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The U.S. is providing surveillance flights over the besieged Iraqi city of Tikrit, where militants from the self-proclaimed Islamic State remain holed up, protected by a defensive network of explosives and snipers.

NPR's Alice Fordman reports that a senior military official from the U.S.-led coalition against the militants, also known as ISIS, says the U.S. has been conducting reconnaissance missions over Tikrit since Saturday.

Until now, she says, the weeks-long military operation around Tikrit has been dominated by Iraqi security forces and allied paramilitary forces strongly backed by Iran. But Alice reports that the operation to take back Tikrit from the militants has stalled, and some Iraqi military officials have told reporters they need U.S. air support to take the city.

Tikrit, about 90 miles northwest of the capital, Baghdad, is the hometown of former Iraqi President Saddam Hussein. Pushing militants from the city would be considered both a military victory and a symbolic victory over ISIS — and a prelude to a battle to retake Mosul, where the jihadist group has set up a major base.

Reuters news agency says the surveillance flights are a lead-up to U.S. airstrikes on Tikrit. The news agency quotes a senior Western diplomat who is part of the coalition as saying that a formal request from the Iraqi government for airstrikes is "imminent."

Still, Alice says one leader of an Iranian-backed militia, Hadi al Ameri, gave a speech over the weekend in which he strongly condemned the idea of U.S. military assistance, calling those who sought American air support weaklings.

Iraqi security officials say their force of 20,000 is made up of mostly Shiite militiamen. It succeeded in pushing militants out of surrounding villages, but hasn't been able to uproot them from the center of Tikrit, according to The Wall Street Journal.

As NPR has reported, ISIS has dug up the streets and planted mines. They've also booby-trapped cars and have snipers protecting the militants.

Sky news says Iraq's interior minister announced last week that the operation had been halted temporarily to avoid casualties and protect infrastructure in the city.

Islamic State

Tikrit

United States

Iraq

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Luis Henry Robles Higinio, 19, has XDR-TB. His right lung was removed due to the extent of the disease, and he had a port implanted in his chest for his twice-daily drip of TB drugs. With the end of IV treatment just two weeks away, he's in a positive frame of mind. Jason Beaubien/NPR hide caption

itoggle caption Jason Beaubien/NPR

Luis Henry Robles Higinio, 19, has XDR-TB. His right lung was removed due to the extent of the disease, and he had a port implanted in his chest for his twice-daily drip of TB drugs. With the end of IV treatment just two weeks away, he's in a positive frame of mind.

Jason Beaubien/NPR

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Diana Corolina Huamani Pasion is a TB nurse with Partners in Health in Lima, Peru. She'll greet a patient with a kiss on the cheek — levels of bacteria are very low after the drug regimen begins, she says. Jason Beaubien/NPR hide caption

itoggle caption Jason Beaubien/NPR

Diana Corolina Huamani Pasion is a TB nurse with Partners in Health in Lima, Peru. She'll greet a patient with a kiss on the cheek — levels of bacteria are very low after the drug regimen begins, she says.

Jason Beaubien/NPR

You sure don't want to get tuberculosis. You'll cough a lot, maybe cough up blood, have fever, chills and chest pain. But most cases of the bacterial disease are curable after taking the two first-line drugs for four to six months.

You really don't want to get multiple-drug resistant TB. That's a strain of the bacteria that resists the front-line drugs. So nastier drugs and a longer treatment span are required. There are roughly 480,000 cases of MDR-TB, as it's called, each year; nearly half of the people with MDR-TB die from the disease.

Worst of all is XDR-TB, or extensively drug-resistant tuberculosis. It's estimated that 9 percent of people with multiple-drug resistant TB are in the XDR category. The treatment is hellish: two daily infusions of IV drugs through a port implanted in the chest, each session lasting about an hour. This goes on for a year. The drugs have horrible side effects, including nausea, permanent dizziness and permanent hearing loss. People are often depressed at the seeming endlessness of it all.

Because the treatment is so harsh, some countries write XDR-TB patients off, don't offer them treatment and just leave them to die. That approach heightens the risk that XDR-TB will be passed on to others. (Like regular TB, XDR-TB is spread when a patient coughs, sneezes or spits, sending bacteria into the air.)

Partners In Health, the global health nonprofit, wants to show that XDR-TB is not a death sentence. So the agency is currently treating 55 XDR-TB patients in Lima, Peru. We spoke with Jason Beaubien, NPR's global health correspondent, who is in Peru reporting on tuberculosis.

