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Personal Views

Paediatrics on the peace line

BMJ 1999; 319 doi: (Published 18 December 1999) Cite this as: BMJ 1999;319:1648
  1. Moira Stewart, consultant paediatrician
  1. Belfast

    See pp 1609, 1636

    Cupar Street Clinic is one of the landmarks in north and west Belfast Situated between the Protestant Shankill and Catholic Falls Roads, it literally formed part of the peace line for many years. A 10 feet high metal fence meant that access from the Shankill was to the front of the clinic and from the Falls was to the back. Pedestrians could pass through a small gate, which was locked at night, but vehicle access was restricted to one or other side of the fence. Attacks across the car park in Cupar Street from both sides of the peace line were regular occurrences, and staff and patients often arrived in the morning to smells of burning and scenes of destruction. Inside the clinic, however, parents including ex-internees—Loyalist and Republican—sat quite happily together, on cramped benches in a small waiting area, in order for their children to be assessed and treated.

    GraphicWe were used to finding roads blocked by burning vehicles

    Twenty years ago, I was one of the first senior house officers to be sent out from the Royal Belfast Hospital for Sick Children for community experience. I have now been back in north and west Belfast for the past 10 years, which is a short time compared with many of the professionals with whom I work. The school nurses have encyclopaedic knowledge of the geography and politics of the area, and the family, personal, and social background of many of the children. When tensions in the area have been high it is often the nurses who have been out at schools or clinics and who have brought back information about the wisdom of trying to get to a particular destination. We were used to finding roads blocked by burning vehicles or army checkpoints, and sounds of helicopters overhead or fire engine sirens alert us to increased activity.

    Cupar Street, itself, is just a few hundred yards from Sinn Fein headquarters. Bomb scares, a part of life in Northern Ireland for so long, tended to come in blocks. The first one usually meant that the clinic was sealed off, and we could use the opportunity for coffee and chat. By the second or third incident, staff and patients had usually discovered alternative routes, and the clinics ran as usual We can predict good attendances from west Belfast (predominantly Catholic) during major demonstrations such as the Drumcree Orangemen's march. On the other hand, when the Orangemen were eventually allowed to walk down the Garvaghy Road two years ago, a patient's father advised us to go home early, as it was the turn of the Nationalists to protest.

    Early on I asked the mother of one young non-compliant lad if she got much support from his father, and was told that “he wasn't home much.” The nurses were more explicit—the father was a well known member of an illegal organisation who, of necessity, moved around. Another mother was amazingly candid when I asked if she could pinpoint when her son's behaviour deteriorated, and told me it was after she was “lifted” when semtex was found in her home. She denied any knowledge of the semtex, although openly admitted to knowing that her home was being used as a “safe house.” Gauging the acceptability of questions, and when to leave things alone, are some of the skills we have had to learn over the years.

    In 1993 the Northern Ireland Office made a decision to move the peace line in an attempt to decrease the frequency and violence of clashes across the strategically vulnerable clinic area. Cupar Street Clinic now lies entirely in west Belfast, and direct access from the Shankill Road is prevented by a new, more impressive metal fence. The concern was that Protestant families would no longer feel safe coming to the clinic as access would be via one of the few link roads between Protestant and Catholic areas, followed by a walk up the Falls Road. For the next three years we moved multidisciplinary teams and their equipment between locations in north and west Belfast However, long before the first cease fire families from both sides of the community had gradually drifted back to Cupar Street, and we no longer duplicate services.


    Dr Stewart at the child development clinic


    Many of the families are disadvantaged, with male unemployment reaching 50% in some electoral wards. One hope now is that peace and ensuing financial and economic improvements will bring a better quality of life to children and their families.

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