Showing papers in "Medicine, Conflict and Survival in 2001"

Ideological commitment, experience of conflict and adjustment in Northern Irish adolescents.

Abstract: This study aims to assess young people's overall experience of political conflict, as well as the extent of these experiences in relation to gender, religious affiliation and residential location (high or low conflict). Second, this study assesses the impact that young people's ideological commitment and experiences of the conflict have on their self-esteem and mental health. A sample of 96 Protestant and Catholic young people (mean age 15.2), drawn from four schools in two areas of Northern Ireland, completed self-report measures of self-esteem, mental health, ideological commitment and experience of conflict. The areas differed substantially in the amount of violence they had experienced. The results indicated that young people's experience of violence varied in relation to the town in which they lived. Boys' experience of violence appeared to be related to their religious affiliation. Experience of conflict and ideological commitment, two attributes that were positively related, interacted to predict both mental health and self-esteem. The importance of ideological commitment to our understanding of the impact of political conflict on young people is discussed.

Civilians and war: A review and historical overview of the involvement of non‐combatant populations in conflict situations

Abstract: The effects of light weapons are now regularly seen on television and are becoming an international issue, particularly regarding their impact on civilians. It is claimed that 80% or more of deaths and injuries in today's wars are civilian; there is no objective evidence for this as little accurate information is available. Recent surveys suggest, however, a proportion of between 35 and 65%--still far too high considering the protection to which civilians are entitled under international humanitarian law. It is proposed the problem arises from twentieth-century killing power in the hands of individuals with fifteenth-century discipline and organization. Recent systematic surveys distinguish between civilian deaths from light weapons in combat and non-combat situations. A high proportion of combat deaths is due to fragmenting weapons such as mortars targeted on populated areas. Many weapon-related deaths in non-combat situations are accidental (cleaning weapons, handling by children during play) and others are related to domestic disputes. The availability and use of weapons also affects civilians indirectly in many ways, such as ill-health in refugees, psychosocial effects on women and children, and economic and environmental consequences. A variety of schemes exist to reduce the availability of light weapons and reintegrate their users into society. The international community must extend and make better use of these measures.

Stories of pre‐war, war and exile: Bosnian refugee children in Sweden

Abstract: While standardized questionnaires produce counts of isolated events, a semi-structured interview derives a story, a complex narrative in time and place. Ninety Bosnian refugee children and adolescents (ages 1-20), resettled in Sweden, were assessed in a semi-structured clinical interview designed to identify and offer support to children at risk. A family-child account of traumatic exposure was analysed quantitatively and qualitatively. Type-stories or clusters of experience were identified for three distinct periods: prior to war, during war, and after war in exile. The extent of trauma-stress exposure during each of these periods proved unrelated. Pre-war experience presented as preponderantly good and safe. Differences in child exposure during war and exile could be understood in relation to identifiable socio-demographic factors; particularly ethnic background, social class, child age and family size. Further, the stories derived cast light on the equity of Swedish refugee reception, exposing both egalitarian and discriminatory tendencies.

'Non-lethal' weapons and international law: three perspectives on the future.

Abstract: Literature on 'non-lethal' weapons (NLWs) frequently contains assertions that more robust NLW development and use are needed because of the changing nature of military operations. These assertions are in opposition to international legal analysis of NLWs, which show international law restricting NLW development and use. This article examines this tension by briefly analyzing the restrictive impact that international law has on NLWs and by elaborating three perspectives on what the relationship between NLWs and international law should be. The article outlines the moral foundations for existing international law on the use of force and armed conflict and then sketches international law's current impact on NLW development and use. Next, the article explores the compliance, selective and radical change perspectives that emerge from discourse about international law and NLWs. The compliance perspective insists that NLWs comply with existing rules of international law. The selective change perspective seeks limited changes in international law to allow more robust use of NLWs. The radical change perspective sees in NLWs the potential to reform radically international law on the use of force and armed conflict. Identifying the three perspectives helps clarify future choices NLWs may present in international law and suggests that the future relationship between NLWs and international law will be more complex, controversial and dangerous than people may realize.

