AUCKLAND, New Zealand — Rawiri Jansen, a Maori doctor, had an urgent message for the 150 people, mostly patch-wearing members of New Zealand’s plentiful street gangs and their families, who sat before him on a bright Saturday afternoon.
Covid is coming for them, he said. Cases in New Zealand’s hospitals are rising rapidly. Soon, dozens of new infections a day might be hundreds or even a thousand. People will die. And vaccination is the only defense. “When your doctors are scared, you should be scared,” he said.
By the end of the day, after an exhaustive question-and-answer session with other health professionals, roughly a third of those present chose to receive a dose then and there.
Having abandoned its highly successful “Covid-zero” elimination strategy in response to an outbreak of the Delta variant, New Zealand is now undergoing a difficult transition to trying to keep coronavirus cases as low as possible. On Friday, the country set a target of getting at least 90 percent of the eligible population fully vaccinated — a goal, the highest in the developed world, whose success hinges on persuading people like those who gathered to hear Dr. Jansen.
intensely criticized, including by police leaders.
Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.
Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.
The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.
The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.
Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.
Chris Hipkins, the minister responsible for New Zealand’s Covid-19 response, acknowledged earlier this month that the decision to enlist gang leaders was an unusual one.
“Our No. 1 priority here is to stop Covid-19 in its tracks, and that means doing what we need to do to get in front of the virus,” he said. “Where we have been able to enlist gang leaders to help with that, and where they have been willing to do so, we have done that.”
Some gang leaders have acted independently to help the vaccination effort. They have connected members of their community to health officials, organized events with health professionals like Dr. Jansen, and streamed events on Facebook Live to allow an open forum for questions about rare health risks. In some cases, they have taken vaccines to communities themselves.
“Our community is probably less well informed; they’re probably not as health literate,” said Mr. Tam, the Mongrel Mob member, who is a former civil servant and who received the border exemption. Constant media criticism has turned them off from reading traditional news outlets, he added.
“They then resort to social media, because they have much greater control,” he said. “It’s also a space that perpetuates conspiracy theories and false information and all the rest of it.” Health advice has to come from trusted individuals and leaders in the community, he said.
In the past week, Mr. Tam has traveled almost the length of the country organizing pop-up vaccination events for members and their communities, as well as coordinating with other chapter leaders to get their members vaccinated, he said.
It was difficult work that put him at personal risk, he said, and that invited intense skepticism from people who thought of gangs only as violent or connected to organized crime.
“Why do we bother?” Mr. Tam said. “We bother because we care about those people that others don’t care about, as simple as that. They can talk about my gang affiliation, all the rest of it. But it’s that affiliation that allows me to have that penetration, that foot in the door. I can do the stuff that they can’t do.”
NECOCLÍ, Colombia — For decades, the Darién Gap, a roadless, lawless stretch of jungle linking South America to the north, was considered so dangerous that only a few thousand people a year were daring, or desperate, enough to try to cross it.
But the economic devastation wrought by the pandemic in South America was such that in the first nine months of this year, Panamanian officials say, an estimated 95,000 migrants, most of whom are Haitian, attempted the passage on their way to the United States.
They made the journey in shorts and flip-flops, their possessions stuffed in plastic bags, their babies in arms and their children by the hand. It’s uncertain how many made it — and how many didn’t. And yet tens of thousands more are gathered in Colombia, eager for their turn to try.
Del Rio and thrusting the Biden administration into a crisis, were just the leading edge of a much larger movement of migrants heading for the jungle and then the United States. People who had fled their troubled Caribbean nation for places as far south as Chile and Brazil began moving north months ago, hoping they would be welcomed by President Biden.
“We very well could be on the precipice of a historic displacement of people in the Americas toward the United States,” said Dan Restrepo, the former national security adviser for Latin America under President Barack Obama. “When one of the most impenetrable stretches of jungle in the world is no longer stopping people, it underscores that political borders, however enforced, won’t either.”
