Sanctions are the go-to tool for imposing costs on bad actors on the global stage. But what happens when the sanctions cause humanitarian crises? Ruth Gibson joins World Class to discuss the latest research into how sanctions impact child and maternal mortality, and the stability of the global order as a whole.
Ruth Gibson is a postdoctoral scholar at Stanford University’s Department of Health Policy and an affiliate at the Center for International Security and Cooperation (CISAC). Her research focuses on volatile regions affected by war and sanctions. She also works with the United Nations High Commission for Human Rights on the use of unilateral sanctions.
McFaul: You're listening to World Class from the Freeman Spogli Institute for International Studies at Stanford University. I'm your host, Michael McFaul, the director of FSI. Today I'm speaking with Ruth Gibson, a postdoctoral scholar in the Department of Health Policy and an affiliate at the Center for International Security and Cooperation, which is also a center here at FSI.
Her research focuses on volatile regions affected by war and sanctions. She also works with the United Nations High Commission for Human Rights on the use of unilateral sanctions. And she recently joined the International Working Group on Russian Sanctions that I coordinate with the help of others, including people in the Ukrainian government.
Ruth, welcome to World Class.
Gibson: I'm thrilled to be here with you, Mike.
McFaul: Earlier this year, you and your college published a pretty interesting research paper about the impact that sanctions have on maternal and child health and mortality. Tell us a little bit about those findings and what policy makers should be paying attention to.
Gibson: This research broadly and my research more generally comes out of the decade that I spent overseas. So for me, my academic work is grounded in my time in Africa where I watched sanctions play out on the ground in response to terrorist concerns and human rights violations and backsliding in democracy, and the Middle East from time in Yemen being in war zones. And so those two pieces are like a decade of living that . . .
McFaul: Right.
Gibson: . . . that’s the reason why I'm doing it.
McFaul: Well, not many people do that, right, Ruth? I mean, there's kind of the medical profession and there's the security profession. It's hard to bridge that gap,
Gibson: Yeah, which is why I’m at Health Policy, which is between the two . . .
McFaul: Right!
Gibson: . . . and why I was at CISAC. This study looked at specifically at foreign aid sanctions. One of the things that you said about your book is that you wrote your book, Autocrats vs. Democrats, before Trump was elected. And I started on this study before the shutdowns of USAID began.
But the study that we did with our colleagues at Drexel University and the University of Washington and Health Policy was looking at foreign aid sanctions, specifically when there's concerns in any number of nations over human rights violations, terrorism, and we impose these sanctions and the world pulls out foreign aid. And what that means in terms of what happens to the country and what happens to the civilian population.
And what we found is that when you impose these foreign aid sanctions, you're going to see drops in official development assistance and in official development assistance for health.
But what I saw on the ground is what we saw in this study. And there's like a 60% backsliding in maternal mortality . . .
McFaul: 60%?
Gibson: Yeah. And 30 % in children under five and infants.
So, we were going to press as USAID was being shut down. This was simultaneous. And we had made policy recommendations. And one of the things that we recommended was a waiver mechanism. Essentially, if you impose these measures and you see the country's people are just like in a horrific set of circumstances, that there's a way to back off.
McFaul: I like that, okay.
Gibson: Yeah, but and that's something that we wrote about in the paper. But what we saw with USAID is that the waiver was tried, and it didn't work. It wasn't fast enough.
McFaul: Why is that Ruth? Explain that.
Gibson: In the case of USAID, when there was the full stop order of all work related to development, then the organizations had to apply for whether or not their programs were deemed life-saving, there was a time lag. And with a lot of this, these organizations couldn't compensate. Like the people need medication, programs need to be administered, it's life-saving food.
McFaul: Right.
Gibson: And then I'll tell you something even more important; the imposition of that sanction, the time delays is four to five years. So you begin to see those spikes in death four to five years after the fact.
Bill Gates has spoken to this, that we won't see the impacts of what this means for years.
McFaul: Right. And that's what makes it such a tough public policy discussion in the United States because we're not seeing effects right away.
Tell us more generally: we've seen these massive cuts to USAID. Essentially USAID just this week was shut down, the way I understood it.
What do you think this is going to mean, the big impact over the long-term?
Gibson: Just to draw upon the best academic work in this field came out two days ago. That was in the Lancet. And what that group did was calculate what USAID has done over the last two decades in terms of lives saved and what it's going to mean until 2030. So from now until 2030, what it's going to mean in terms of lives lost.
