The global tuberculosis (TB) response is at a crossroads. In recent years, new ideas, technologies, and political commitments have reinvigorated the fight against this age-old disease that kills more people each year than HIV and malaria combined. But with key indicators just beginning to recover after moving in the wrong direction during the COVID-19 pandemic, hard-earned gains are at stake. In this rejuvenated yet challenging context, we critically review an idea and practice at the heart of the TB response—directly observed therapy or DOT. First, we explore DOT’s controversial method and history as a component of the World Health Organization’s recommended TB strategy. Second, we outline a rights-based disease response and examine DOT through the lens of human rights and related principles. Third, we review the evidence for DOT’s effectiveness. Fourth, we highlight DOT’s most salient and enduring problems. Finally, we propose two essential principles for the way forward to protect and promote the rights of people affected by TB.

A key thesis of this article is that since renewable energy is quintessentially a public good both in constitutional and macroeconomic terms, its availability without restrictions to all people is a true manifestation of economic self-determination, ultimately entailing what this author calls “energy equality.” Although this equality is dictated by the nature of renewable energy as a public good, it risks being eroded by the rush to implement the Paris Agreement. This is certainly one of the shortcomings of the Paris Agreement. With nation states eager to meet their targets and energy concessionaires given unprecedented financial and other incentives, we are witnessing not only the infiltration of criminal elements in the licensing of renewable projects, but also an absence of appropriate impact assessment. In the process of energy transition, the absence of a robust business and human rights framework is giving rise to irreparable damage to the natural environment and social livelihoods. It is suggested that many states, particularly in the industrialized world, are obsessed with their energy grids because the energy grids allow them to sell energy at monopolistic prices, impose taxes through it, as well as exert control over their citizens. With this in mind, national grids adversely impact the socio-economic and developmental rights of the poor and the middle class and prevent them from living decent lives in many cases. The transition to zero carbon economies and the availability of cheap renewable resource harnessing devices for the first time in history can promise energy equality in a sustainable manner. The poor can enjoy the fruits of energy in the same manner as the rich. The article therefore suggests that whatever investment on national energy grids, this should not be made compulsory by states and concessionaires on individual households and communities.

During this paper’s drafting, an indigenous people’s independent government collapsed. For over thirty years, the Republic of Artsakh was a de facto independent region inside the internationally-recognized borders of Azerbaijan. The region comprised of an indigenous Armenian majority—until September 2023. In December 2022, Azerbaijani authorities blocked the only road that connected Nagorno-Karabakh to the outside world. This blockade resulted in shortages of food, medical supplies, and fuel, the severity of which was especially felt during a harsh winter. After experiencing starvation and preventable medical complications under a nine month-long blockade, the Azerbaijani government launched a military incursion on the Republic of Artsakh—claiming it was an “anti-terrorist offensive.” By September 2023, under mounting pressure from the crippling blockade and a large-scale military offensive by Azerbaijan, the Republic of Artsakh’s government signed a decree announcing its dissolution by January 2024—officially transferring control over the Artsakh region to Azerbaijan. By October 2023, nearly the entire Armenian population of Artsakh fled their homes in a mass exodus. For the first time in the region’s history, the majority of Artsakh’s indigenous population no longer lived on their native land. How did we get here? Well, Nagorno-Karabakh—known to its indigenous Armenian population as Artsakh—was not always encompassed within Azerbaijan’s internationally-recognized borders. In fact, for the majority of the region’s history, it was an autonomous region that later fell under Azerbaijani authority after post-Soviet era colonization. On December 10, 1991, the Republic of Artsakh (formerly the Nagorno-Karabakh Republic) held a democratic referendum—where ninety-nine percent of Nagorno-Karabakh residents voted in favor of independence from Azerbaijan. That same year, the Republic of Azerbaijan’s Supreme Council abolished Nagorno-Karabakh from possessing autonomous status. For over thirty years, the Armenians of Nagorno-Karabakh witnessed the Republic of Azerbaijan deny their desire for independence—ultimately culminating in an ethnic cleansing of their native land. Further, the Armenians of Nagorno-Karabakh cannot directly fight for their interests themselves under international law, given that they have no international legal personality. When it came to advocating for their independence—and attempting to avoid forcible displacement from their ancestral homes—the Armenians of Nagorno-Karabakh had nowhere to turn. Advancing the right to self-determination under international and domestic laws was their only hope for a sustainable and peaceful future. Yet, the right to self-determination maintains a nebulous meaning under international law, despite being deeply rooted in key legal documents. The United Nations General Assembly explicitly declared that indigenous peoples have a right to self-determination in the 2007 United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). However, there is no authoritative answer regarding what indigenous people’s right to self-determination precisely entails. This article analyzes three distinct indigenous groups in the Middle East and South Caucasus to argue for the advancement of their right to self-determination under their respective regions’ domestic constitutional provisions and international law, namely: (a) Armenians in the autonomous Nagorno-Karabakh region of the internationally-recognized borders of western Azerbaijan; (b) Assyrians in the Nineveh Plains of northern Iraq; and (c) the Talysh in southern Azerbaijan (“the selected groups”). The selected groups do not encompass all indigenous groups in the Middle East and South Caucasus. But analysis of these groups can provide an “indigenous peoples” lens to what a right to self-determination can look like in the Middle East and South Caucasus through a comparative analysis. Each selected indigenous group has undergone a shared history of seeking autonomy over their native lands—with such efforts met with violence ranging from outright dismissal to ethnic cleansing by their respective governments in power. Legal instruments for indigenous groups to at least partially assert self-determination and autonomy over their ancestral lands generally exist. However, authoritative legal bodies have not interpreted or implemented these rights to their fullest potential. But even though the implementation of indigenous people’s rights under international law “is far from perfect,” recognition of the selected groups’ indigeneity under international law may introduce important rights recognized by the UN in the UNDRIP. It may open a door to international recognition of rights to autonomy, and it may play a meaningful role in the administration of natural resources on their historic lands. Regional inter-governmental organizations also have their own human rights protection frameworks covering their respective geographic regions. Iraq is a member state of the Organisation for Islamic Cooperation (the “OIC”) and the Arab League. Azerbaijan is a member state of the Council of Europe, Organization for Security & Co-operation in Europe (the “OSCE”), and the OIC. The OIC is “a peripheral grouping and a marginal player” in the public international legal field and has a defunct judicial body. The Arab League has also received consistent criticism “for disunity and poor governance”—being more representative of states’ autocratic regimes than its citizens. Although the OSCE organized the Minsk Group to facilitate diplomatic cooperation between Armenia and Azerbaijan with regards to the Nagorno-Karabakh conflict, it has been decried as meaningless and ineffective in resolving the conflict. Lastly, Heads of State and Government of the Council of Europe explicitly rejected a proposed protocol potentially granting national minorities a right to self-determination inside the Council’s member states. Moreover, protections for minorities in the European Court of Human Rights do not include an explicit right to self-determination. Given the considerations above, this article does not review these regional legal mechanisms that may provide a right to self-determination. This article only articulates and addresses important legal and policy issues that arise when considering each group’s right to self-determination under domestic and international law.