Editor's Choice

Failures of development

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7462.0-g (Published 12 August 2004) Cite this as: BMJ 2004;329:0-g
  1. Kamran Abbasi (kabbasi{at}bmj.com), acting editor

    Will quiet diplomacy save the world? It is doing little for Sudan, described by the UN as the world's worst humanitarian crisis. Will goals and targets save the poor? I challenge BMJ readers to name the millennium development goals related to health. Many readers will not have heard of them. I had to remind myself by reading this week's analysis by Andy Haines and Andrew Cassels (p 394). Although these goals were agreed in 2000—at the largest ever gathering of heads of state—HIV/AIDS aside, they are unchanged from 1900: eradication of poverty, universal primary education, gender equality, reduction in child mortality, and improvements in maternal health are familiar development themes.

    These goals should be viewed as a contract between rich and poor countries, recognising the role that rich countries must play through fair trade, development assistance, debt relief, access to essential drugs, and technology transfer. But one reason why progress is slow is revealed in a simple statistic presented by Haines and Cassels: development assistance dropped from $57.6bn in 1990 to $56.5bn in 2002. The war on Iraq has already cost over $150bn.

    An important failing of these and similar targets set by international agencies is scant awareness among health professionals beyond feverish interest in the international public health community. Why should it be otherwise? What does a surgery in a Cambridgeshire village have in common with a basic health unit in Rwanda? What hope that development issues will register when the media are obsessed with the loins of a 56 year old Swedish football manager and people search for profound meaning in reality television shows? In our integrated world, as Bill Clinton dubbed it, eradication of poverty and improvements in health must be a priority for both rich and poor.

    Working in “humanitarian” medicine has always implied devoting time to poorer countries, but doctors everywhere must be humanitarian in their work, particularly now this integrated world brings greater challenges of health care for migrants and asylum seekers (p 398). And doctors need be vigilant. Deborah Harding-Pink argues that politicisation of migration may blind doctors to the “slippery slope of failing to perceive human rights abuses.” She calls for a strong system of standards and ethical guidelines. Historically at times doctors have been ready political pawns and accomplices. Hitler's Germany and Stalin's Russia are extreme examples (p 408). Identifying with the cause of torturers, fear of refusing to comply, “bureaucratisation” of the medical role, and inadequate understanding of ethics, are—according to Amnesty International—some reasons for medical participation in human rights abuses.

    Ethical pitfalls can be hard to avoid, as doctors at Abu Ghraib prison and Guantanamo Bay will know. Political traps can be equally inescapable, as five Bulgarian nurses and a Palestinian doctor have discovered in Libya as they wait for a firing squad (p 409). Quiet diplomacy is failing them too.

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