Children of traumatized and exiled refugee families: Resilience and vulnerability a case study report

Abstract: This paper focuses on the main problems and outcomes of two children of a traumatized refugee family who have been in Britain since 1993 Their parents witnessed near death experiences and physical assaults, and suffered losses and a wide range of physical problems; the father manifests post traumatic stress disorder (PTSD) symptoms The children have been exposed regularly to episodic rage and violent behaviour by their father, and have developed separation problems and psychosomatic complaints Their mother has coped better and is very resilient in her care and approach to problems This report acknowledges the negative experience of trauma, but also the sources of resilience of parents, children's adjustment and cultural differences in coping styles Refugee experiences devastate individual well-being and coping mechanisms if there is no hope, support and faith in one's own potential Protective and risk factors that may affect the manifestation of trauma symptoms are highlighted A variety of treatment approaches are required for both adult and child victims of multiple trauma A wide range of techniques, such as group therapy, behaviour and cognitive therapy, and desensitization and relaxation training, can help sufferers to enhance their coping skills and deal effectively with devastating life events

Providing health care for refugee children and unaccompanied minors.

Abstract: The health of refugee children must be considered beyond ensuring access to health care to include issues such as housing and education. Refugees require support in using services, and their culture and religious background must be taken into account. Asylum seeking children have the same rights to health as any other children, yet non-eligibility for welfare foods may have implications for their nutrition. Providing for 15-18 year olds presents particular problems. It is important to arrange access to appropriate care for unfamiliar diseases and to recognize emotional health problems, particularly when they are related to past experiences of violence.

Survival with pain: an eight-year follow-up of war-wounded refugees.

Abstract: The aim of this study was to investigate the nature of chronic pain in male war‐wounded refugees and to examine the relationship between chronic pain and psychiatric symptoms. A culturally heterogeneous group of 44 war‐wounded refugees were investigated during hospitalization, shortly after arrival, and followed up after two years. This study is an additional follow‐up after eight years. The data collection methods used were structured interviews and physical examination. The measures of outcome were: Visual Analogue Scale (VAS) grading of pain; clinical categorization of pain into nociceptive or neurogenic; Hopkins Symptom Check List (HSCL‐25); Post Traumatic Symptom Scale (PTSS‐10). Chronic pain was found in 32 (73%) out of 44 subjects. The pain was purely nociceptive and neurogenic in 53% and 25%, respectively. The frequency of psychiatric symptoms was significantly related to the mean intensity of pain. War‐wounded refugees display psychiatric symptoms and chronic pain in a complex pattern. Further re...

The United States and biological warfare: secrets from the early cold war and Korea.

Abstract: The United States and Biological Warfare is about accusations that the United States resorted to bacteriological warfare at a time of great military stress during the Korean War. In December 1951, the then US Secretary of Defense ordered early readiness for offensive use of biological weapons. Soon afterwards, the North Korean and Chinese armies accused the United States of starting a large-scale biological warfare experiment in Korea. The US State Department denied the accusation. Both parties to the dispute maintain their positions today. The authors spent 20 years researching the accusations in North America, Europe and Japan. They were the first foreigners to be given access to Chinese classified documents. The reader is also introduced to the concept of 'plausible denial', an official US policy which allowed responsible governmental representatives to deny knowledge of certain events. The authors hope that their work will contribute to the understanding of a time when modern war expanded into a new type of violence.

The role of sub-lethal weapons in human rights abuse.

Abstract: This article is based on two recent reports contracted by the European Parliament (EP), which assessed sub‐lethal weapons as flexible tools of political control. It analyses the role and function of existing weapons systems in human rights abuses using examples from Indonesia, Israel, Kenya, Northern Ireland and Turkey. These weapons are designed to ‘appear’ rather than ‘be’ safe and, since they augment rather than replace lethal technologies, their use can distort conflicts and actually bridge the firewall between use of less‐lethal and lethal technologies.

How primary care services can incorporate refugee health care.