The Darién, also known as the Isthmus of Panama, is a narrow swath of land dividing the Pacific Ocean and the Caribbean Sea. Parts are so inaccessible that when engineers built the Pan-American Highway in the 1930s, linking Alaska to Argentina, only one section was left unfinished. That piece — 66 roadless miles of turbulent rivers, rugged mountains and venomous snakes — became known as the Darién Gap. Today, the journey through the gap is made more perilous by a criminal group and human traffickers who control the region, often extorting and sometimes sexually assaulting migrants.
a growing number of migrants had begun to brave the corridor, a journey that can take a week or more on foot. But after the pandemic, which hit South America particularly hard, that surge has become a flood of desperate families. At least one in five of those who crossed this year were children, Panamanian officials said.
As the number of migrants arriving at the U.S. border grew, the Biden administration retreated from a more open approach to migration embraced in the president’s first days in office to a tougher stance with a singular goal: deterring people from even attempting to enter the United States.
said in September. “Your journey will not succeed, and you will be endangering your life and your family’s lives.”
But the warning is unlikely to turn back the tens of thousands of Haitians who are already on the road.
On a recent day, there were about 20,000 migrants in Necoclí, in Colombia. And there are up to 30,000 Haitian migrants already in Mexico, according to a senior official in the Mexican foreign ministry who spoke on the condition of anonymity.
“They’ve already started the journey, they’ve already started to think about the U.S.,” said Andrew Selee, president of the Migration Policy Institute. “It’s not that easy to turn that off.”
On a recent morning, Ms. Alix and Mr. Damier woke their children before dawn in the small home they’d been sharing with a dozen other migrants. Their turn had come to board the boat that would take them to the edge of the jungle.
In the darkness, Ms. Alix threw her backpack over her shoulders and strapped Vladensky to her chest. In one hand she carried a pot of spaghetti, meant to sustain them while it lasted. Her other hand reached out to her toddler, Farline.
On the beach the family joined a crowd of others. A dockworker handed a large life vest to Ms. Alix. She draped it over Farline’s small body and climbed into the boat. Aboard: 47 adults, 13 children, seven infants, all migrants.
“Goodbye!” yelled a man from the boat company. “Have a good trip!”
Government officials are largely absent from the Darién. The area is controlled by a criminal group known as the Clan del Golfo, whose members view migrants much as they view drugs: goods they can tax and control.
Once the migrants step off the boats, they are met by smugglers — typically poor men in the area who offer to take them into the jungle, starting at $250 a person. For an extra $10 they will carry a backpack. For another $30, a child.
Farline and her family spent the night in a tent at the edge of the jungle. In the morning, they set out before sunrise, alongside hundreds of others.
Soon, a vast plain became a towering forest. Farline clambered between trees, following her parents. Vladensky slept on his mother’s chest. Other children cried, the first to show signs of exhaustion.
As the group crossed river after river, tired adults began to abandon their bags. They clambered up and then down a steep, muddy slope, only to stare up at the next one. Faces that were hopeful, even excited, that morning went slack with exhaustion.
A woman in a leopard-print dress fainted. A crowd formed. A man gave her water. Then they all rose, picked up their bags and began to walk.
Today, after all, was just day one in the Darién, and they had a long journey ahead.
Julie Turkewitz reported from Necoclí, Colombia; Natalie Kitroeff from Mexico City; and Sofía Villamil from Necoclí and Bajo Chiquito, Panama. Oscar Lopez contributed reporting from Mexico City, and Mary Triny Zea from Panama City.
The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.
David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.
“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”
But there was no evidence that Mr. Blakeney actually had schizophrenia.
Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.
one in 150 people.
Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.
“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”
refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.
But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.
hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.
One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.
According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.
To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.
The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.
The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.
“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”
significant drop since 2012 in the share of residents on the drugs.
But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.
A Doubled Risk of Death
For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.
In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.
But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.
11 percent from less than 7 percent, records show.
The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.
A Substitute for Staff
Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.
Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)
more than 200,000 since early last year and is at its lowest level since 1994.
As staffing dropped, the use of antipsychotics rose.
Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.
Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.
“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”
Homes that violate the rules face few consequences.
In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.
In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”
a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.
There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”
Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”
“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”
Representatives of Hialeah Shores declined to comment.
Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.
make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.
But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.
Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.
in a “sprinkle” form that makes it easy to slip into food undetected.
“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.
In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.
