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Out-of-pocket payments are the principal source of health care finance in most Asian countries, and India is no exception. This fact has important consequences for household living standards. In this paper the author explores significant changes in the 1990s and early 2000s that appear to have occurred as a result of out-of-pocket spending on health care in 16 Indian states. Using data from the National Sample Survey on consumption expenditure undertaken in 1993–94 and 2004–05, the author  measures catastrophic payments and impoverishment due to out-of-pocket payments for health care. Considerable data on the magnitude, distribution and economic consequences of out-of-pocket payments in India are provided; when compared over the study period, these indicate that new policies have significantly increased both catastrophic expenditure and impoverishment.

Published in Economic and Political Weekly, November 19, 2011  Vol. XLVI No. 47, pp. 63 - 70

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The Woods Institute for the Environment has awarded four new Environmental Venture Project grants for interdisciplinary projects promoting global sustainability. FSI faculty Jeremy Goldhaber-Fiebert, PI, Walter P. Falcon, Paul H. Wise, and David Lobell, won an award for a project on nutrition-related health policies in India, which examines the impact of climate change on agricultural production and food availability.
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Encina Hall
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Consulting Scholar, 2014-16; Visiting Associate Professor 2013-2014, 2010-2011
dan_pressebilde7.jpg PhD

Professor Dan Banik is a Consulting Scholar at CDDRL and is currently completing a study examining the impacts of development aid from Norway and China on poverty reduction in Malawi and Zambia. He is a professor of political science and research director at the University of Oslo’s Centre for Development and Environment (SUM). He is also holds a visiting professor at China Agricultural University in Beijing.

Prof. Banik has conducted research in India, China, Bangladesh, Malawi, Uganda, Ethiopia, Tanzania, South Africa and Mexico, and directs the interdisciplinary research program 'Poverty and Development in the 21st Century (PAD)' at the University of Oslo. He has previously served as the head of the Norwegian-Finnish Trust Fund in the World Bank for Environmentally and Socially Sustainable Development (TFESSD) and on the Board of the Norwegian Crown Prince and Crown Princess's Foundation. His books include ‘The Democratic Dividend: Political Transition, Poverty and Inclusive Development in Malawi (with Blessings Chinsinga, Routledge 2016), ‘The Legal Empowerment Agenda: Poverty, Labour and the Informal Economy in Africa’ (2011, Ashgate), ‘Poverty and Elusive Development’ (2010, Scandinavian University Press) and ‘Starvation and India’s Democracy’ (2009, Routledge).

Prof. Banik is married to Vibeke Kieding Banik, who is a historian at the University of Oslo.

 

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By the end of the year, scholars of security studies will be able to use a new website to learn how terrorist and militant organizations evolve over time and how they collaborate with--and compete against--one another.

"Mapping Terrorist Organizations," an interdisciplinary online project headed by CISAC Senior Fellow Martha Crenshaw, will focus initially on providing detailed, annotated information on militant and terrorist groups operating in Iraq since 2003, Pakistan and Afghanistan--areas of current policy concern for the United States. Future plans involve expanding research to include groups in Latin America, Europe, the Middle East and the United States and, if time and resources permit, to include major historical groups such as the Russian revolutionary movement.

The three-year project is funded by a $500,000 grant awarded to Crenshaw last fall by the National Science Foundation. It is part of the Department of Defense's Minerva Initiative launched in 2008 to support "research related to basic social and behavioral science of strategic importance to U.S. national security policy."

"No such study exists in the literature of terrorism," Crenshaw wrote in a report on the project. "Evolutionary mapping can enhance our understanding of how terrorist groups develop and interact with each other and with the government, how strategies of violence and non-violence are related, why groups appear and disappear, and how opportunities and constraints in the environment change organizational behavior over time." Furthermore, Crenshaw noted that visual mapping of highly complex, shifting information is likely to stimulate new observations that might otherwise have been overlooked."

Student involvement

Daniel Cassman, a 2010 CISAC honors graduate in political science and computer science, is building the site, which will contain interactive timelines, family trees and detailed group profiles. Cassman's programming--developed specifically for the website--will allow scholars to better understand and analyze patterns and structures of violent and non-violent opposition groups in multiple contexts.