Abstract: Two principles should underpin the provision of primary health care to refugees: (a) that refugees should have the same access to quality primary care services as the local population, and (b) any specialist service should have the goal of full integration of the refugee into normal general practice. The various ways in which medical care can be provided to refugees and the knowledge, skills and attitudes important to such provision are described. One way in which such a service was provided in east Kent is reported. The term ‘refugee’ encompasses newly arrived refugees who are awaiting a decision from the Home Office, as well as those who have been given permission to stay, either as recognized Refugees under the provisions of the 1951 United Nations Convention, or with Exceptional or Indefinite Leave to Remain.

An overview of the future of non-lethal weapons.

Abstract: During the past decade, vast changes have occurred in the geopolitical landscape and the nature of the types of conflicts in which technologically developed countries have been involved. While the threat of conventional war remains, forces have been more frequently deployed in situations that require great restraint. Adversaries are often likely to be elusive and commingled with noncombatants. There has been some shift in public opinion away from tolerance of collateral casualties. Therefore there is a need to be able to apply force while limiting casualties. Non-lethal weapons provide part of the solution. Among the changes that will influence the future have been studies by the US and NATO concerning the use of non-lethal weapons, coincidental with increased funding for their development and testing. New concepts and policies have recently been formalized. Surprisingly, the most strident objections to the implementation of non-lethal weapons have come from organizations that are ostensibly designed to protect non-combatants. These arguments are specious and, while technically and academically challenging, actually serve to foster an environment that will result in the deaths of many more innocent civilians. They misconstrue technology with human intent. The reasons for use of force will not abate. Alternatives to bombs, missiles, tanks and artillery must therefore be found. Non-lethal weapons are not a panacea but do offer the best hope of minimizing casualties while allowing nations or alliances the means to use force in protection of national or regional interests.

The future of non‐lethal weapons

Abstract: The collection of articles published in this issue of Medicine Conflict and Survival have been developed from presentations at a conference in Edinburgh, December 2000, organised by the Bradford Non-Lethal Weapons Project. This conference brought together a small working group of international experts reflecting a variety of perspectives and approaches under the heading of The Future of Non-Lethal Weapons: Technologies, Operations, Ethics and Law. Interest in non-lethal weapons (NLWs), which have been defined as being 'explicitly designed and primarily employed to incapacitate personnel or material while minimising fatalities, permanent injury to personnel, and undesired damage to property and the environment' has increased dramatically over the last five years. 5 This is a result of non-lethal technology progress and increasing calls from military forces (especially those engaged in peacekeeping) and civil police for more sophisticated non-lethal responses to violent incidents. As the articles will show, whilst there are evident advantages linked with non-lethal weapons, there are also key areas of concern associated with the development and deployment of such weapons. These include threats to existing weapons control treaties and conventions, their use in human rights violations (such as torture), harmful biomedical effects and what some predict as a dangerous potential for use in social manipulation and social punishment within the context of a technology of political control.\" Recently, concern has been voiced over a new plastic bullet to be issued to police which, it is claimed in a report emanating from the Ministry of Defence, will lead to an increase in the incidence of intra-abdominal (from bullets aimed below the rib cage) and head injuries (from ricochets).

Future police operations and non-lethal weapons.

Abstract: Society has entrusted the police with power and obligation to enforce law, maintain order and protect its members and the legal order of society. To be able to fulfil these obligations the police need credible means of countering threats against these values. Selecting the weapons, or rather use of force instruments, presents a multifaceted problem of balancing human considerations, judicial and societal requirements with tactical needs and technological possibilities. No matter what the incident is, a police-officer is expected to protect the innocent, him/herself, colleagues and the object persons and to cause no more harm than is justifiable and unavoidable. Unfortunately there is no safe use of force and in real life the only option available for resolving certain conflicts is some degree of force. Any weapon can be misused but most weapons have a legitimate use. Denying legitimate use, as well as allowing uncontrolled use, may lead to unnecessary suffering and loss of life. Technology is offering interesting alternative possibilities to the police and these must be considered with open eyes, bearing in mind that misuse, like torture, is not a property inherent to technology but an intentional behaviour of some people. Thorough research and fair and credible controls on police weaponry are needed to avert the possibility of misuse and to maintain trust.