According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.
Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.
Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.
“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”
published a brochure titled “Nursing Homes: Times have changed.”
“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.
Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.
“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.
The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)
‘Hold His Haldol’
Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)
During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.
In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.
“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”
Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.
In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.
“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”
Women at tech start-ups wrote to her thanking her for saying what they had been feeling, Ms. Esponnette said.
Lola Priego, 30, the founder of Base, which offers at-home blood and saliva tests that are processed at traditional labs, hears a Theranos comparison at least once a week, she said. The references come directly or indirectly from potential partners, advisers, investors, customers and reporters, she said.
She said she understood the need for skepticism, since new health care companies should be looked at critically to prevent malpractice. Often the comparisons stopped after people learned that Base works with Quest Diagnostics, a multinational company, for analysis of its tests.
“But the additional bias and skepticism is challenging to overcome,” Ms. Priego said.
The biggest blow came from a scientific adviser whom Ms. Priego said she had tried to recruit in 2019. The adviser took the meeting only to tell her that bringing technology into health care was doing a disservice to the industry, just like Theranos. It caused Ms. Priego to question whether she could hire the caliber of advisers she had hoped for.
“It was quite demoralizing,” she said. She has since recruited six advisers.
In July, Verge Genomics struck a three-year partnership with the pharmaceutical giant Eli Lilly to work on drugs for the treatment of amyotrophic lateral sclerosis, or A.L.S., Ms. Zhang said. The company also published a paper about its methods in a scientific journal last year and recruited a chief science officer this year.
It was a relief to have something to show to those who were doubtful, Ms. Zhang said.
“The most fragile part of the company is the earliest stage, when you have to buy into the people, the vision and the idea,” she said. Reflecting on Ms. Holmes and Theranos, she added, “It’s where these types of associations can be really harmful and curtail potential.”
PORT-AU-PRINCE, Haiti — The commander in charge of guarding the Haitian president’s home quickly became a suspect in the assassination of President Jovenel Moïse last month when his security team inexplicably melted away, enabling hit men to enter the residence with little resistance and kill the president in his own bedroom.
But current and former officials say that the commander, Dimitri Hérard, was already a suspect in a separate case that the United States Drug Enforcement Administration has pursued for years: the disappearance of hundreds, if not thousands, of pounds of cocaine and heroin that were whisked away by corrupt officials only hours before law enforcement agents showed up to seize them.
Now, some international officials assisting with the investigation into the president’s assassination say they are examining whether those criminal networks help explain the killing. Haitian officials, including the country’s prime minister, have acknowledged that the official explanation presented in the days after the assassination — that Mr. Moïse was gunned down in an elaborate plot to seize political office — does not entirely add up, and that the true motive behind the murder has not been uncovered.
Haiti is a major transit point for drugs heading to the United States, and American and United Nations officials say the trade flourishes through an array of politicians, businesspeople and members of law enforcement who abuse their power. Now, current and former officials say that Mr. Hérard has long been a focal point of the investigation into one of the biggest drug trafficking cases the D.E.A. has ever pursued in Haiti.
detained in connection with the assassination. The president’s widow has angrily demanded to know what happened to the dozens of guards Mr. Hérard commanded, and why none of them were killed when assailants stormed her home on July 7, wounding her and shooting her husband dead on the floor beside her.
they said they were rebuffed.
“The port is an open sewer,” Mr. Greco said.
Van Williams, another United Nations anti-narcotics supervisor based in Haiti at the time, agreed.
“There was very little importance placed on the docks, which I found very strange,” Mr. Williams said. “Corruption in Haiti from the top on down is so rampant.”
report earlier this year. Only five people have been convicted of drug trafficking in Haiti, and the government did not classify corruption as a crime until 2014, the report added.
as the killers stormed the house, pleading for help. Phone records and Mr. Hérard’s initial testimony also showed that Mr. Moïse had called him at 1:39 a.m. on the night of the killing. But Mr. Hérard and his unit never engaged the hit squad at the residence, instead mounting a roadblock some distance away, according to his initial police testimony.
reprimanded the D.E.A. for its handling of the Manzanares case and for not doing more to clean up Haiti’s ports.
