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Rapid Responses: Rapid Responses published:
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Withholding standards of humanitarian medicine for refugees
- Siroos Mirzaei (18 August 2004)
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humanitarian medical workers need online ethical guidance
- Walter Jung (23 August 2004)
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Siroos Mirzaei, Physician for Nuclear Medicine and chairman of Hemayat (www.hemayat.org) Centre Hospitalier de Luxembourg, L-1210 Luxembourg
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In her article (1) Harding-Pink point to an important medico- political issue which has still not received the necessary attention of international bodies such as world medical association (WMA). On our own experience of several years in working with traumatized refugees (2) and also according to reports from other centers, there are misuses of medical knowledge regarding refugees in different western countries which should be as soon as possible adequately handled with by WMA. One other possible way at a national level to recognize and avoid the participation of doctors that are at limit of international humanitarian and ethical law would be the establishing of a referent for human rights in every national physicians’ organizations as suggested previously (3). The lack of guidelines for doctors dealing with migrants is another important issue which has been discussed by Harding-Pink. We support it cordially and have already asked for it in Austria in 2003 together with amnesty international office in Vienna (4). This gap of specific knowledge of guidelines to deal with refugees and in particular with traumatized refugees is the main factor which often leads to violation of human rights by involved physicians. Such guidelines has been published and should be implemented in the curriculum of medical universities (5-8). References: 1. Harding-Pink D. Humanitarian medicine: up the garden path and down the slippery slope. BMJ. 2004 Aug 14;329(7462):398-9. 2. Mirzaei S, Zajicek HK, Knoll P. The life of refugees. Lancet. 2001 Sep 29;358(9287):1102. 3. Mirzaei S, Knoll P. Challenge of the world order and its implications for health personnel. Int J Equity Health. 2003 ; 2:6. 4. http://www.hemayat.org/html/texte/011015%20mirzaei%20jb.html 5. Montgomery E, Foldspang A. Criterion-related validity of screening for exposure to torture. Dan Med Bull 1994; 41: 588-591 6. Kastrup M. The psychiatric examination of torture victims. Torture 1992; 1(suppl): 22-4S. 7. Burnett A, Peel M. Asylum seekers and refugees in Britain. The health of survivors of torture and organised violence. BMJ. 2001; 322: 606 -9. 8. Mirzaei S., Knoll P., Köhn H. Medical aspects of objectivation of torture sequels. Wien Klin Wochenschr. 2004; 116: (in print). 9. Physicians for human rights. Examining Asylum seekers: A health professional’s guide to medical and psychlogical evaluations of torture. PHR; Boston 2002. Competing interests: None declared |
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Walter Jung, pediatric nurse currently between missions with UN organisations
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Dr. Harding-Pink raises important issues for all doctors nurses and other medical workers undertaking humanitarian missions. We all start with the idea that our work responds to ethical imperatives and is within international human rights and humanitarian law. It takes time to realise how organisations (both intergovernmemtal and non-governmental) have political agendas, often hidden. We find ourselves slipping down the slope which Dr. Harding-Pink describes, with no independent support or advice. I recently experienced this as the world media arrived in a refugee camp, eager to film dehydrated and starving children and their mothers. No explanations, no consent just filming confused and desperate people in a treatment setting. Could this happen in a pediatric clinic in London or Paris, where the teams came from? "It alerts public opinion and helps to get donations" my non-medical superior said. But it also diverts attention from the many other refugee situations which the media are not following. Forrest and Barret's response seems complacent. Is Amnesty International's credo really "torture, degrading treatment and other human rights violations are pifalls difficult to avoid"? Of course ethical education is good. But it cannot prepare us fully for the highly charged situations that occur in humanitarin crises. Surely we should be more active in seeking to avoid ethical pitfalls and to challenge organisations such as those described by Dr. Harding-Pink. The editor rightly links a series of "failures", including the "slippery slope" in his "editor's choice". But perhaps he has the key. An online ethical and human rights resource desk could be sponsored by the BMJ and be available to all medical workers working in distant places without adequate professional support. It should be manned by former humanitarian workers who have no further contact with the organisations concerned. (Thanks for help with my English to Dr.Karen Webster ,who does not necessarily agree with all I have writtren) Competing interests: None declared |
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