Showing papers in "Medicine, Conflict and Survival in 2005"

The responsibility to protect.

Abstract: The decision whether, if ever, to intervene in the affairs of a sovereign state with military force has become a critical issue of the post Cold War era. In 2000 the Canadian government launched the International Commission on Intervention and State Sovereignty (ICISS), which in 2001 published its findings in The Responsibility to Protect. The Commission found broad support for the notion of sovereignty not only as a right, but also a responsibility, the responsibility of a state to provide protection for its people. The primary responsibility for protecting citizens rests with states. But when states are unable or unwilling to provide this protection, or are themselves the perpetrators of atrocities, the Commission argues that the international community has a responsibility temporarily to step in, forcefully if necessary. The Commission resisted the temptation to identify human rights violations falling short of outright killing or ethnic cleansing. This eliminates the possibility of intervening on the ...

Radiation-induced bystander effects: are they good, bad or both?

Abstract: Our current knowledge of the mechanisms underlying the induction of bystander effects by low dose–low linear-energy-transfer ionising radiation is reviewed, and the question of how bystander effects may be related to observed adaptive responses, systemic genomic instability or other effects of low doses exposures is considered. Bystander effects appear to be the result of a generalised stress response in tissues or cells. The signals may be produced by all exposed cells but the response may require a quoram in order to be expressed. The major response involving low LET radiation exposure discussed in the existing literature is a death response, which has many characteristics of apoptosis but may be detected in cell lines without p53 expression. While a death response might appear to be adverse, it can in fact be protective and remove damaged cells from the population. Since many cell populations carry damaged cells without being exposed to radiation (‘background damage’) low doses exposures might cause re...

Internally Displaced Peoples in Bosnia-Herzegovina: Impacts of Long-term Displacement on Health and Well-being

Abstract: Several hundred thousand people remain internally displaced in Bosnia-Herzegovina living in camps and settlements. The public gaze of the media has long since moved on elsewhere and donors have shifted their resources. Displaced peoples have specific burdens over belonging, housing, occupation, welfare, security and loss of communities. The decision whether to return to their homes is complex, with local and international political pressures adding to their uncertainties and insecurities. In addition there is the impact of the war, the experiences of violence, the remembering and issues of reconciliation, and a variety of mostly unevaluated psychosocial programmes aimed at helping with these. All this has a profound impact on their health and well-being. Understanding these processes and the views of chronically displaced people themselves should guide policies of post-conflict management to plan for the longer-term and to be more focussed on the human factors rather than simply rules and properties.

The body at war.

Abstract: The eighth Annual Conference of the University of Westminster’s Group for War and Culture Studies (GWACS) was held on 25 and 26 June 2004, in association this year with the Department of Sociology and Anthropology and the School for Journalism and Communications of Carleton University, Ottawa. Its theme, a fruitful one for this avowedly interdisciplinary project, was ‘The Body at War: Somatic Cartographies of Western Warfare in the 19th and 20th Centuries’. Participants included several from the United States and a few from France, although, unlike previous years, only one paper was given in French. Starting from the premise (in the Call for Papers) that ‘Throughout history, war has been conducted on, in and through the terrain of human bodies – individual, social, and culturally constructed [while] the human body, in turn, has served as a potent metaphor that continues to inform the ways we conceptualise, practise, and experience war’, they brought their varied expertise to bear in a number of thoughtful and thought-provoking ways. All six sessions were plenary, but a great deal was packed into the two days. As was to be expected, some of the 22 papers were more relevant to the themes of Medicine, Conflict and Survival than others, so that this report is necessarily selective. Quotations are taken from the programme and abstracts provided to those attending.

Towards collation and modelling of the global cost of armed violence on civilians.

Abstract: A method is described which translates qualitative reports about armed violence into meaningful quantitative data allowing an evidence-based approach to the causes and effects of the global health impact of armed violence on unarmed people. Analysis of 100 randomly selected news reports shows that the type of weapon used, the psychological aspect of the violence, the number of weapons in use and the victims' vulnerability independently influence the mortality of victims. Data collated by the same method could be analysed together with indicators of poverty, development and health so illuminating the relationship between such indicators and degradation of peoples' physical security through acts of armed violence. The method could also help uphold the laws of war and human rights.

