Doctors must speak out over war and humanitarian crises
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7316.771c (Published 06 October 2001) Cite this as: BMJ 2001;323:771All rapid responses
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Physicians are first and foremost charged with caring for the health
and well being of individuals. This moral imperative does not stop at
one's own border, nor with one's own culture, but exists in all places at
all times, and is never modified at a fundamental level by political or
religious beliefs. Some, and usually many, individuals suffer greatly
during wars. If physicians will not speak up in defence of the people
whose bodies and lives will be shattered by war, who will. Who indeed
will?
Competing interests: No competing interests
Dear Michael. Thank you for reminding us that there is always another
side of the coin to be looked at. Always! May I send you these words of
the Dalai Lama: his direct response to the 11th September. I believe the
points he makes deserve consideration not only in the context of that day.
A Message from The Dalai Lama
Dear friends around the world,
The events of this day cause every thinking person to stop their
daily lives, whatever is going on in them and to ponder deeply the larger
questions of life. We search again for not only the meaning of life, but
the purpose of our individual and collective experience as we have created
it-and we look earnestly for ways in which we might recreate ourselves
anew as a human species, so that we will never treat each other this way
again.
The hour has come for us to demonstrate at the highest level our most
extraordinary thought about Who We Really Are.
There are two possible responses to what has occurred today. The
first comes from love, the second from fear.
If we come from fear we may panic and do things - as individuals and
as nations - that could only cause further damage. If we come from love we
will find refuge and strength, even as we provide it to others.
This is the moment of your ministry. This is the time of teaching.
What you teach at this time, through your every word and action right now,
will remain as indelible lessons in the hearts and minds of those whose
lives you touch, both now, and for years to come.
We will set the course for tomorrow, today. At this hour. In this
moment. Let us seek not to pinpoint blame, but to pinpoint cause.
Unless we take this time to look at the cause of our experience, we
will never remove ourselves from the experiences it creates.. Instead, we
will forever live in fear of retribution from those within the human
family who feel aggrieved, and, likewise, seek retribution from them.
To us the reasons are clear. We have not learned the most basic human
lessons. We have not remembered the most basic human truths. We have not
understood the most basic spiritual spiritual wisdom. In short, we have
not been listening to God, and because we have not, we watch ourselves do
ungodly things.
The message we hear from all sources of truth is clear: We are all
one. That is a message the human race has largely ignored. Forgetting this
truth is the only cause of hatred and war, and the way to remember is
simple: Love, this and every moment.
If we could love even those who have attacked us, and seek to
understand why they have done so, what then would be our response? Yet if
we meet negativity with negativity, rage with rage, attack with attack,
what then will be the outcome?
These are the questions that are placed before the human race today.
They are the questions we have failed to answer for thousands of years.
Failure to answer them now could eliminate the need to answer them at all.
If we want the beauty of the world that we have co-created to be
experienced by our children and our children's children, we will have to
become spiritual activists right here, right now, and cause that to
happen. We must choose to be at cause in the matter.
So, talk with God today. Ask God for help, for counsel and advice for
insight and for strength and for inner peace and for deep wisdom. Ask God
on this day to show us how to show up in the world in a way that will
cause the world itself to change. And join all those people around the
world who are praying right now, adding your Light to the Light that
dispels all fear.
That is the challenge that is placed before every thinking person
today. Today the human soul asks the question: What can I do to preserve
the beauty and the wonder of our world and to eliminate the anger and
hatred-and the disparity that inevitably causes it - in that part of the
world which I touch?
Please seek to answer that question today, with all the magnificence
that is You. What can you to TODAY...at this very moment? A central
teaching in most spiritual traditions is: What you wish to experience,
provide for another.
Look to see, now, what it is you wish to experience-in your own life,
and in the world. Then see if there is another for whom you may be the
source of that.
If you wish to experience peace, provide peace for another. If you
wish to know that you are safe, cause another to know that they are safe.
If you wish to better understand seemingly incomprehensible things, help
another to better understand. If you wish to heal your own sadness of
anger, seek to heal the sadness or anger of another. Those others are
waiting for you now. They are looking to you for guidance, for help, for
courage, for strength, for understanding and love. My religion is very
simple. My religion is kindness.