“I went through hell, speaking the truth and trying to do the right thing,” said Mr. McNichols.
Anatoly Kurmanaev in Port-au-Prince and Julian Barnes in Washington, D.C., contributed to this report.
Despite the chaotic end to its presence in Afghanistan, the United States still has control over billions of dollars belonging to the Afghan central bank, money that Washington is making sure remains out of the reach of the Taliban.
About $7 billion of the central bank’s $9 billion in foreign reserves are held by the Federal Reserve Bank of New York, the former acting governor of the Afghan central bank said Wednesday, and the Biden administration has already moved to block access to that money.
The Taliban’s access to the other money could also be restricted by the long reach of American sanctions and influence. The central bank has $1.3 billion in international accounts, some of it euros and British pounds in European banks, the former official, Ajmal Ahmady, said in an interview on Wednesday. Remaining reserves are held by the Swiss-based Bank for International Settlements, he added.
Mr. Ahmady said earlier on Wednesday that the Taliban had already been asking central bank officials about where the money was.
International Monetary Fund said on Wednesday that it would block Afghanistan’s access to about $460 million in emergency reserves. The decision followed pressure from the Biden administration to ensure that the reserves did not reach the Taliban.
Money from an agreement reached in November among more than 60 countries to send Afghanistan $12 billion over the next four years is also in doubt. Last week, Germany said it would not provide grants to Afghanistan if the Taliban took over and introduced Shariah law, and on Tuesday, the European Union said no payments were going to Afghanistan until officials “clarify the situation.”
The central bank money and international aid, essential to a poor country where three-quarters of public spending is financed by grants, are powerful leverage for Washington as world leaders consider if and when to recognize the Taliban takeover.
Mr. Ahmady, who fled Afghanistan on Sunday, said he believed the Taliban could get access to the central bank reserves only by negotiating with the U.S. government.
high-profile talks last month. But so far, China hasn’t shown an eagerness to increase its role in Afghanistan. The Taliban could try to take advantage of the country’s vast mineral resources through mining, or finance operations with money from the illegal opium trade. Afghanistan is the world’s largest grower of poppy used to produce heroin, according to data from the United Nations Office on Drugs and Crime.
But these alternatives are all “very tough,” Mr. Ahmady said. “Probably the only other way is to negotiate with the U.S. government.”
Afghanistan has about $700 million at the Bank for International Settlements, Mr. Ahmady said. The bank, which serves 63 central banks around the world, said on Wednesday that it “does not acknowledge or discuss banking relationships.”
On Wednesday, Mr. Ahmady wrote on Twitter that Afghanistan had relied on shipments of U.S. dollars every few weeks because it had a large current account deficit, a reflection of the fact that the value of its imports are about five times greater than its exports.
Those purchases of imports, often paid in dollars, could soon be squeezed.
“The amount of such cash remaining is close to zero due a stoppage of shipments as the security situation deteriorated, especially during the last few days,” Mr. Ahmady wrote.
He recalled receiving a call on Friday saying the country wouldn’t get further shipments of U.S. dollars. The next day, Afghan banks requested large amounts of dollars to keep up with customer withdrawals, but Mr. Ahmady said he had to limit their distribution to conserve the central bank’s supply. It was the first time he made such a move, he said.
Mr. Ahmady said that he had told President Ashraf Ghani about the cancellation of currency shipments, and that Mr. Ghani had then spoken with Secretary of State Antony J. Blinken. Though further shipments were approved “in principle,” Mr. Ahmady said, the next scheduled shipment, on Sunday, never arrived.
their origin story and their record as rulers.
Who are the Taliban leaders? These are the top leaders of the Taliban, men who have spent years on the run, in hiding, in jail and dodging American drones. They are emerging now from obscurity, but little is known about them or how they plan to govern.
The New York Fed provides safekeeping and payment services to foreign central banks so they can store international reserves securely, and to facilitate cross-border payments and other dollar-based transactions. International reserves often take the form of short-term Treasury bonds or gold. The New York Fed has been storing gold for foreign governments for nearly a century.
Though Mr. Ahmady has left the country, he said he believed that most members of the central bank’s staff were still in Afghanistan.