The role of health professionals in preventing and mediating conflict

Abstract: Since the early 1980s academics, governmental and non-governmental organisations have undertaken field projects inspired by the Peace through Health and similar concepts formulated by the World Health Organisation and the Department of Peace Studies at McMaster University, Canada. These have been criticised for lack of proper evaluation, the appropriateness of the skills of health workers involved, and the overall usefulness of the approach. This article, based on a literature review, compares existing evidence with the theoretical framework. There is still a lack of systematic evaluation, but no direct disproof of Peace through Health theory. It is concluded that the Peace through Health approach can have a positive impact on healing and reconciliation on a community scale, but there is no evidence of a peace impact on a larger scale.

Wounds Caused by Firearms in El Salvador, 2003–2004: Epidemiological Issues

Abstract: This study presents data from hospital records in El Salvador describing the features of 100 patients admitted to a public hospital with firearm wounds. Wounds caused by Firearms (WFA) account for 70 per cent of homicides; 30 per cent of WFA homicides died in hospital. For every death in hospital there are five admissions who need treatment and survive. The typical victim is a young man with reasonable education but poor earning capacities and some family responsibilities, who lives in an urban setting where drugs, alcohol and firearms are commonplace. Extrapolating from this study, an estimated 2,580 people were treated in El Salvador hospitals during 2003; and of these 2,400 were treated in public hospitals at a cost to the state of 7.4 million USD, just over seven per cent of the health budget. Using further extrapolations, the total social costs for WFA morbidity would amount to around 34 million USD. There needs to be greater controls on firearms, public education on their risks and a more unified surveillance system.

The State, Conflict and the Individual: The Effect of the Janatha Vimukthi Peramuna (JVP) Insurrections in Sri Lankan on the Mental Welfare of a Population

Abstract: This article describes the nature and effect of violence and conflict on the social and personal welfare of a local population using the example of the Janatha Vimukthi Peramuna (JVP) insurrections in Sri Lanka. It considers the impact of violence on individuals and communities both directly from traumatic events and indirectly through the social and political consequences of the violence. Mental health is taken as an indicator of human welfare, and its relationship to the political and economic factors that form the environmental context is examined. The paper concludes that the mental welfare of a population following an insurrection is impaired by the effect of individual trauma, the nature of violence experienced and the way that social and economic conditions supporting mental health are undermined.

Uncertainties in Doses and Risks from Internal Radiation

Abstract: Many uncertainties exist in current estimates of radiation doses and risks: larger uncertainties exist with internal radiation. These arise mainly from the many steps used to derive doses, and partly from lack of statistical precision in deriving risks from epidemiology studies. The size of these uncertainties has been estimated by a number of expert dosimetrists: for some nuclides these are very large. The recent report by the CERRIE committee recommended that uncertainties should be acknowledged and dealt with by the government. Its parent committee, COMARE, backed these findings. A number of practical recommendations are suggested for government action in the light of the CERRIE report.

Science, politics and ethics in the low dose debate.

Abstract: The roles of science, ethics and politics are identified in respect of the risks of exposure to low-dose radiation. Two case studies, the epidemiology of the United Kingdom nuclear test veterans and the risks to civilians associated with the military use of depleted uranium, are considered in the context of their ethical framing, scientific evaluation and political resolution. Two important issues for the present and future, the safe management of U.K. radioactive waste and the future of nuclear power, in which the science of low dose effects will be crucial and where the ethical issues are much more complex, are introduced. Specific consideration is given to the potential hereditary effects of ionising radiation in relation to the current state of radiobiological knowledge. It is concluded that for science to be useful in public health policy making there needs to be some reform from within the profession and the political imperative for freely independent scientific institutions.