How bad are the side effects from treatment?

It knocks some people on their butt. They are exhausted for a year.

It must be hard to convince people to take debilitating drugs for so long a period.

Oscar Ramirez, the PIH coordinator here, said to me, "It's not just about the drugs." It's about nurses coming to visit, talking with them. It's about setting up support groups so these people don't get so depressed. Some patients just drop out.

And if they drop out?

The TB would come back.

How do people earn a living during treatment?

In a lot of places where you've got XDR-TB, there's not a social safety net. Partners In Health has this microfinance loan program to help patients. One woman is now knitting things and selling them. One woman with multiple drug resistant TB got a loan and opened a corner store.

How could she run a store if she's contagious?

Soon after you start treatment, you actually aren't contagious anymore.

That's surprising.

I was astounded. I put on a mask when I went to the first XDR-TB patient house, and the nurse was kissing him on the cheek. She said: "Don't worry. The levels of bacteria once he's been in treatment are so low that he's not contagious."

Can you tell me about some of the people you met?

One woman lives so far out of the capital — 6 1/2 hours away by bus — that PIH is renting a small apartment for her in Lima.

She's Jenny Tenorio Gallegos. She's 35 and her kids are 3 1/2 and 13. She was really heartbreaking. I asked her, "What's the worst part of the treatment?" She said, "I miss my children." She saw them in December and will see them again next month, during holy week.

Were there other patients in a better frame of mind?

I met a guy, Luis, who's 19. His TB was so bad they had to take out an entire lung. He was just two weeks away from finishing one year of the IV treatment. He's just about through the worst. Then there's another year, on pills. He was very upbeat. He had been driving a mototaxi — a three-wheeled jitney cab. He's hoping next year he'll be able to go to school and study to be a professional.

Shots - Health News

What It Takes To Cure Drug-Resistant Tuberculosis

Related NPR Stories

'How Unromantic It Is To Die Of Tuberculosis In The 21st Century' March 22, 2015

What kind of professional?
I asked him. He said, "Anything other than driving taxis!"

tuberculosis

Infectious Disease

Global Health

General Motors announced last week that it's closing its auto plant in St. Petersburg, and Volkswagen says it will lay off workers and reduce shifts at a plant in central Russia.

The latest auto industry troubles highlight a dismal picture for foreign investment in Russia, which could see a 35 percent drop in sales this year.

Seven years ago, GM was looking at a bright future in the Russian market. Cars sales were taking off and would eventually grow at a rate more than 10 percent a year.

The company promoted its newest auto plant with a video that praised Russian government cooperation with the industry, which had already attracted companies such as Ford, Nissan and Toyota.

Related NPR Stories

The Two-Way

Kerry Warns More Russian Sanctions Possible Over Ukraine

Parallels

Sanctions Intensify Russia's Free Fall Into Economic Crisis

Now, GM has announced that it will close that plant and take a $600 million charge to pay for the restructuring. Like many foreign automakers in Russia, GM is facing a car market that's near collapse.

Low oil prices and Western sanctions, imposed on Russia for its annexation of Crimea last year, drove the ruble down by 40 percent, and with it, consumer buying power, says Mark Adomanis, an analyst who has covered the subject for Forbes.

"Given what Russians' average incomes are," he says, "big-ticket items like cars have never been easy to afford. But if all of a sudden, you make that car 50 percent more expensive, 30 percent more expensive, it's just beyond people's reach."

GM's costs rose more than many other automakers in Russia because the company imported many of its parts, Adomanis says, instead of sourcing them locally.

GM workers in St. Petersburg say the company failed to address a problem that many people saw coming.

Pyotr Letkeman, chairman of the union shop committee, say the workers feel they are being made to pay for management's mistakes.

"As far back as 2013, it was clear that sales were declining in Russia," Letkeman says. "GM had very little localization of production in Russia, so foreign parts became expensive when the ruble lost value. GM couldn't compete."

i

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling. Olga Maltseva/AFP/Getty Images hide caption

itoggle caption Olga Maltseva/AFP/Getty Images

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling.

Olga Maltseva/AFP/Getty Images

But GM isn't the only foreign carmaker having problems in Russia. Volkswagen announced that it's cutting back. The Korean company Ssangyong says it didn't ship any cars to Russia in January and February, because there simply wasn't a market for them.

The Russia government announced plans to provide carmakers with $166 million in subsidies to help tide them over.

Letkeman says the workers are angry and scared by a closure that will affect thousands of people.

