Street-level diplomacy

NEW YORK CITY - Not since Nikita Khrushchev beat his shoe on the desk 46 years ago have UN delegates absorbed such a high-level tirade. "And the devil came here yesterday," Venezuelan president Hugo Chavez told dignitaries gathered for the opening of the UN's 61st General Assembly, a reference to President George Bush. "Yesterday the devil came here. Right here." He paused to cross himself. "And it smells of sulfur still today."

Mr. Chavez, seizing the podium a day after Bush and more than two dozen other heads of state addressed the general assembly on Sept. 19, broke open the frosty tension that was felt in the hall as Bush and his allies square off against those who oppose the war on terror. "The hegemonic pretensions of the American empire are placing at risk the very survival of the human species," said Chavez, who took on the UN as well: "Let's be honest. The UN system, born after the Second World War, collapsed. It's worthless."

Each year the inaugural of the UN general assembly is a harmonic convergence of world leaders and causes: Sixty-four heads of state, dozens of foreign ministers, and hosts of VIP attendees watched over by a press corps from around the world filled this year's formal opening session Sept. 19. They covered special interests as wide-ranging as global poverty and as mundane as agriculture: Greek delegates hosted a champagne reception titled "In Praise of the Olive."

But try as the UN establishment might to appear tolerant and inclusive, the overarching tenor of this year's general assembly was captured by the fanatical lashing out at U.S. policy by Chavez and Iranian president Mahmoud Ahmadinejad. And while their anti-U.S. rhetoric was no surprise, the religious language wrapping it was striking: "I emphatically declare that today's world more than ever before longs for just and righteous people with love for all humanity, and above all longs for the perfect, righteous human being and the real savior who has been promised to all peoples and who will establish justice, peace, and brotherhood on the planet," said Ahmadinejad, a not-so-oblique reference to the 12th Imam, whom Ahmadinejad champions to bring the end of the world (perhaps with the help of nuclear weapons and the annihilation of Israel, which he also champions). The Iranian president used much of his time at the podium to accuse the Bush administration of rigging the UN to do its bidding.

As president and Mrs. Bush helicoptered into lower Manhattan Sept. 18, New Yorkers were thinking more about street-level security than high-level confrontation. Just a few blocks away from the landing pad, health experts gathered to hear the latest on emergency preparedness at a symposium sponsored by Downtown Hospital. Located three blocks from Ground Zero, the acute-care facility was the first among first responders to victims of the World Trade Center attacks, treating 1,200 patients on 9/11 alone.

It has been leading the way for hospitals in the city ever since: focusing the attention of health workers on impending disasters, linking arms with other hospitals in how to prepare for them, and spending millions on improvements to minimize casualties in the next disaster. If President Bush and other world leaders gathered in New York to give voice to the threats of terrorism, nuclear and other potential disasters, these experts put feet to making street-level solutions possible.

"Where are we now?" asked an administrator from New York Hospital in Queens. "What is our ability in the metropolitan area to sustain a long-term catastrophic event?"

Those are questions that work on the sleep patterns of countless city officials, from law enforcement to transportation experts to water-quality specialists. After spending millions and millions to prevent another attack, to protect dignitaries and others who flock to events like last week's UN session, what happens if terrorists succeed here, anyway? How will the city cope again? Most Americans manage thoughts of potential terrorist attacks from a safe distance. New York is the city that can't forget.

Where are we now? "That's not so much a difficult question as a scary one," responded Don R. Boyce, director of emergency hospital preparedness for Continuum Health Partners, a consortium of five public hospitals in New York. Health-care workers recognize that most city hospitals are very old, he said. "The infrastructure is old, the generators are original generators. We have figured out how to sustain ourselves for 24-48 hours. But we are not ready to sustain for a longer period of time without help."

In many ways post-9/11 threats loom larger than ever for these health-care workers-because now they know that worst-case scenarios can come true. Add to terror threats the related threat of biological and chemical sabotage, the prospect of citywide blackouts as occurred in August 2005, and the prospect of an influenza pandemic, and it's easy to see why this sort of health-care war-gaming is essential. This was the second year Downtown Hospital officials brought in public-health experts from Louisiana, acutely aware following Hurricane Katrina that total breakdown in emergency caregiving is possible.

But hospital workers in New York are better prepared, better supplied, better supported than they were five years ago. And more realistic. Downtown Hospital just finished a $25 million emergency room renovation complete with a decontamination unit and a cafeteria newly outfitted for conversion to an additional trauma unit. Hospital president Bruce Logan said he considers the recent upgrades national defense expenditures, yet less than 15 percent of the ER renovation was paid for with funds from any government agency.

Debra Berg, medical director for New York City's emergency hospital preparedness program, said city health-care workers have also learned practical dos and don'ts for hospitals by focusing on emergency scenarios:

Above all, city hospital workers say they have learned to value communication and to avoid isolation-something they say hindered recovery in New Orleans. "We are a small fraternity in many ways when it comes to emergency preparedness. We are competitors, but if something happens that goes away," said Boyce. For that reason, the Downtown Hospital symposium has become an annual event, drawing hospital officials from all five boroughs.