IPPNW's ‘Aiming for Prevention’ Campaign on Small Arms and Light Weapons

Abstract: A surfeit of small arms – handguns, rifles and machine guns – is spreading like a plague throughout the developing world, shattering lives and hope in some of the world’s poorest countries. Gun violence kills hundreds of thousands of people each year, most of them unarmed civilians, leaving many more maimed, injured, disabled and traumatised. Indeed, up to 90 per cent of all casualties in modern armed conflict are innocent men, women and children. While death and injury are the most visible consequences, human rights, sustainable development, public health and humanitarian assistance are all harmed by the proliferation and misuse of small arms. An outbreak of gun violence can destroy years of hard-earned progress in peace-building, community investment and promoting democracy. Since 1990, small arms have been the only weapons used in 46 of the 49 major conflicts, causing legions of refugees and internally displaced persons (1 person in 170 worldwide), contributing to outbreaks of disease and diverting precious resources away from basic education and nutrition programs. Small arms use is also strongly associated with the increasing lethality of criminality and forced migration. Wars and conflicts have held economies hostage, led to erosion of societal cohesiveness and created cultures of violence. Directly and indirectly, then, small arms misuse undermines the quality and quantity of health and development in poor countries.

Present status and self-reported diseases of the Korean atomic bomb survivors: a mail questionnaire survey.

Abstract: Many Koreans were forced to move to Japan while Korea was occupied by Japan. Consequently, when the atomic bombs were dropped on Hiroshima and Nagasaki an estimated 40,000 Koreans died and 30,000 survived. In 2004, 2,235 Koreans were registered as A-bomb survivors in South Korea. A mail questionnaire survey to evaluate the present status and self-reported diseases of the Korean survivors was conducted. In total, 1,256 questionnaires were returned and analysed. The most frequent chronic diseases reported by Korean survivors were hypertension (40.1 per cent), peptic ulcer disease (25.7 per cent), anaemia (23.3 per cent) and cataracts (23.1 per cent). The most frequent malignant diseases were stomach cancer (1.9 per cent), colon cancer (0.5 per cent) and leukaemia/multiple myeloma (0.4 per cent). This study suggests that further investigations are needed into the health concerns of the survivors and into health protection measures.

With war in mind: a dialogical analysis of the mindset underlying Blair's case for war with Iraq in 2003.

Abstract: Dialogical Analysis, a tool from Cognitive Analytic Therapy, is used to discover how the mindset of war silences dialogue. The savage costs of war were hidden whilst the United Kingdom government expected to attract the admiration of a grateful world. This article looks at an example of this mindset expressed through Tony Blair MP's speech to the House of Commons on 18 March 2003. The speech aimed at convincing parliament that war was inevitable, necessary and the only obvious choice. It offered an extremely narrow presentation of options available to the government, in which 'staying firm' was coupled with the case for war whilst alternative, peaceful methods of conflict resolution were identified as 'weak and feeble' and viewed as encouraging terrorists.

Strengthening the Health Claims of the Poor: Promoting Social Inclusion and Redistribution in the Health Sector

Abstract: The problems for poor people generated by 'disorganised health care markets' in the developing world have grave consequences for their health. In many countries, processes of liberalisation and commercialisation have generated a number of dilemmas for policy-makers, non-governmental organisations and individuals seeking health care. Complex markets for health care provision and financing exist, regulation is lacking and rates of exclusion are high due to the effects of prices and a lack of concerted efforts to make health systems more accessible to the poor. Analysis of health systems and the problems they create for the poor should lead to responses that protect and enhance the rights of poor people to health.

Improving governance at the United Nations level.

Abstract: Under the doctrine of 'Responsibility to Protect' the United Nations is steadily moving towards a position of being prepared to intervene militarily against states that are committing gross human rights abuses. Before the UN takes such a step, it should have in place statutory instruments to identify and bring non-violent persuasion to bear on the regimes that run these states. The Index of Governance is a phased proposal that will measure and influence the behaviour of these regimes. In Phase 1 it will use a derivative of the Observer Index of Human Rights to 'name and shame' governments that are oppressive. As the Index is a product of an objective data collection exercise, it will avoid the politically motivated bias and double standards that too often obtain when judgements are made of governmental performance. In Phase 2, after a legal process, governments that rank lowest on the Index will be subjected to a graduated array of penalties including 'Smart Sanctions' targeted on the ruling elite.