If the Taliban can’t gain access to the central bank’s reserves, it will probably have to further limit access to dollars, Mr. Ahmady said. This would help start a cycle in which the national currency will depreciate and inflation will rise rapidly and worsen poverty.
“They’re going to have to significantly reduce the amount that people can take out,” Mr. Ahmady said. “That’s going to hurt people’s living standards.”
The more than $400 million from the International Monetary Fund, which the Biden administration has sought to keep out of the Taliban’s hands, is Afghanistan’s share of a $650 billion allocation of currency reserves known as special drawing rights. It was approved this month as part of an effort to help developing countries cope with the coronavirus pandemic.
But the toppling of Afghanistan’s government and a lack of clarity about whether the Taliban will be recognized internationally put the I.M.F. in a difficult position.
“There is currently a lack of clarity within the international community regarding recognition of a government in Afghanistan, as a consequence of which the country cannot access S.D.R.s or other I.M.F. resources,” the organization said in a statement Wednesday. It added that its decisions were guided by the views of the international community.
Jake Sullivan, the White House’s national security adviser, said Tuesday that it was too soon to address whether the United States would recognize the Taliban as the legitimate power in Afghanistan.
“Ultimately, it’s going to be up to the Taliban to show the rest of the world who they are and how they intend to proceed,” Mr. Sullivan said. “The track record has not been good, but it’s premature to address that question at this point.”
GRANTHAM, England — Daniela Espirito Santo died after waiting on hold for the police to answer her call for help.
It was the seventh time in a year that she had reported her boyfriend to the police, including for death threats and for trying to strangle her. Two of those calls came in the hours before her death. The first was in the morning, after her boyfriend pinned her on the bed and pressed his forearm against her throat.
“Is this it?” Ms. Espirito Santo, 23, had gasped, according to a police report. “Are you going to kill me this time?”
The police took him into custody but quickly released him. He returned to Ms. Espirito Santo’s apartment and soon afterward she called the police to report that he had assaulted her again. The dispatcher told her that her situation wasn’t urgent, because the boyfriend had left. He directed her to a nonemergency hotline and hung up after 94 seconds.
during the first month of Britain’s lockdown — more than triple the number in that month the previous year, and the highest figure in a decade. But it also illustrates another flaw in British authorities’ efforts to address violence against women: the repeated failure of prosecutors to punish abusers.
Initially charged with manslaughter, the boyfriend, Julio Jesus, then 30, was eventually sentenced to only 10 months behind bars. The Crown Prosecution Service, the national public prosecutor, dropped its manslaughter charge because of complicating medical opinions about the condition of Ms. Espirito Santo’s heart, and convicted him on two counts of serious assault. He was released before England’s coronavirus lockdowns had ended.
“There was a litany of failures where once again a woman’s voice hasn’t been listened to,” said Jess Phillips, a Labour lawmaker who speaks for the opposition on domestic violence policy. “This case shows nothing is changing, even though victims keep being promised it is.”
fewer than 2 percent of rape cases and 8 percent of domestic abuse cases reported to the police in England and Wales are prosecuted, even as complaints are rising.
The nation was shocked earlier this year when a police officer confessed to kidnapping, raping and murdering Sarah Everard, a 33-year-old marketing executive who was abducted while walking home in South London. The crime underscored the vulnerability felt by many British women and their concern that the police and prosecutors are failing to protect them.
Parliament recently approved new legislation on domestic abuse. But changing policing and public attitudes has proved difficult for decades. Failings and missed opportunities by the police often remain hidden.
Ms. Espirito Santo’s case fit that pattern. Her death in Grantham, a market town in the largely rural English county of Lincolnshire, received little outside attention and was regarded as a tragedy, not a scandal. An inquest into her death is in limbo. Lincolnshire Police — a small force covering a wide area with a sparse but often deprived population — refused an interview, as did the Crown Prosecution Service.
But an investigation by The New York Times lays bare the escalating abuse Ms. Espirito Santo reported, gives a rare insight into police failings and raises questions about the decision by prosecutors to drop the manslaughter charge. The Times has obtained a confidential 106-page report compiled by the Independent Office for Police Conduct, an official watchdog, into the Lincolnshire force’s handling of the case.