What the study going is it's 14 million deaths between now and 2030.
McFaul: That is shocking.
Gibson: Yeah, and it's like 4.5 million children under the age of five by 2030. And then they broke it down by HIV-AIDS, malaria, neglected tropical diseases, TB, nutritional deficiencies.
But I think that part of the policy divide here is that the current administration is citing these fringe programs and not explaining to the American people what the legacy of American foreign aid has done over decades of work.
McFaul: That's a great point. And let's talk about that a little bit. So right, there are all these kinds of, like you say, “fringe projects,” exotic things that they point to, you know, “woke aid” and therefore we have to shut the whole thing down.
Talk a little bit about what you think needs to happen to win this debate again with the American people. I mean, maybe it's just citing the data that you just cited.
But what's striking to me watching these horrific cuts in different places is that there was no constituency for USAID, right? There was no interest group. I mean, there was, but it was a weak one compared to other places that they tried to cut. And I worry and I wonder: is that because the American people don't see the benefit of this kind of work for American national interests?
And if so, how do we . . . what's the right way we make that argument to the American people thinking that this is probably going to be a long conversation to get back to doing the kind of work that we used to do.
Gibson: Yeah, so I think that the first thing that I would say is the intersection of academics with policymakers. And as I've watched this debate play out, it is so heated that it's like the people in decision-making power are perhaps it's challenging for them to get briefings from academics who can explain to them what this will mean and what programs they need to be paying attention to. And I think that my colleagues have been working on that. But more needs to be done.
The second is to speak to the American public about what the core, the backbone of American foreign aid has done in terms of PEPFAR, in terms of malaria eradication, and what this means in terms of conflict resolution, in terms of making sure that terrorism is not rising in various parts of the Sahel in the Middle East, and pointing to those programs again and again.
McFaul: Tell us some of those stories for the people that don't know, like PEPFAR. Talk a little bit about what has been achieved there.
Gibson: Yeah, so that's the largest effort that's ever been undertaken in terms of the eradication of AIDS from the planet. Tens of millions of dollars have been put into this program to both slow the spread of AIDS around the world, but also stop the transmission from mother to child. And with the shutdown of AIDS, that was stop work orders immediately.
And so HIV antiretroviral medication was sitting on the shelves and because it was so sudden these countries essentially couldn't compensate. So you know our colleague Michelle Berry runs the SASH program and I went to one of her events and was speaking to the doctors that she's brought in from around the world. But essentially it's so sudden that they can't . . . they don't have a plan for getting that medication. They don't have a plan for programs.
But I think Mike, one of the broader pieces that we have to, like, step back and look at as a world is what's happening in terms of, like with the NATO summit. We now have to reach 5% of defense spending — 3.5 % is the base for military and then another 1.5 on the critical infrastructure.
But countries are making decisions and even as early as February, the UK government was saying, “Okay, we have to do more in terms of defense spending. So we're going to get that by pulling back on foreign aid.”
And what does that mean in terms of global stability?
McFaul: Interesting. So it's not just the United States that's having this debate. You're going to see this in other countries as well.
Gibson: Yeah, Belgium, Norway, Finland. I mean, this is a conversation that was happening at the NATO summit. Where is that going to come from? It's going to come from social programs and foreign aid.
McFaul: Well, that's even more depressing because I always thought the Europeans were going to pick up the slack.
Do you see a way that this can change over time? Is there . . . obviously the private sector, you'd already mentioned Bill Gates has been involved also in these things, but is there . . .
Gibson: Yeah, Bill Gates is going to spend the entire foundation's assets over the next 20 years, right? So it was going to be a lifetime and he's made a strategic decision to spend everything.
And he has not said publicly whether or not that's in response to the administration's decision, but that's a major strategic move. But even that move is a fifth of what the U.S. was spending.
McFaul: I didn't realize that; even if he spends everything, the United States was still spending 80% compared to 20%. That is sobering. That is very sobering.
Are there other philanthropic resources that could be leveraged or is this going to be a cataclysmic failure for the world?
Gibson: I think it's going to be cataclysmic, And my hope is that we can get to this in our conversations about what to do about Iran and the upcoming conflict between China and Taiwan, but making strategic decisions to figure out how we move towards more stability.
McFaul: Well, let's talk about that a little bit. Let's go back to sanctions for a minute and start with the big hard to answer question: do sanctions work or not?