Lessons from the unsuccessful 2005 Nuclear Non-Proliferation Treaty Review Conference.

Abstract: The Nuclear Non-Proliferation Treaty is probably the most important treaty for the control of nuclear weapons. A Review Conference was held in May 2005 but the member states failed to agree on any decisions or recommendations. Possible causes for this failure reside in the unsupportive geopolitical climate surrounding the conference, design limitations of the Treaty, and the obstructionist actions of particular states. However, valuable contributions were made at the conference by some states and by civil society representatives. Fortunately there are still many ways for states and civil society to make future conferences more successful in eliminating the threat to human security from nuclear weapons.

What are we capable of? The motivations of perpetrators in South Africa during the Apartheid era.

Abstract: This article attempts to explain the motivations of perpetrators who committed violent acts in South Africa during the apartheid era. The relevant psychosocial literature is reviewed and the implicit and explicit explanations given during the amnesty hearings of the Truth and Reconciliation Committee by perpetrators working for the state security forces are analysed. The mental health of the South African society during this period is considered, as is the role of the former white South African government and its authorities in shaping the climate for a violent struggle involving all groups. The issues of individual versus social and state culpability, accountability, justice and reconciliation are explored and their implications for the future prevention of reoccurrences are assessed. The aim of the article is to prompt readers to ask the question: what are we capable of?

The responsibility to protect and the root causes of conflicts.

Abstract: The increase in humanitarian crises due to states failing to observe the human rights of their citizens led to the establishment of the International Commission on Intervention and State Sovereignty. Whilst all agree with the need for concerted action to protect innocent civilians from human rights abuses the focus must be on prevention; the use of military force creates further problems. An analysis of failed states, such as Rwanda, shows how the actions of the international community, especially the most powerful states, contribute to conditions creating the abuse and how appropriate actions by the external players could have prevented these abuses.

Intractable limits to a sustainable human population.

Abstract: The pressing need for a much smaller world population arises for two reasons. Humans are emitting about two and a half times as much carbon as the maximum permissible to achieve stabilisation of carbon in the atmosphere. Today's six billion humans, in striving to enjoy at least a basic quality of life, are damaging many vital ecological systems and causing a major extinction of other forms of life. Within the next half century, a new and compelling reason for a smaller human population is likely to arise through the fact that we cannot be at all sure that a suitable replacement to fossil fuel energy is going to be found. Analysis of all these aspects indicates the need for a world population of about 2000 million (2 billion).

The Watershed Empires

Abstract: Watershed empires, founded by states in the highlands on the upper reaches of river systems, conquered the flood plains and other regions around them. Three of these, Ch'in in ancient China, Assyria in the middle east, and the Inca of Peru, are described, with emphasis on the horrific socio-political systems which they developed. All, however, were eventually overthrown by a combination of internal revolt and external pressures.

The impact of small arms on health in Nigeria.

Abstract: Nigeria, the most populous Black country in the world, though it has contributed to the welfare of other African countries, is plagued by internal conflicts with small arms Over a million illegal small arms circulate in Nigeria in the hands of militant groups Over 10,000 may have died in conflicts between these groups and the government Quality health care is unavailable in much of the country, and small arms injuries often overstretch emergency health care A national committee has been set up to implement the ECOWAS moratorium on small arms and light weapons, but much remains to be done

After Kosovo, Afghanistan and Iraq: what is the future for the UN?