Dalai Lama
Competing interests: No competing interests
Editor,
Few would agree with the extremist views of the Taliban and all would
mourn the events of September 11th. There is however another side of
terrorism screened on Australian television but very likely censored in
Britain and the USA leaving the average citizen ignorant of their leaders
complicity.
1. An Arab father clutching his dying son and crouched behind a wall
while snipers continue their sniping.
2. An Iranian shepherd dead among his dead sheep in the “no fly” zone
patrolled by British and American airmen.
3. An Iranian mother cradling her emaciated child dying from a
malignancy induced, according to the attending Physician, by uranium
charged missiles used in ‘Desert Storm’
4. A two or three year old child, weakened by starvation, crawling
to its mother - her face the picture of despair resigned to the death of
her child.
5. Afghan homes destroyed by a missile launched by permission of the
government of America prior to any declaration of war. It was intended to
kill Osama bin Laden but killed several innocent people.
“Co-lateral damage” is what the perpetrators call these acts. You
be the judge.
Michael Innis
Competing interests: No competing interests
American Doctors Speaking out on War Issues
Colombia – Once Famous for Coffee
There is a well known fable describing the creation of the world in
which an angel concerned with resource inequality tells God that it seems
unfair: Colombia is generously bestowed with vast fertile land, two
beautiful coasts, petroleum, emeralds and gold. God replies, “Don’t
worry; I’ve evened things out: take a look at the situation for the
people!”
Indeed Colombia, a nation of 44 million people, seems both blessed
and cursed. It is rich in natural resources, yet it has been strangled by
violence and widening economic disparities for many generations. Fifty-
two percent of Colombians live below the poverty level, 22% of them in
abject poverty.
The origins of the current violence date back more than a half
century to the period known as “La Violencia,” marked by political
homicides and massacres. It was then that the roots of the guerilla
movement took hold. The Colombian guerilla began as militant Communist
groups protesting land ownership by the wealthy and the government’s
inaction regarding poverty and labor issues. Since then, financial greed,
drug and gun trafficking have distorted political ideals. Today the
guerillas are frightening, sophisticated and powerful groups who exploit
those they were once supposed to defend.
The guerillas are small armies made up mostly of poor youth directed
by “officers” coordinating kidnappings, bombings, land control and
intimidation of entire communities. The guerillas control at least 50% of
Colombian territory and imprison more than 500 Colombian soldiers. In
addition, there are smaller, well-financed “narco-guerilla” groups
operating to protect the interests of drug cartels. Given that the
Colombian military cannot sufficiently protect the populace from the
guerillas, private paramilitary groups have arisen. Often employing even
more egregious techniques, the paramilitary contribute significantly to
the chaos and violations against human rights.
The result is an undeclared war being fought by more than two sides
with no clear objective and an ever-rising count of victim atrocities.
More than 1.8 million people have been displaced, 25,660 were killed last
year, and over 3,000 are kidnapped every year. There have been more than
20,000 human rights violations in the past two years, explaining why
Colombia has been dubbed “the Bosnia of Latin America.”
Forced displacement is astronomic. Colombia has the fourth largest
displaced population in the world, behind only Sudan, Angola and
Afghanistan. Commonly, a guerilla group such as FARC or ELN overtakes a
“pueblito” with bombs, massacres and other brutal intimidation. They
demand money, livestock or goods and may recruit boys and girls to join
them. After weeks or months they may leave, only to be replaced by a
paramilitary encampment. The paramilitary will kill or force the
evacuation of anyone they suspected to have supported the guerillas. As a
result, poor “campesinos” fill Colombian cities, which are marked by
inadequate housing, a 20% unemployment rate and mounting levels of non-
combat violence. Makeshift refugee camps have arisen, often the only
shelter for orphans of the war. Sanitation is poor, health care and
education minimal.
The Colombian homicide rate of 60 per 100,000 persons translates to a
murder every twenty minutes and bares witness to the insignificant value
placed on life in this country under siege. The degree of fatal violence
overshadows all other countries in Latin America. From 1994 to 1998 there
were 15,000 political assassinations. And yet, there are even more
homicides due to common violence, unrelated to war or politics.