At a June 1 meeting of a half dozen students working on the project, Crenshaw said one of the most challenging problems facing researchers is documenting how terrorist organizations evolve over time. With no official sources to rely on, Crenshaw's team spent the last year combing through government documents and academic research, autobiographies, newspaper reports and even jihadist websites-many of which disappear as quickly as they pop up. Crenshaw acknowledges that "precision in this field is elusive" even though the project emphasizes using documented primary sources. Students working on the project include Christy Abizaid and Sadika Hameed, 2010 graduates of the International Policy Studies master's program, and undergraduates Rob Conroy, Asfandyar Mir and Ari Weiss. CISAC staff member Julia McKinnon is assisting Crenshaw as well.

"We're keenly interested in changes in the sizes of groups," Crenshaw said. "That's one of the hardest things to figure out." It also is difficult to know when a group dissolves, becomes dormant or morphs into something else, she said. To obtain as complete a profile as possible, the website will include information about failed and foiled plots, as well as successful attacks, she said.

Charles Nicas, a student in International Policy Studies and Public Policy, said he joined Crenshaw's project to learn more about militancy and terrorism in South Asia. "The U.S. presence in Afghanistan and the fact that Pakistan is a nuclear-armed country mean that the U.S. will be involved in this region...for a long time," he wrote in an email. "The complexity of the situation takes a lot of research to understand."

Nicas's area of work focuses on sectarian groups in Pakistan, mainly Sipah-e-Sahaba Pakistan (SSP) and its offshoot Lashkar-e-Jhangvi (LeJ), both virulently anti-Shia groups. Nicas said SSP was founded in 1985 with state support and spawned LeJ in the mid-1990s. The groups are based in Punjab province in eastern Pakistan but had a significant presence in neighboring Afghanistan during Taliban rule. Both have become increasingly allied with militant groups in the border region, including al-Qa'ida, and are part of an umbrella group known as the Punjabi Taliban. "I've been surprised to learn how far back the roots of this problem go, which makes the challenge of effectively countering it especially daunting," Nicas said.

Terrorist organizations profiled

In addition to Afghanistan and Pakistan, Crenshaw's website will feature profiles of the following groups:

  • 1920s Revolution Brigades
  • Mujahideen Army
  • Islamic Army in Iraq
  • Ansar al-Islam
  • Al-Qa'ida in Iraq

Group profiles include the following attributes:

  • The group's name, including pseudonyms and name changes
  • A history with a timeline, including whether the group is active, dormant or disbanded
  • The group's goals/ideology
  • Key leaders
  • Group size (by date)
  • Resources in the form of money and weapons
  • Outside intervention and influence
  • Dates of first and last known attacks
  • Targets
  • Area of Operations
  • Tactics
  • Political activities (by date)
  • Key operational experiences (by date)
  • Known splinter groups (by date)
  • Relationship to other groups (by date)
  • Relationship with surrounding population/popular support
  • Defining characteristics/Major events
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Understanding the relationship between female employment and fertility is a vital ingredient for effective population policy. This column presents new findings from China based on well over 2000 women between 20 and 52 years old. It finds that non-agricultural jobs for women reduce the number of children per woman by 0.64 and the probability of having more than one child by 54.8%.

As the realities of an ageing population tick ever closer, policymakers have sharpened their focus on fertility. While low fertility in Europe has been labelled a crisis (Doepke et al. 2008), fertility in some high-income countries of East Asia, such as Japan and South Korea, is even lower. Fertility has also fallen significantly even in rapidly developing middle- and low-income economies, including those of China, India, Indonesia, and Vietnam (Figure 1). In China, the personal forces promoting fertility decline reinforce ongoing policies to curb population growth.

Also available in Chinese: "Gongzuo he zinü: Zhongguo nongcun nüxing jiuye he shangyulü."  Comparative Studies (Bijiao) 49(4) (Beijing: China CITIC Press): 1-7.

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Karen Eggleston
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We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental health issue in this population.