Operationalizing non-lethality: a Northern Ireland perspective.

Abstract: 'The troubles' over the last 33 years in Northern Ireland have claimed the lives of 3,636 people, including 302 police-officers and 644 soldiers. Of these deaths, 315 were attributed to the military and 52 to the police.(1) Formative experience of public disorder within the early parts of the conflict is reviewed. This article places the evolution, development and use of baton rounds (rubber and plastic bullets) in context and describes the training of police in their use. The development of a conflict management strategy which provides synergy with community based policing is discussed and the importance of understanding the underlying causes of a conflict for law enforcement personnel is emphasized.

Non-lethal weapons technologies--the case for independent scientific analysis.

Abstract: Various technologies have been proposed for non-lethal weapons (NLW), some of them credible, or at least plausible, but strong claims were made for others without evidence or references. Five such technologies are examined. For the chemical and biological examples, detailed information is lacking but the diminishing number of such claims over time and general scientific knowledge suggest that fulfilment of the promises is improbable. For acoustic weapons, a detailed study found that many of the claims are plainly untrue. In this case, even wrong values for physiological thresholds were presented. Civil and military NLW programmes in the USA put their main emphasis on simple, short-term technologies rather than exotic ones. In order to avoid dangers arising from unrealistic promises, the concept of preventive arms control should be applied to NLW. Its first step is a scientific analysis, investigating the new weapons, the propagation of their effects and the effect on the targets. Such detailed studies are needed for each proposed NLW technology.

Sustainable energy, economic growth and public health.

Abstract: Dramatic economic growth over the last 50 years has been accompanied by widening inequalities world-wide in wealth and energy consumption, diminished life expectancy in some countries, and deteriorating indices of environmental sustainability including loss of bio-diversity. Raised output of carbon dioxide (CO2) and other greenhouse gases due to increased economic and industrial activity is causing progressive climate change, leading in turn to direct and indirect adverse effects on health. Emissions of greenhouse gases can be lowered by increased use of renewable energy sources, for example, wind power in the United Kingdom (UK), greater energy efficiency and other measures to promote sustainability. The experience of some developing countries shows that favourable indicators of health and development can accompany a low output of greenhouse gases. It is unclear whether contemporary political and social systems can deliver improved human development without increased use of fossil fuels and other resources.

Perspectives and implications for the proliferation of non-lethal weapons in the context of contemporary conflict, security interests and arms control.

Abstract: This article briefly looks at the characteristics of contemporary conflict and the global political arena, particularly from 1989 and the end of the cold war. The development of and potential roles for second generation non-lethal weapons (NLWs) in war-fighting, peace support operations, and civil policing are discussed. There are arguments both for and against further and rapid development of NLWs. The question of proliferation and arms control is examined within the context of concepts such as the revolution in military affairs (RMA) and factors such as the increasing role of non-state actors, current security requirements and the problems concerning the implementation and enforcement of current and envisaged arms control regimes. Proliferation, which may be vertical or horizontal, may not always be seen as a malign process but rather one which requires specific ethical and operational perspectives. Proliferation is about both technology push and operational requirements. The effectiveness of legislative approaches to controlling proliferation, especially to countries which are considered to have poor human rights records, is discussed and issues about who wants to control NLWs, and why, are raised. Some technologies may be seen as less threatening to existing arms control and management treaties and the ethical debates which surround them. A concern regarding increasing use of non-lethal technologies for political oppression is part of this debate. The issues are illustrated using India as case study.

Globalization and health.

Abstract: Globalization means different things to different people; a general definition is the increasing movement of information, material and people across borders. It can be considered in terms of five conflicting but inter-relating themes, economic transformation; new patterns of trade; an increasing poverty gap associated with widening health inequalities; the revolution in electronic communication; and the growing role of non-state actors, such as non-governmental organizations and transnational corporations, in global governance. Globalization is both an opportunity and a threat, but it is not inexorable. Successful action against its undesirable aspects is possible.

Sitting it out in the sealed room: the Israeli response in the 1991 Gulf War.