In addition to being good neighbors, hospitals are learning to practice something health experts call the "graceful degradation of care," where medical teams understand and plan for failure in the event of a dire event rather than naïvely proposing to meet every need.

They also count on outsiders. "If we need something, it'll be coming from the West or Midwest," said Boyce. "That's understandable, but I need to know that if I need something with a window of 12 hours, I'm not going to be waiting for a truck to get hitched up in California. I couldn't say we're in really good shape; we're not even close. What we have done is identify our sources of potential flaws. And we're learning to live with what little resources we have."

In many ways, New York five years since the UN session opened in September 2001 is a remarkable story. Budget shortfalls in the years following 9/11 ran $5 billion to $6 billion annually, as the city took hits to tourism and its financial base. This year the city ended its fiscal year in June with a $3.75 billion surplus. A hefty boost to law enforcement has reduced crime by over 17 percent since 2001. And the city's population is growing, including in residential areas around Ground Zero thought off-limits after the World Trade Center collapse. "Instead of experiencing the post-9/11 economic collapse that al-Qaeda envisioned and that many doomsayers feared, we are stronger and safer now than we have ever been before," Mayor Michael Bloomberg told New Yorkers during this month's 9/11 remembrances.

The city has added 1,200 street cops to its police force just this year and increased by nearly 10 times its counterterrorism detective force since 9/11. NYPD even bases officers overseas now as a kind of forward defense for intelligence-gathering in terror hot spots like London, Madrid, Tel Aviv, Singapore, and Amman. Authorities haven't forgotten about environmental terrorism; New York's water supply now has bluegill fish as experimental monitors. The fish react to any sort of chemical agent or other hazards introduced into the water supply, and so they swim in computer-monitored tanks where water samples are tested.

That attention to detail carried over to security on New York's East Side near UN headquarters, coordinated among area precincts, UN security, the Secret Service, and State Department diplomatic security. In all, about a dozen major thoroughfares were closed intermittently throughout the week. Security barricades went up along the streets, even closing some sidewalks, and steel-plate barriers were thrown up on 1st Avenue just outside the UN entrance. The lockdown continued as long as the president, first lady, Secretary of State Condoleezza Rice, and other dignitaries shuttled cross-town in massive, armor-plated motorcades between the East River and events at the Waldorf-Astoria.

One post-9/11 development is that New Yorkers seem less inclined to take out commuter frustrations on the cops and more inclined to take them out on reporters: "Let the UN move to Alaska!" railed 62-year-old Stephanie Boren to a New York Daily News journalist. The paper sent two reporters on a 26-block race through congested midtown Sept. 19, one on foot and one on a bus; the reporter on foot arrived five minutes before the bus did.

The dignitaries, meanwhile, were spared the traffic headaches but not the tension of an emotional opening session. Delegations from 192 member nations filled the green-carpeted general assembly hall to capacity and just beyond, while VIP guests ascended three balconies. This general assembly marks the last for Secretary-General Kofi Annan, whose second five-year term expires at the end of this year.

Events of his tenure, he said, "have not resolved, but sharpened" global challenges, including "an unjust world economy, world disorder, and widespread contempt for human rights and the rule of law." Annan spoke in overbroad terms, but his voice broke with emotion as he turned to his own time in office. "Together we have pushed some big rocks to the top of the mountain, even if others have slipped from our grasp and rolled back," he said.

Then it was left to President Bush to bring on specifics. The president began a 21-minute speech with a subdued summation of the ideological struggle "between extremists who use terror as a weapon to create fear, and moderate people who work for peace."

But he quickly turned pointedly to battleground states: Iraq, Afghanistan, Lebanon, Iran, Syria, and the Darfur region of Sudan. With three heads of state from those countries in attendance-Iraq's president Jalal Talabani, Afghanistan president Hamid Karzai, and Sudanese president Omar al-Bashir-he gave pointed praise and criticism to each. "Your government must choose a better way forward by ending its support for terror," he said, turning to the Syrian table. And to Iranians, he said the greatest obstacle to a free society "is that your rulers have chosen to deny you liberty and to use your nation's resources to fund terrorism, and fuel extremism, and pursue nuclear weapons."

Ahmadinejad, who had called for a public debate with Bush during this general assembly, in the end avoided the opening remarks, turning up in the hall after Bush spoke to deliver his own speech and defend Iran's pursuit of uranium enrichment and nuclear capability.

Outside, the expected thousands of anti-war and anti-Bush demonstrators clogged 6th Avenue but gave way to hundreds of unexpected but tenacious anti-Ahmadinejad protesters. "Stop Mullahs' nukes-UN sanctions now," read signs carried by a crowd of mostly Iranian-Americans shouting "Ahmadinejad out!" And for once the demonstrators appeared more civilized than the dignitaries inside.