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Mark W. Smith
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The Center for Strategic and International Studies (CSIS) hosted a live debate May 25 between Scott Sagan and Keith Payne, CEO and president of the National Institute for Public Policy. CSIS is a bipartisan, nonprofit organization in Washington, D.C.

Scott Sagan's Introductory Statement

I have been asked to address the question: "What should be U.S. declaratory strategic deterrence policy?"

I continue to believe, as I wrote in my 2009 Survival article, that,

"The United States should, after appropriate consultation with allies, move toward a No-First Use declaratory policy by stating that the role of U.S. nuclear weapons is to deter nuclear weapons use by other nuclear weapons states against the United States, our allies, and our armed forces and to be able to respond, with an appropriate range of nuclear retaliation options if necessary in the event that deterrence fails."

I believe that slow but steady movement toward a No-First Use (NFU) doctrine is in the U.S. interest because I think U.S. declaratory policy should have three characteristics.

U.S. declaratory policy should:

a) address the full range of nuclear threats to U.S. national security objectives (not just basic deterrence);

b) be accurate and consistent, reflecting actual military doctrine rather than being mere rhetoric; and

c) U.S. declaratory policy should reflect what U.S. leaders really might want do in the event of a deterrence failure.

In my brief opening remarks, I will explain these three points and outline the logic and evidence that leads me to the conclusion that the benefits of an NFU declaratory policy outweigh its costs.

Point #1: Deterrence is one, but only one critical U.S. national security objective and prudent decisions about declaratory policy regarding the use of nuclear weapons should take into account its likely effects on deterrence of adversaries, bit also the reassurance of allies, the further proliferation of nuclear weapons to additional states, the risks of nuclear terrorism, the impact of our declaratory policy on nuclear doctrines of other states; and the prospects for long-term nuclear disarmament. In this sense, the CSIS question (like previous Nuclear Posture Reviews (NPR) before this latest one) is too narrow in scope and could therefore lead to an excessively narrow, indeed a wrong-headed, answer. Historically, many actions and statements made in the name of deterrence - think of Richard Nixon's Madman Nuclear Alert over Vietnam or George W. Bush's suggestion that "All Options are on the Table" included nuclear preventive strikes on Iran -- might add just a smidgen of deterrence, but can be highly counterproductive with respect to other U.S. nuclear security goals. This is true of the NPR in general: just as war is too important to be left to the generals, nuclear declaratory policy is too important to be left solely to the Pentagon.

Opponents of this broader conception of nuclear posture claim that there is no evidence that U.S. nuclear posture influences others or perceptions that we are honoring our NPT Article VI commitments help with non-proliferation goals. That view is wrong. Let me give just two examples:

1. Evidence to support the point about U.S. disarmament steps helping encourage others to act is seen with Indonesia's decision to ratify CTBT earlier this month:

When Indonesia announced its decision it said it had taken note of the "serious effort" on the part of the current United States Administration in promote disarmament. "We do feel that at this time, what is needed is positive encouragement rather than pressure of a different type that we've been trying to impart in the past," he said, voicing hope that the U.S. will follow suit from his country's actions. "We are also cognizant of some positive aspects of the United States' Nuclear Posture Review."

2. For evidence on the doctrinal influence or mimicry point let me cite India. In January 2003, the BJP government in New Delhi, influenced by the U.S. NPR, adopted a revised, more offensive nuclear doctrine including the explicit threat of Indian nuclear first-use in response to biological or chemical weapons use. "India must consider withdrawing from this [NFU] commitment as the other nuclear weapons-states have not accepted this policy." Although it is too early to know the final result, the Indian government today appears to be reversing course: A group of very senior former officials has stated that, "It is time to review the objectionable parts" of India's nuclear posture and the Foreign Minister has called for universal declarations of NFU.

