really have a crisis of access on our hands now.

Eric Sorensen: What is the risk here for Canada?
Eric Sorensen: Well and we have, you know, six million Canadians. We talked about this on this program a year ago and the situation only seems to have gotten worse. Six million Canadians can’t access primary care. Dr. Ross, why is that?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: So there’s clearly a mismatch between the number of Canadians seeking primary care and those of us providing primary care. The time is now for us to look at exponentially increasing team based care so we can leverage the skillset of a number of providers as part of the team to improve access to the primary care. These are the inflow issues when we look at our emergency department, overcrowding. If people have no access to primary care in the community, of course they’re going to turn to the emergency room. As Dr. Jain has said, the lights are always on. It’s always open. And the greater issue I think we need to look at for our overcrowding in emerge is how do we move people out of emerge into those acute care beds, into long term care beds where that’s appropriate, exponentially increasing access to hospital at home to try and offload treatments that we can offload. These are all areas that we can target in the year ahead.

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Eric Sorensen: Dr. Jain, I think that’s the concern of ER doctors is that there is—that people are seeing it as a problem of too many people arriving at ER but describe the fact that it’s really there’s a bottleneck that occurs at ER.

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: Yeah, there’s this myth that, you know, that some planners and agencies have socialized that patient diversion, that is telling sick people not to come to the emergency department as a way to solve emergency department overcrowding. Look, we know those patients that show up with minor illnesses or minor issues, they don’t cause emergency department overcrowding. It is an outflow problem. It’s the admitted patients that we have on stretchers that we cannot move to hospital beds because the hospitals are full. You know, you talk to any emergency department, we can stand being busy. We don’t mind being busy, but overcrowding kills and that’s what we’re starting to see.

Eric Sorensen: You know I want to kind of get to this question right away because it’s just hanging out there. What is it—you know, Dr. Ross I’ll start with you and I’ll ask you both the same question—what is your message to the political leaders when we have a situation like this getting worse?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: We need to move quickly on the targets that have already been established. There are dollars on the table from the federal government to provincial and territorial organizations that we can actually start to address some of the challenges we’re facing. We have to look at our staffing issues. We need to train more physicians and nurses, and we need to retain more physicians and nurses. And that means making sure that our workplaces are safe, secure and well-supported. And at the moment with overcrowding, certainly the patients are waiting long times. Certainly patients suffering, but those of us providing care are suffering as well and that leads to more burnout and more turnover.

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Eric Sorensen: And I’ll stay with you for just a second. I asked you about that federal funding because that was put in place, or at least offered, almost a year ago now. Only four provinces: B.C., Nova Scotia, P.E.I., Alberta have signed up. What’s holding it up for Ontario, Quebec and the others?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: That’s a great question, and I think Canadians are really losing patience with this challenge. We know we need sustainable, long term plans for health care, with absolutely transparent and accountable measures on access. And certainly access to primary care and access to emergency rooms have to be top of that list. That’s the front door foundation of our health care system and we need to get moving.

Eric Sorensen: Dr. Jain, what is your primary message to political leaders who watch a program like this?

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: Well what I would say is this, the Canadian Association of Emergency Physicians, we asked for a meeting with the ministers of health across the country and they had a meeting in October, in the fall, in Charlottetown with all the ministers of health. And the Canadian Association of Emergency Physicians is asking for an immediate national forum on the acute care crisis with premiers across the country and with fellow stakeholders in order to address this issue. I think that, you know, to Dr. Ross’ point, Canadians have had enough. They’ve been extremely patient, but regardless of their postal code, Canadians deserve timely access to acute care services.

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Eric Sorensen: Dr. Ross, I mean we were used to seeing these kinds of political summits where premiers and maybe the prime minister gather around a table and the country pays attention. What about the doctors being on hand at a table like that, the medical association and the administrators being at the table like that, and those political leaders and having them all talk about it in a way that would have Canadians paying attention?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: So I really think we’ve gotten very good at naming the problem. We’ve identified solutions. We haven’t been the greatest at implementing those solutions. I’ll add that I don’t believe that any one jurisdiction, no one entity is going to be able to resolve this crisis. We need to be collaborative. We need to bring the voices of the front line and experience together with those that are writing the cheques and distributing the money alongside those that are administering the problem is too huge for us to actually address as individuals. And I support Dr. Jain’s calls for a national forum.