The report documents Ms. Espirito Santo’s ever more desperate interactions with the police, revealing a haphazard response as her situation worsened. It noted that some male officers felt sympathetic toward Mr. Jesus before releasing him on bail, including one who said his “biggest concern” was the boyfriend’s mental health.
government failings on domestic abuse at the start of Britain’s lockdowns, which left victims trapped at home with abusers and isolated from family and friends. The rules were especially constricting for people with serious health conditions, like Ms. Espirito Santo, who had to pause her job at a nursing home.
“Daniela’s case is a scandalous failing by the police to recognize someone who was at an increasing risk of domestic homicide,” Ms. Wistrich said. “But it is sadly illustrative of many cases we see.”
Lincolnshire Police refused to answer even written questions, citing concerns about prejudicing a future inquest. A spokesperson for the Crown Prosecution Service said it was determined to improve the handling of crimes against women and girls and to “narrow the gap” between “reports of these terrible offenses and cases reaching court.”
Ms. Espirito Santo’s story — pieced together by The Times through the confidential report, other documents and more than a dozen interviews — is of a yearlong cry for help that went unheard.
“Everything happened because the police didn’t help Daniela when she rang,” said Isabel Espirito Santo, Ms. Espirito Santo’s mother. “If the police had helped more, I think she could still be here.”
Ms. Espirito Santo was pregnant with her second child when she first reported Mr. Jesus to the police. It was May 19, 2019, and she told officers that he had threatened to kill her, that he was violent and controlling and “excessively jealous.”
examination of domestic abuse complaints stated that it was officers’ job to “build the case for the victim, not expect the victim to build the case for the police.”
‘Is This It?’
Fifteen hours before she died, Ms. Espirito Santo made her penultimate call to the police. It was 9:48 a.m. She told the operator that Mr. Jesus had thrown her on the bed and grabbed her neck, leaving a mark. He had left, but not before pinning her with the front door and threatening to kill her. When two officers arrived, she agreed to support a prosecution.
She told the officers that she had “lost count” of how often Mr. Jesus had assaulted her, often squeezing her neck so tightly that she struggled to breathe. She said that he sometimes slammed her against furniture, that he had once broken her finger, and that she was afraid he might kill her.
Two hours later, Mr. Jesus was arrested, crying as he was taken into custody. Later that afternoon, Ms. Espirito Santo called Ms. Price-Wallace and said the police had told her that Mr. Jesus would be released pending a charging decision.
can qualify as manslaughter if it leads to a death, even if the killing was unintentional. Those found guilty can face up to life in prison.
But prosecutors decided to drop the charge after a cardiologist hired by Mr. Jesus’s lawyers argued that while the assault could have caused the heart failure, so could a verbal argument.
Prosecutors concluded that they could no longer meet the tests for a manslaughter conviction by proving that the heart failure was caused by an assault, a spokesperson for the Crown Prosecution Service said.
That was despite the fact Ms. Espirito Santo had reported an assault, not an argument, minutes before her death; despite Mr. Jesus’s admission that he had assaulted her that morning; and despite her history of domestic violence complaints.
The official watchdog report on Lincolnshire Police found that the “decision making of its officers may have influenced the circumstances of the events” around Ms. Espirito Santo’s death, if not caused it, and blamed officers for a “lack of detailed consideration of Mr. Jesus’s situation” on release.
Yet the report did not recommend disciplinary action and mentioned only one “potential learning recommendation” — for a formal policy around sending calls to the nonemergency number, a change that has been introduced. In a statement to The Times, the watchdog agency said it had also made “learning” recommendations for two officers on how they interacted with Mr. Jesus.
Domestic Abuse Act. It was a response to growing outrage over failures in abuse cases. For the first time, the law established that nonfatal strangulation — which Ms. Espirito Santo repeatedly reported — is a criminal offense, bringing up to five years in prison.
Since such strangulation usually does not leave marks, the police often fail to recognize it as a serious crime. Prosecutors, in turn, do not bring more serious charges. Advocates for abuse victims have welcomed the law but say it will change little unless police and public prosecutors are educated in using it, and given proper resources.