Point #2: U.S. Strategic Nuclear Declaratory Policy should be consistent with actual U.S. Nuclear Doctrine. That is, U.S. government officials should not misrepresent what its "real" nuclear policy is when it makes public statements about intent and plans. This may seem like an obvious point to some... but history suggests that this principle is not always followed--from Robert McNamara's mid-1960s declaratory statements about Assured Destruction (which often downplayed the heavy Counter-Force emphasis of U.S. doctrine at the time) to the Bush Administration's February 2002 statement in which in the same speech it "reaffirmed" the 1995 Negative Security Assurances not to use nuclear weapons against NNWS parties to the NPT unless they attack the U.S. or our allies with a NWS and, in the same speech, also stated that, "If a weapon of mass destruction is used against the United States or its allies, we will not rule out any specific type of military response. This followed the leaking of the classified portion of the 2001 NPR which reportedly placed Iran, Libya, and Syria on target lists, creating a flurry of negative international press reports.

In an era in which leaks should be considered highly likely, if not inevitable and, at a time in which we want more transparency around the world, the U.S. Government should err on the side of transparency. With multiple audiences present, calculated ambiguity may sometimes be necessary and even helpful; clear contradictions and calculated hypocrisy are not.

Here, I must give the current Administration some credit, for it judged that there was a small set of specific threats that could not currently be met by U.S. and allied conventional forces. It said so clearly in the Nuclear Posture Review and also clearly committed itself to deal with the challenge:

"The United States will continue to strengthen conventional capabilities and reduce the role of nuclear weapons in deterring non-nuclear attacks, with the objective of making deterrence of nuclear attack on the United States or our allies and partners the sole purpose of U.S. nuclear weapons." (p. ix)

Critics say that this will weaken extended deterrence as key allies will feel abandoned. Evidence so far is to the contrary:

  Japan: Foreign Minister Okada said, in October 2009, "We cannot deny the fact that we are moving in the direction of No-First Use of nuclear weapons. We would like to discuss the issue with Washington." The Japanese 2010 Rev Con statement said, "Japan appreciates and welcomes the Nuclear Posture Review by the United States." "We call on all states possessing nuclear weapons to reduce the role of nuclear weapons in their national security strategies. In this connection, we call on the Nuclear Weapon States to take, as soon as possible, such measures as providing stronger negative security assurances that they will not use nuclear weapons against Non-Nuclear-Weapon States that comply with the NPT." Japanese 2010 NPT Review Conference statement

  This is also the case in NATO: The German, Dutch, Belgian and Norwegian governments have all called for removal of the tactical nuclear weapons on their soil. NATO meetings will address this soon. We should not just assume that the credibility of extended deterrence and reassurance to allies is threatened by NFU declarations or removal of tactical weapons. Instead, we should listen to what our allies are saying and work with them.

Point #3: U.S. declaratory policy should reflect what the U.S. might really want to do if deterrence fails. Doctrine and declaratory policy should be made with an acute awareness that deterrence might fail and not succumb to the common wishful thinking biases that assumes perfect prospects of success. This leads me to appreciate the wise advice that Brent Scowcroft gave to President George H.W. Bush during the first Gulf War to avoid "spoken or unspoken threats to use them (Nuclear Weapons) on the grounds that it is bad practice to threaten something that you have no intention of carrying out."

When an official threatens actions that we have no intention of carrying out it can add a thin sliver of deterrence strength but at the grave cost, if the action occurs anyway, of either cheapening the currency of deterrence or risking the creation of a commitment trap that leads the state to execute an option that it otherwise would deem ill-advised. Here, I think of General Chilton's recent remarks about using nuclear threats to deter cyber attacks, as an example.

Here, I should note that in order to enhance non-proliferation and move slowly in the direction of a nuclear-free world the current NPR adds new NSAs and threatens conventional attacks only against NNWS in compliance with the NPT: "The United States will not use or threaten to use nuclear weapons against non-nuclear weapons states that are party to the NPT and in compliance with their nuclear non-proliferation obligations" (p.viii) and promises that its conventional responses would be "devastating" and that, "any individuals responsible for the attack, whether national leaders or military commanders , would be held fully accountable."

Dr. Payne, in his 2009 article, was critical of the whole goal of nuclear disarmament, despite the U.S. Article VI commitment to work in good faith toward that objective. He has written that, "The continuing threat posed by chemical and biological weapons is a fatal flaw in the logic of the nuclear-disarmament narrative, one that is all but ignored by its proponents.