Abstract: The response of the Israeli civilian population to the Scud missile attacks and the possibility of chemical and biological warfare during the 1991 Gulf War have been monitored in various contexts. The present article reviews the findings and their implications for civilian defence planning in the event of a reprise. In 1991 the most controversial policy was the insistence that Israeli families prepare a sealed room in which to sit out the Iraqi attacks. The evidence suggests that in some instances this may have been counterproductive, even during relatively short periods of immurement.

The revolution in military affairs debate and non-lethal weapons.

Abstract: This article introduces a discussion on developments in political and strategic thinking on the use of existing and emerging weapons (including Non-lethal Weapons) and their doctrinal operational implications in the context of present trends in international relations. It asserts the need to address both the strategic assumptions and the political implications of choosing military-led solutions to trends in international social conflict. The so-called Revolution in Military Affairs (RMA) must be considered in the light of the current debate on the military application of non-lethal weapons (NLWs) to present or future conflict. The issue is introduced from a politico-strategic perspective, with a critique of the RMA debate as a starting point for discussion of the role of NLWs in conflict. Questions are set out for the politicians and strategists who are asked to formulate policy based on technology to be used in new political/social conflicts. The danger of neglecting other important dimensions of politics and strategy vis-a-vis present conflict is noted.

Health for all in the new millennium.

Abstract: (2009). Health for All in the New Millennium. Medicine, Conflict and Survival: Vol. 25, No. 4, pp. 286-290.

Child soldiers ‐ and others

Abstract: (2001). Child soldiers ‐ and others. Medicine, Conflict and Survival: Vol. 17, No. 1, pp. 71-76.

Preventing war through non‐violent direct involvement in conflict

Abstract: International Physicians for Prevention of Nuclear War now considers prevention of all violent armed conflict as one of its core objectives, as such conflict is incompatible with health Health professionals have long been involved in this area with an inclination towards non‐violent means The growth of interest in the area of non‐military peacemaking, the growth of knowledge and research in the last few years and the post‐cold‐war nature of most contemporary wars mean that IPPNW needs to approach war prevention in a systematic way, benefiting and co‐operating with other creative forces in the field In this first of two articles we present some important work by contemporary non‐violent researchers We seek to develop an imagination and a mode of thinking to enable health professionals to prepare to engage in Non‐violent Direct Involvement in Conflict (NVDIC)

Reconciliation and healing of a nation.

Abstract: This article explores the effect of mass trauma and how it is dealt with both individually and socially. The question why the systematic massacres happened in Cambodia is addressed. Also covered is a brief history of the continual divisions in Cambodian society. The Cambodians have not come to terms with their tragedy or moved closer to the rest of the world. Some means of reconciliation are suggested.

The hidden casualties of conflict.

Abstract: The direct casualties of the 'formal' inter-state wars of the late nineteenth and first half of the twentieth century can be fairly well documented: modern armies knew how many soldiers were sent into battle and how many were killed or injured. Generally accurate figures could also be given for civilian deaths in developed countries, even in massive disasters such as the bombings of Rotterdam, Dresden and Hiroshima. The picture becomes blurred in the second half of the twentieth century, as wars developed into intrastate conflicts involving irregular armies and guerrillas. Such episodes lead to an increasing proportion of civilian casualties, though probably less than the 80 to 90% sometimes claimed, and not all directly conflictrelated. But by far the largest group of sufferers are internally displaced persons (homeless within their home country), refugees and asylum seekers the majority homeless as a result of conflict, though some from natural disasters such as earthquakes and floods.

The incidence of childhood Leukaemia in West Berkshire

Abstract: This paper gives an overview of local work on the incidence of childhood leukaemia in West Berkshire since 1971. The most recently published figures show that between 1972–96, a total of 106 children contracted leukaemia when 81 cases would have been expected in the under 14s. Within ten kilometres of the nuclear establishments at Aldermaston and Burghfield, the risk of a child getting leukaemia, which is very small (400 children a year in the UK) is none the less doubled in under‐fives meaning that one more child a year is affected. There is also an increased incidence of all cancers in this age group and geographical area. Theories as to why this should be abound, but until the cause of cancer is fully understood, and what the part of radiation in the process could be, no firm measures can be taken to redress the balance.