Eric Sorensen: You know the CMA wants doctors to be allowed to practice in other provinces without additional bureaucratic licensing requirements. Dr. Jain, in Atlantic Canada you’re doing that. How is that working?

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: Well it’s a great program, and I’m thankful for the leadership of the CMA continuing to move the ball forward on this. And what I would say is it provides some labour mobility and, you know, from a regional plan, if there’s one part of the region that is desperately in need of health care providers, it’s a nice way to increase that labour mobility. But going to what Dr. Ross has said, unless we increase our HR resources, those are training more physicians, training more nurses, building more infrastructure to handle our patients in all aspects of their care, you know, national licensing is a positive move but it’s only one part of a many complex solution that’s required.

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Eric Sorensen: From your perspective, Dr. Ross, that mobility question, does that help in some way? And once again, where are the other provinces on this?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: Yeah. So certainly, I applaud the Atlantic Provinces for moving first on this area. We know that there’s 250 physicians that have signed on to that Pan-Atlantic Mobility Registry. It’s important for us to actually evaluate that, show the successes, show the areas where physicians have been able to provide that critical coverage that’s needed to ensure emergency rooms don’t close, that there’s speciality services available where they might not have been before and provide those necessary coverage’s for rural, remote physicians to be able to take time away for educational, personal leave, medical leave for that matter, to be able to make that practice sustainable.

Eric Sorensen: So just a quick answer from each of you then, in 30 seconds. Dr. Jain, one year from now, what changes would you like to see that you could pinpoint that you would see a year from now that isn’t here right now?

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: I would like to see the premiers make this one of their number one priorities and meet with the Canadian Association of Emergency Physicians, the CMA and other stakeholders to address the health care crisis and in particular, from our lens, the acute care crisis and primary care crisis with actionable steps. You know, we’ve said it before, you know, we’ve named the problem. It’s time to move on with actionable steps and solutions. So let’s roll up our sleeves. Let’s get together and let’s get the care that Canadians deserve.

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Eric Sorensen: Dr. Ross, one year from now, what do you want to see that’s different from what’s happening right now?

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: I’d like to see a long term plan in place with clear and measureable targets that Canadians can look to and understand where their health care dollars are being spent and how we’re making progress.

Eric Sorensen: All right. Dr. Ross, Dr. Jain, thanks so much for talking to us. It’s a big problem, but we’ve got to keep cracking at it. Thank you.

Dr. Kathleen Ross, CMA President—Coquitlam, B.C.: Thank you very much.

Dr. Trevor Jain, Canadian Association of Emergency Physicians—Charlottetown: Thanks very much.

Eric Sorensen: Up next, remembering former NDP Leader Ed Broadbent and his impact on this country.

Jagmeet Singh, NDP Leader: “We think about Ed’s legacy, he spent his entire life fighting for working class people. He grew up in the City of Oshawa, a very worker’s town, and that stayed with him in his whole career politically. Even after he retired politically, he continued to give back so he’s someone that is a passionate voice for working people and a fighter for a future where they’re not left behind.”

[Break]

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Eric Sorensen: Now for our final one last thing …

The country lost a political giant this past week: Ed Broadbent. Like Tommy Douglas and David Lewis before him, Broadbent was a pioneer of modern social democracy in this country, building the foundation of the New Democratic Party that we know today.

The institute that bears his name called Broadbent a champion for ordinary Canadians. It’s the word ordinary that sticks out. In a long career in public life, Broadbent didn’t curry favour with the wealthy or the political power brokers in Canadian life. He genuinely just wanted a better life for all of us. And in politics, he believed that started with working together, even with your political foes. Clash over policy, not personality and build a better country.

On the Constitution, he worked with Pierre Trudeau and with Brian Mulroney. One of his great regrets he said was seeing the decline in civility in Parliament.

Ed Broadbent, Former NDP Leader: “There is a difference between personal remarks based on animosity and vigorous debate reflecting big differences of judgement. However we may differ, we’re all human and we all have the right to have our inner dignity respected—and especially in this House in debate. Thank you very much.”

Eric Sorensen: Politics has become more disparaging. Broadbent yearned for more decency, and not just in Parliament. He said we all have the right to our inner dignity. Ed Broadbent was an extraordinary Canadian who cared about ordinary Canadians.

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That’s our show for today. Thanks for watching. We’ll see you next week.

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