How do you answer that question based on your own research and experiences?
Gibson: Let's use an example from Russia. If we consider Putin's shadow fleet. And for those listening, that's essentially when Putin has acquired a series of vessels that is able to work outside of the normal fleet capacity.
And that is a tool, essentially, to be able to evade restrictions and the sanctions on oil. So that's a major source of income for Putin's war machine, and the shadow fleet is part of how Russia can get that out.
And the EU in 2024 banned numerous vessels and the U.S. Office of Foreign Asset Control has banned hundreds of tankers of that shuttle fleet. And it's worked; there's been a 50% decrease in the shadow fleet capacity and that’s all reducing the oil revenue for the war machine.
But there are more complex examples. Depending on how you want to slice the international legal tools here, but whether using sanctions or peacetime unilateral countermeasures for the seizing of Russian assets. All the Western countries who have assets of the Russian central bank and how to get those assets, how to confiscate them, how to allocate them, and how to figure out a way to get those into Ukraine's hands to offset military supplies and civilian government services and ultimately to rebuild. And that's enormously complex, and you've been working on this since 2020, since the beginning.
McFaul: It is complex, you're right. And I think most certainly reducing funding to Putin: that's a good thing. But it hasn't achieved the ultimate goal, of course, of ending the horrific war.
And I think that's the general problem with sanctions. It's just one instrument against a complex array of things that are happening. So, it's easy to say they don't work when it doesn't achieve the ultimate outcome, but it doesn't mean that it's not having an impact.
And I think I would say that about other sanctions that I've worked on too. Think of Iran . . . similar kind of thing. And then you tease this idea about Taiwan. I mean, have you thought about what might happen if there was a conflict and how sanctions might work there or is that too far-fetched to think about so far?
Gibson: No. I mean, it isn't far-fetched. There is an enormous amount of work going on in terms of what the U.S. response would be to China as they escalate beyond what we consider tolerable. Things have been escalating since February or March, with live fire drills and increasing pressure into that water space.
So, my primary concern in that potential conflict is — I'm looking in terms of my next project — I'm looking a lot in terms of what's going to happen with naval blockades and what that would mean for maritime transport, what that means for civilian preparedness in Taiwan.
As you know from meeting with President Lai, he started the Office of Whole of Society Resilience. But more broadly, what that means for human health in the region. Because as we've seen with the conflict in the Middle East, the Strait of Malacca is a quarter of global shipping. And if that's impacted, what that means for Taiwan, but also more broadly, what does that mean for the entire region?
McFaul: Great point. I hadn't thought of that; it's not just Taiwan that'll be affected,
Gibson: I hope that I'm wrong, but I think that there's a potential that it's like truly catastrophic.
McFaul: Scary stuff. Depressing stuff. So let's try to end on something more positive. Tell us, are there any trends in terms of the work you're doing that irrespective of short-term imprudent policies by, say, the Trump administration, are still moving in the right direction?
Gibson: I turn a lot to military generals and history to provide the bird's eye view of looking out past where we are now. And we have learned lessons in the past. General David Petraeus said, “We can't kill our way out of war.” Right? And that was in response . . .
McFaul: Interesting.
Gibson: That's in response to two decades of the global war on terror.
Jim Mattis says, “If you do not fully fund the State Department, if you do not fund our diplomats, then I need to buy more ammo.” It speaks to this tension of these two forces opposing one another.
But I am optimistic that we will move towards making those decisions to invest in long-term strategies. I don't think in the short term we're looking at that, right?
McFaul: Right.
Gibson: But if we zoom out to your kids and my kids, I'm hopeful, Mike.
McFaul: Well, thanks for ending on that note. And it makes me hopeful that people like you are working on these issues, right?
If we don't have evidence-based arguments and it's just about opinion, then I think we lose. But if we have evidence to support these hypotheses, I think in the long run, I'm optimistic that the kinds of arguments we're making will prevail.
So I just keep telling — I say this to many of our colleagues on this podcast — just keep working at it. Because we need more expertise in this world.
So, thanks Ruth for joining World Class today.
Gibson: My pleasure, Mike.
McFaul: You've been listening to World Class from the Freeman Spogli Institute for International Studies at Stanford University. If you like what you're hearing, please leave us a review and be sure to subscribe on Apple, Spotify, or wherever you get your podcasts to stay up to date on what's happening in the world, and why.