"In fact, even if all enemies and potential enemies of the United States miraculously gave up their nuclear weapons, the United States would still need to maintain a nuclear deterrent arsenal. Why? Because some enemies reportedly retain other types of weapons of mass destruction (WMD), such as chemical and biological weapons, that could inflict enormous civilian casualties...If we also take nuclear deterrence off the table, we may, as Gen. Paul Fouilland, commander of the French Strategic Air Forces, has observed, 'Give a green light' to chemical and biological threats," Dr. Payne states.

I fail to see how a promise of "devastating" conventional responses and a promise that, "Any individuals responsible for the attack, would be held fully accountable" is giving any kind of green light to an adversary contemplating a chem/bio attack.

Furthermore, the only historical evidence that Dr. Payne cites to demonstrate his belief that, "Nuclear weapons threats have unique deterrent qualities" is the alleged success in deterring Iraqi use of Chem/Bio during the 1991 Gulf War:

The preponderance of evidence suggests that this is not right: Saddam did not use his WMD in 1991 because we threatened to march on Baghdad and overthrow his regime if he did that and "promised" to do that if he refrained from using his WMD.

First, look at the Bush, 25 January, 1991, letter to Saddam:

"Should war come it will be a far greater tragedy for you and your country. Let me state too that the United States will not tolerate the use of chemical or biological weapons or the destruction of Kuwait's oil fields and installations. Further, you will be held directly responsible for terrorist actions against any member of the coalition. The American people would demand the strongest possible response. You and your country will pay a terrible price if you order unconscionable acts of this sort." Two of the three things that Bush warned about happened...hardly good evidence that vague threats or calculated ambiguity worked as a deterrent.

Second, look at James Baker's memoirs in which he claimed that he "purposely left the impression that the use of chemical or biological agents by Iraq could invite tactical nuclear retaliation," but also warned Aziz that if Iraq used weapons of mass destruction, "Our objective won't just be the liberation of Kuwait, but the elimination of the current Iraqi regime." Advocates of maintaining calculated ambiguity too often cite the first statement but fail to cite the second Baker statement.

Third, look at what Saddam said under interrogation: "How would Iraq have been described if it had used nuclear weapons? A: "We would have been called stupid." In the May 2004 interrogation: "The WMD was for the defense of Iraq's sovereignty. Iraq demonstrated this with the use of WMD during the Iraq and Iran War, as Iran had threatened the sovereignty of Iraq. Yet, Iraq did not use WMD during the 1991 Gulf War as its sovereignty was not threatened."

In conclusion: I think you will discover today that reasonable people can certainly disagree about how to value and prioritize these different nuclear-related objectives and reasonable people can (and do) disagree about how best to pursue them. But reasonable people should not ignore the full range of U.S. objectives and narrowly conflate deterrence with security, should continue to search for evidence that supports or weakens their assumptions, and should engage in rigorous dialogues like this to help propel the debate forward.

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The Obama administration's decision to preview its National Security Strategy at West Point highlighted its coverage of security crises from Afghanistan to North Korea. But back-to-back events at Brookings with Hillary Clinton and Samantha Power today showed that the core of the strategy is a deeper argument about the central challenge confronting America -- the increased impact on our economy and security of a new global reality.

For two decades, the United States could take economic and security supremacy for granted. Three things have changed.

First, the global economic boom. Yes, boom -- remember? Before the crash, there were two decades of uninterrupted growth in the global economy, global trade, and global financial activity. The U.S. profited, but so too did China, India and Brazil, which grew into major economic players; so did several others, like Mexico, Indonesia and Turkey, which have emerged as the new middle powers.

Second, the Iraq war. Love or loath U.S. policy in Iraq, it launched us into sustained expenditure of financial and military resources alongside another draining war in Afghanistan. In the minds of the Vulcans, decisive U.S. victory in Iraq was to assert global order by force of -- well, force. The strategy backfired, and rising states from Ankara to Brasilia found few, if any, costs to opposing U.S. strategy in the Middle East -- and domestic political points to be won. The Obama administration is feeling the consequences in its Iran policy.