On July 5, on what would have been Ms. Espirito Santo’s 25th birthday, her mother and two dozen others scattered her ashes at her favorite spot, a lake in the Lincolnshire countryside. Her grandmother gave a reading in Portuguese by the water’s edge. Her mother wept.
“I didn’t get justice in court,” she said. “But I believe in justice of the gods.”
www.thehotline.org. In the United Kingdom, call 0808 2000 247, or visit www.nationaldahelpline.org.uk.
TRIPOLI, Lebanon — Rania Mustafa’s living room recalls a not-so-distant past, when the modest salary of a security guard in Lebanon could buy an air-conditioner, plush furniture and a flat-screen TV.
But as the country’s economic crisis worsened, she lost her job and watched her savings evaporate. Now, she plans to sell her furniture to pay the rent and struggles to afford food, much less electricity or a dentist to fix her 10-year-old daughter’s broken molar.
For dinner on a recent night, lit by a single cellphone, the family shared thin potato sandwiches donated by a neighbor. The girl chewed gingerly on one side of her mouth to avoid her damaged tooth.
“I have no idea how we’ll continue,” said Ms. Mustafa, 40, at home in Tripoli, Lebanon’s second-largest city, after Beirut.
The huge explosion one year ago in the port of Beirut, which killed more than 200 people and left a large swath of the capital in shambles, only added to the desperation.
and the central bank unable to keep propping up the currency, as it had for decades, because of a drop in foreign cash flows into the country. Now, the bottom has fallen out of the economy, leaving shortages of food, fuel and medicine.
All but the wealthiest Lebanese have cut meat from their diets and wait in long lines to fuel their cars, sweating through sweltering summer nights because of extended power cuts.
long lines at gas stations, where drivers wait for hours to buy only a few gallons, or none at all if the station runs out.
hampered the investigation into the port explosion, and a billionaire telecoms tycoon, Najib Mikati, is currently the third politician to try to form a government since the last cabinet resigned after the blast.
Mustafa Allouch, the deputy head of the Future Movement, a prominent political party, said, like many other Lebanese, that he feared that the political system, intended to share power between a range of sects, was incapable of addressing the country’s problems.
“I don’t think it will work anymore,” he said. “We have to look for another system, but I don’t know what it is.”
His greatest fear was “blind violence” born out of desperation and rage.
“Looting, shooting, assaults on homes and small shops,” he said. “Why it hasn’t happened by now, I don’t know.”
The crisis has hit the poor hardest.
Five days a week, scores of people line up for free meals from a charity kitchen in Tripoli, some equipped with cut off shampoo bottles to carry their food because they can’t afford regular containers.
Robert Ayoub, the project’s head, said demand is going up, donations from inside Lebanon are going down, and the newcomers represent a new kind of poor: soldiers, bank employees and civil servants whose salaries have lost the bulk of their value.
In line on a recent day were a laborer who had walked an hour from home because he couldn’t afford transportation; a brick layer whose work had dried up; and Dunia Shehadeh, an unemployed housekeeper who picked up a tub of pasta and lentil soup for her husband and three children.
“This will hardly be enough for them,” she said.
The country’s downward spiral has set off a new wave of migration, as Lebanese with foreign passports and marketable skills seek better fortune abroad.
“I can’t live in this place, and I don’t want to live in this place,” said Layal Azzam, 39, before catching a flight to Saudi Arabia from Beirut’s international airport.
She and her husband had returned to Lebanon from abroad a few years ago and invested $50,000 in a business. But she said that it had failed and that she worried they would struggle to find care if their children got sick.
“There’s no electricity. They could cut the water. Prices are high. Even if someone sends you money from abroad, it doesn’t last,” she said. “There are too many crises.”
Drone footage by David Enders and Bryan Denton. Hwaida Saad contributed reporting.
More than 1,500 workers for the video game maker Activision Blizzard walked out from their jobs this week. Thousands signed a letter rebuking their employer. And even as the chief executive apologized, current and former employees said they would not stop raising a ruckus.
Shay Stein, who used to work at Activision, said it was “heartbreaking.” Lisa Welch, a former vice president, said she felt “profound disappointment.” Others took to Twitter or waved signs outside one of the company’s offices on Wednesday to share their anger.