Once famous for coffee, Colombia is now distinguished as the world
leader in kidnappings. There is a reported kidnapping every 2.8 hours.
It is illegal to pay ransom in Colombia and yet the populace has little
faith that the police can safely return their loved ones. As a
consequence, as many as three out of four kidnappings go unreported to the
authorities. Large ransoms are paid by individuals, multi-national
companies, kidnap insurance and community collections. With the profits
so high, the guerillas can employ sophisticated technology to identify and
capture their targets. Indeed, FARC, the largest guerilla organization
recently sent out notification that anyone with assets over a million
dollars must pay them taxes or be subjected to kidnapping. However, the
risk is not reserved only for the rich. Colombians of more modest means
have been taken for ransom requests as small as several hundred dollars.
Their kidnappers are often less organized groups and entrepreneurial
individuals who have taken note of the money to be made in “secuestros.”
In a country where only 37% of crimes are reported and 40% of those go
unpunished, kidnappings have become a common business enterprise
presenting a reasonable amount of risk.
If the worst of the war is its victims, the worst victims are its
children. Two thirds of those displaced are children; thousands have been
orphaned. A child is kidnapped every 36 hours in Colombia. Eighteen
percent of children have seen someone tortured. More are killed, or
maimed by landmines. Colombia is sown with more land mines than any other
country in Latin America. There are insufficient social supports and
protections for these children of the war, of the violence. Faced with
few options, too many children are both victims and perpetrators of the
violence. Six thousand young adolescents are guerilla or paramilitary
combatants. A Colombian government study found that forty percent of
children have shot someone and nearly one in five have killed.
It is impossible to find anyone in Colombia who has not been affected
by the violence. Everyone has a family member or close friend who has
been killed, kidnapped or threatened. “La inseguridad” has touched us
both personally. Dr. Arboleda has suffered the murder of a colleague and
teacher. Dr. Schaechter’s family has left the country. Both of us have
known friends and family who were taken for ransom. For those who remain
in Colombia, the violence has become the way of life. It’s not uncommon
to hear a Colombian say, “It’s not so bad!” Officially, Colombia denies
that it is experiencing a civil war. But the denial only adds to the
acceptance of a violence spiraling out of control. The “cycle of
violence” is in the fabric of Colombian society.
In the hospitals, we see only those who are lucky enough to make it
to our doors. Yet they are far from fortunate. Their physical injuries
may be crippling, and the best possible is done with limited resources.
Patched and bandaged, patients are discharged with little consideration of
where they will find shelter, who will give them protection or will abuse
them, what they will find to eat. There is no triage or first aid for the
psychological suffering of the victims of violence. For all the chaos and
inhumanity, no one knows how many Colombians, how many children, will be
haunted by fear and nightmares, how many will turn the violence on
themselves or another.
The sequelae of the violence extend beyond the borders of Colombia.
The displaced have fled to the United States, Costa Rica, Panama and
elsewhere. The psychological consequences of kidnapping, entrenched
violence and forced displacement are being carried with these emigrants.
To our knowledge Colombian immigrants to the United States and Latin
American countries, are not being routinely or adequately screened and
treated for post traumatic stress disorder, depression, and the other
variables that put them at risk for re-victimization, becoming violent
perpetrators, suicide, etc. Appropriate medical and mental health
services are critical to the successful life functioning of Colombian
youth, both those who remain and those who have fled.
Political and humanitarian efforts must be made to protect and heal
the civilian population who stay or leave until the undeclared war comes
to an end, when Colombia is once more distinguished as the world leader in
something other than violence.
Nelson Arboleda, M.D.
University of Miami /Jackson Memorial Medical Center
The Partnership for the Study and Prevention of Violence
Universidad del Valle
Cali - Colombia
CISALVA
Investigative Center of Health and Violence
Judy Schaechter, M.D.
University of Miami /Jackson Memorial Medical Center
Department of Pediatrics
The Partnership for the Study and Prevention of Violence
.
Competing interests: No competing interests