Wars of the 1990s.

Abstract: The 40 wars of the past decade, all 'minor', have resulted in a total of more than two million deaths and 20 million refugees or displaced persons Few have been the international wars typical of previous periods Nine out of ten began as internal or civil wars, foreign intervention--when it occurred--being always secondary The weapons used, the effects on the civilian populations, the type and extension of damages are different but equally destructive The main causes of these conflicts are cultural or religious, rather than economic The best attitudes to attempt to prevent or stop them are surveyed

Preventing war through non‐violent direct involvement in conflict: II. Proposal for the role of IPPNW

Abstract: IPPNW now considers prevention of all violent armed conflict as one of its core objectives, as such conflict is incompatible with health. Secondary prevention of war must involve early detection of volatile conflicts and their effective treatment by non‐violent but direct intervention. Such non‐violent direct interventions in conflict (NVDIC) are most desirable but currently underdeveloped. Most importantly they do not enjoy the prominence that would facilitate their wide understanding, acceptance and support. This article discusses ways in which IPPNW can best use its experience and resources to engage more appropriately and systematically in NVDIC. It is suggested that participation in observation and mediation missions, direct health related work, public promotion of health and environmental concerns, prominent involvement of women, use of health professionals’ status, support of peace‐promoting local health professionals, use of local knowledge and experience of IPPNW affiliates, psychological analysi...

Who are the ‘states of concern’ ‐ and why?

Abstract: United States plans for National Missile Defence (NMD), first floated by the Clinton administration and now to be speeded up and extended by George W Bush, assume that there is a threat to the US from certain 'States of Concern' (also known as 'rogue' or 'problem' states). They also assume that this threat takes the form of a possible attack with missiles armed with nuclear, biological or chemical weapons. If this is the case, and such missiles can be destroyed before arrived, NMD seems at first hearing not unreasonable. Why then the furore? There are certainly states with a visceral hatred of the US the 'prime suspects' are North Korea, Iran, Iraq, Libya and Syria. Of these, North Korea has tested a multi-stage missile and spends far too much, particularly for a country verging on starvation, on its military. It has a limited civil nuclear power programme and is not too far from Alaska and California. Of the others, all have interests in civil nuclear power and have (or have had) some ballistic missile capability. They may represent a threat to neighbours (notably Israel but also one another) but barely to Europe which is largely unconcerned and surely not to the US without several years of arms build-up. Certainly the effects of even a very limited attack with weapons of mass destruction would be horrific. NMD may not work two out of four tests failed and two were 'successful' under more-or-less artificial conditions but with the vast resources available to the US the success rate could improve. No defence system can ever be 100 per cent reliable but a ballistic missile attack on the US, successful or otherwise, would be readily identified and produce massive retaliation. A 'rogue state' or terrorist group would thus be more likely to smuggle in chemical or biological weapons in a suitcase and disseminate them in a metro system (as Aum Shinrikyo attempted in Tokyo), by lorry, or from a light plane. Enough plutonium could be scattered from a conventional explosion in a lorry bomb to make a city centre uninhabitable for centuries. NMD would be no defence against these possibilities.

The UN in crisis

Abstract: The United Nations (UN), the principal role of which is dealing with crises, has been in almost perpetual crisis since its foundation. The situation has become worse in the 1990s, a time when the need for an effective UN has been greater than ever, to cope with issues such as climate‐change, pollution and the consequences of globalization. The current crisis has various aspects. Politically there have been widely publicized failures in peacekeeping, largely due to the Security Council being a body of compromise, while successes in peacekeeping have been largely ignored. In the economic and social field, influence has passed to the International Monetary Fund (IMF) and the World Bank. Development aid has plummeted, despite its key role in peace and security, and so an integrated approach to development and security is urgently needed. The UN has been constantly under‐funded, with the failure of the United States (US) to pay its dues a key factor. Reform of the UN is vital, but the vested interests of membe...