Activision, known for its hugely popular Call of Duty, World of Warcraft and StarCraft gaming franchises, has been thrown into an uproar over workplace behavior issues. The upheaval stems from an explosive lawsuit that California’s Department of Fair Employment and Housing filed on July 20, accusing the $65 billion company of fostering a “frat boy workplace culture” in which men joked about rape and women were routinely harassed and paid less than their male colleagues.
Activision publicly criticized the agency’s two-year investigation and allegations as “irresponsible behavior from unaccountable state bureaucrats.” But its dismissive tone angered employees, who called out the company for trying to sweep away what they said were heinous problems that had been ignored for too long.
Hollywood, restaurants and the media — the male-dominated video game sector has long stood out for its openly toxic behavior and lack of change. In 2014, feminist critics of the industry faced death threats in what became known as Gamergate. Executives at the gaming companies Riot Games and Ubisoft have also been accused of misconduct.
Now the actions at Activision may signal a new phase, where a critical mass of the industry’s own workers are indicating they will no longer tolerate such behavior.
“This could mean some real accountability for companies that aren’t taking care of their workers and are creating inequitable work environments where women and gender minorities are kept at the margins and abused,” said Carly Kocurek, an associate professor at the Illinois Institute of Technology who studies gender in gaming.
She said California’s lawsuit and the fallout at Activision were a “big deal” for an industry that had traditionally shrugged off claims of sexism and harassment. Other gaming companies are most likely watching the situation, she added, and considering whether they need to address their own cultures.
spared little detail. Many of the misconduct accusations focused on a division called Blizzard, which the company merged with through a deal with Vivendi Games in 2008.
The lawsuit accused Activision of being a “a breeding ground for harassment and discrimination against women.” Employees engaged in “cube crawls” in which they got drunk and acted inappropriately toward women at work cubicles, the lawsuit said.
In one case, a female employee died by suicide during a business trip because of the sexual relationship she had been having with her male supervisor, the lawsuit said. Before her death, male colleagues had shared an explicit photo of the woman, according to the lawsuit.
Employees reacted furiously. An open letter addressed to Activision’s leaders calling for them to take the accusations more seriously and “demonstrate compassion” for victims attracted more than 3,000 signatures from current and former employees by Wednesday. The company has nearly 10,000 employees.
“We no longer trust that our leaders will place employee safety above their own interests,” the letter said, calling Ms. Townsend’s remarks “unacceptable.”
a $155 million pay package that makes him one of the country’s highest-paid executives, added that the company would beef up the team that investigated reported misconduct, fire managers who were found to have impeded investigations and remove in-game content that had been flagged as inappropriate.
Employees said it was not enough.
“We will not return to silence; we will not be placated by the same processes that led us to this point,” organizers of the walkout said in a public statement. They declined to be identified out of fear of reprisal.
“Online, people are suggesting that you were taking cocaine,” the reporter said. “What was it?”
Mr. David denied the speculation, saying that he bent down because another band member had broken a glass.
“I don’t use drugs, please, guys,” he said. “No, please don’t say that. Don’t say that, really. No cocaine. Please, don’t say that.”
A moderator of the news conference quickly tried to cut off the line of questioning.
“Let’s keep the questions about the artists and the music for tonight,” she said.
The European Broadcasting Union said in a statement on Sunday that a broken glass had been found after a check of the site.
Barbara Pravi, the French singer, finished second at Eurovision.
Before the show’s broadcasters announced that Mr. David had passed a drug test, Clément Beaune, the French minister of state for European affairs, suggested during an interview with the television network BFMTV on Monday that there should be sanctions against Maneskin, including the band’s possible disqualification, if Mr. David tested positive for drugs.
In an Instagram post on Monday, Ms. Pravi said that Maneskin’s win was well deserved and that the band had been chosen by the viewers. She said it was their victory and their moment.
As the band’s members hoisted the glass microphone trophy that is given to the winners of Eurovision, Mr. David declared that rock ’n’ roll was here to stay.
“We just want to say to the whole Europe, to the whole world,” he said, “rock ’n’ roll never dies.”