Abstract: There have been enormous changes in the world order over the last 15 years, which have seen the United States, closely supported by the United Kingdom, become more unilateral in its actions, and in doing so damaging the United Nations. Attempts to create an ethical dimension in foreign policy have failed. The brief consensus after 9/11 has been lost in the war against terror, whilst other more appropriate measures to diminish the risks of terrorism, such as creating greater equity in trade and meeting the UN millennium goals, have been left to one side. Iraq and the ongoing failure to resolve the Palestinian issues have left the world a less safe place. The need for the UN to establish itself as a dominant force for global justice is paramount. To do so there must be reform, particularly of the Security Council.

Humanitarian intervention after the Iraq crisis.

Abstract: Defining the criteria for intervening in the affairs of sovereign states has become a pressing issue for the international community. Pre-emptive actions, based on a unilateral view of evil or risk, have caused divisions and questions of legitimacy, whilst the failures to take collective actions against extreme suffering reflect a lack of coherence in international decision making. The current concerns about terrorism, weapons of mass destruction and failed states lack clear definition of these and of how risks might be estimated, to whom the risks apply and the responsibilities of the various players. The primacy of the United States is without question, but opinion within and without is divided, many feeling the US should use its power to do what is best for the world as a whole and not just act out of self-interest. There is a need to engage with the US and its institutions at all levels. There is also a need to develop more robust conflict prevention strategies with adequate resources, personnel and m...

Make war history

Abstract: The slogan ‘Make Poverty History’ was the theme of appeals and demonstrations marking the July 2005 meeting at Gleneagles in Perthshire of the G8 leaders. It has been unashamedly welcomed, poached and adapted by anti-war activists. There have been mixed opinions about the outcome of the aid and development aspect of the G8 summit – there was near-unanimous condemnation of the statement on climate change. What are the chances of doing any better with ending war? All the papers in this issue have some bearing on this question. Nick Wilson and colleagues (pp. 274–282) report on the even more comprehensive failure of the Review Conference of the Nuclear Non-Proliferation Treaty two months earlier. This outcome had been widely feared. The intransigence of the GW Bush administration was expected, but was shared by the other four nuclear-weapon states party to the NPT, and taken advantage of by others, notably Iran. While no great progress can be expected at least until after the next United States presidential election, there are fears that others that feel threatened by US policy may follow North Korea out of the NPT. Meanwhile, IPPNW affiliates in Europe can press for the United Kingdom not to replace Trident, for France to reduce its rather larger arsenal, and for the US to take home the B-61 free-fall nuclear bombs currently based in six European countries. This could allow US/Russian negotiations to reduce tactical nuclear weapons, which are not covered by any of the existing nuclear-armscontrol treaties. Further progress on controlling and eliminating chemical and biological weapons is also unlikely during the remainder of the Bush administration, particularly on the key issue of an effective verification protocol for the Biological Weapons Convention. However, support is growing for a code of conduct that could restrict work in the field. Perhaps this could even extend to some form of international ethical committee. Of course, almost all of the more than 20 million deaths in war since 1945 have been due to ‘conventional’ arms, including ‘small arms and light weapons’. Africa has been particularly badly affected, and Ime Akpan John (pp. 312–314) summarises the experiences and response of Nigeria. In a recent speech to the Non-Governmental Organisation Saferworld, UK Foreign Secretary Jack Straw seemed to promise action from the British government on a treaty to curb arms exports; we must hope that he is aware that UK arms exports to Africa reached £1 billion last year, though the Blair government is better at fine words than effective action. It is scarcely surprising that, even with whatever concrete follows the recent G8 summit at Gleneagles, Africa will fall far short of achieving the United Nations Millennium Development Goals. On pages 299–311, Caecilie Buhmann assesses the successes and failures of Peace through Health initiatives. She concludes that these are helpful in achieving reconciliation between factions locally and in healing conflict-torn communities, but that there is no evidence of an effect on peacemaking more widely. Such initiatives are of course much more difficult to implement in larger areas seriously affected by major wars.

Congratulations on the 20th Anniversary

Abstract: I congratulate Medicine, Conflict and Survival on its 20th anniversary. Its principles and objectives were well put at that time by Ian Munro (then editor of The Lancet) in this extract from the fi...