I just found a neat article in the expensive Air Traffic Management journal at our school that might help expand a little bit.
Most of this is paraphrased from the article "ICAO Language Rules" in the summer 2008 version of Air Traffic Management:
75% of ICAO's members are currently non-compliant with the level 4 (termed "operational") requirement, according to the International Federation of Air Traffic Controllers' Association. Under ICAO's own grading of language proficiency, pilots and controllers are functioning at level 3 (termed "pre-operational"). The level 4 English requirement were supposed to be in place as of March 5, 2008, but because much of the world is not yet up to par, it was extended until 2011.
One angry pilot says, "The ICAO level 4 requirement is long overdue, and instead of having some backbone and sticking to it, they've chosen to delay it once again. I hope whoever made this decision will accept full responsibility when a major accident occurs due to lack of English communication skills."