"It's very painful," he adds. "People are calling me, asking 'what should I do? How will I feed my kids? How will I pay my mortgage?' "

Adomanis, the analyst, says that although it's very hard on people who lose their jobs, the overall job loss probably won't be felt in an economy where many people are employed by the government.

He says the real danger is the signal this sends to potential foreign investors.

"The automobile industry is one of the very few where they did a good job of attracting foreign investment," he says, "and to see one of the few industries where they have some real success stories to tell — to see people slashing production or in GM's case, pulling out entirely — is very worrying."

Adomanis says it's a sign that foreign investors no longer see the costs of doing business in Russia as being worth the benefits.

GM's plant closure will stop production of Chevrolets in Russia and wind down production of its German-designed Opel brand.

During its hot-selling days in Russia, Opel hired supermodel Claudia Schiffer to appear in an ad touting the car's engineering.

The ad closes with Schiffer speeding down a ramp in a parking garage.

These days, that downward spiral could just as well represent the auto market in Russia.

auto industry

Russia

General Motors announced last week that it's closing its auto plant in St. Petersburg, and Volkswagen says it will lay off workers and reduce shifts at a plant in central Russia.

The latest auto industry troubles highlight a dismal picture for foreign investment in Russia, which could see a 35 percent drop in sales this year.

Seven years ago, GM was looking at a bright future in the Russian market. Cars sales were taking off and would eventually grow at a rate more than 10 percent a year.

The company promoted its newest auto plant with a video that praised Russian government cooperation with the industry, which had already attracted companies such as Ford, Nissan and Toyota.

Related NPR Stories

The Two-Way

Kerry Warns More Russian Sanctions Possible Over Ukraine

Parallels

Sanctions Intensify Russia's Free Fall Into Economic Crisis

Now, GM has announced that it will close that plant and take a $600 million charge to pay for the restructuring. Like many foreign automakers in Russia, GM is facing a car market that's near collapse.

Low oil prices and Western sanctions, imposed on Russia for its annexation of Crimea last year, drove the ruble down by 40 percent, and with it, consumer buying power, says Mark Adomanis, an analyst who has covered the subject for Forbes.

"Given what Russians' average incomes are," he says, "big-ticket items like cars have never been easy to afford. But if all of a sudden, you make that car 50 percent more expensive, 30 percent more expensive, it's just beyond people's reach."

GM's costs rose more than many other automakers in Russia because the company imported many of its parts, Adomanis says, instead of sourcing them locally.

GM workers in St. Petersburg say the company failed to address a problem that many people saw coming.

Pyotr Letkeman, chairman of the union shop committee, say the workers feel they are being made to pay for management's mistakes.

"As far back as 2013, it was clear that sales were declining in Russia," Letkeman says. "GM had very little localization of production in Russia, so foreign parts became expensive when the ruble lost value. GM couldn't compete."

i

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling. Olga Maltseva/AFP/Getty Images hide caption

itoggle caption Olga Maltseva/AFP/Getty Images

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling.

Olga Maltseva/AFP/Getty Images

But GM isn't the only foreign carmaker having problems in Russia. Volkswagen announced that it's cutting back. The Korean company Ssangyong says it didn't ship any cars to Russia in January and February, because there simply wasn't a market for them.

The Russia government announced plans to provide carmakers with $166 million in subsidies to help tide them over.

Letkeman says the workers are angry and scared by a closure that will affect thousands of people.

"It's very painful," he adds. "People are calling me, asking 'what should I do? How will I feed my kids? How will I pay my mortgage?' "

Adomanis, the analyst, says that although it's very hard on people who lose their jobs, the overall job loss probably won't be felt in an economy where many people are employed by the government.

He says the real danger is the signal this sends to potential foreign investors.

"The automobile industry is one of the very few where they did a good job of attracting foreign investment," he says, "and to see one of the few industries where they have some real success stories to tell — to see people slashing production or in GM's case, pulling out entirely — is very worrying."

Adomanis says it's a sign that foreign investors no longer see the costs of doing business in Russia as being worth the benefits.

GM's plant closure will stop production of Chevrolets in Russia and wind down production of its German-designed Opel brand.

During its hot-selling days in Russia, Opel hired supermodel Claudia Schiffer to appear in an ad touting the car's engineering.

The ad closes with Schiffer speeding down a ramp in a parking garage.

These days, that downward spiral could just as well represent the auto market in Russia.

auto industry

Russia