Third, the global financial crisis. The bust, when it came, reaffirmed the centrality of the U.S. in the short term. But it also showcased the growing weight of the emerging economies, which now lead the global recovery. Before Lehman Brothers collapsed, other big players may have disliked our Middle East policy, but they banked -- figuratively and literally -- on our stewardship of the global financial system. Since then, doubts have crept in, and a new assertiveness to match.

The net result is rising global influence and solidifying regional power for China, India, and Brazil -- and less room for maneuver for the US.

The administration will be criticized in predictable terms from predictable quarters for acknowledging any of this, even in tacit terms: for 'giving ground' to the emerging powers, for 'ceding' American supremacy, for forgetting to carry a big stick while talking softly. But that dog won't hunt. The Bush administration had begun to adapt to these changed realities towards the end of its tenure, and the Obama administration deserves credit for putting the new global realities front and center in its assessment of U.S. national strategy. The core concepts of revitalizing international order, pressing others to take up their responsibilities and working within, not against, multilateral arrangements are the right ones.

The tougher question is, will it work? Skeptics will point to Chinese heel-dragging and Brazilian gallivanting on Iran to say no. Optimists will point to Chinese cooperation on the financial crisis, and everybody's cooperation on Somali piracy and counter-terrorism, to say yes.

The reality is, we don't know. There's a struggle in Beijing between betting on cooperation with the US, and those who seek sharper competition. A pro-U.S. strategy in India has the high ground for now, but divisions remain. The better angels in Brazil's foreign ministry can't quite hold back Lula's dalliance with global populism -- an October election there may tilt the balance.

But we know this much: if the U.S. doesn't try, no one will succeed. None of the emerging powers can underwrite stability, and none that are serious want the job. The emerging powers may not play ball, and if so, we'll be in a lose-lose global game. But only U.S. strategy can pull us into win-win, and the Administration is right to try. Making this point to the American people won't be popular; but reality is reality, and denial does not a strategy make.

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Secretary of State Hillary Clinton recounts a story to President Barack Obama and Senior Advisor Valerie Jarrett, outside the Sultan Hassan Mosque in Cairo, Egypt, June 4, 2009.
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10:00 - 10:15: Introductory Remarks

J. P. Daughton, Stanford University

Panel 1

10:15 - 12:00: Humanitarian Relief as a Historical and Methodological Challenge

"Assisting Civilian Populations: Notes on an Ongoing Research Project"

  • Davide Rodogno, Graduate Institute of International and Development Studies, Geneva

"Who Qualifies as the Object of Humanitarian Relief? Italian Refugees after World

War II"

  • Pamela Ballinger, Bowdoin College
  • Comment: Priya Satia, Stanford University

 

Panel 2

1:15 - 3:00: In the Wake of War: Rebuilding 1920s Europe

"Foreign Humanitarian Actors in Poland, 1918-1923"

  • Shaloma Gauthier & Francesca Piana, Graduate Institute of International and Development Studies, Geneva

"Post-WWI Humanitarian Efforts in Poland's Eastern Borderlands"

  • Kathryn Ward, Stanford University

"A Sketch of Humanitarian Emergency Relief Operations in Greece during the 1920s"      

  • Davide Rodogno, Graduate Institute of International and Development Studies, Geneva
  • Comment: Robert Crews, Stanford University

 

3:00 - 3:15: Coffee Break

Panel 3

3:15 - 5:00: European "Humanity" in Global Context

"Early Humanitarianism and Local Knowledges: Black Experts and the Conference on the African Child of the Save the Children International Union (Geneva, 1931)"

  • Dominique Marshall, Carleton University

"Humanitarian Internationalism, the South Asian Refugee Regime, and the ‘Kashmir Refugees Fund', 1947-1951"

  • Cabeiri Robinson, University of Washington

"Human Rights and Saharan Prisons in Post-Colonial Mali"

  • Gregory Mann, Columbia University
  • Comment: Liisa Malkki, Stanford University

Sponsored by:

  • Transnational, International, and Global History Program, Department of History
  • Graduate Institute of International and Development Studies, Geneva
  • The Mediterranean Studies Forum
  • Stanford Humanities Center

BOARD ROOM, STANFORD HUMANITIES CENTER

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