Taking up cudgels for peace

In a week that has seen anti-war demonstrations take place around the world, Jocalyn Clark looks at what doctors in Europe, North America, and Australia are doing to promote peace

In what has been described as the strongest anti-war movement since Vietnam, scores of organisations representing health professionals around the world have joined thousands of international protesters opposing war on Iraq.

Anti-war sentiment was fuelled last week when a campaign group opposed to sanctions against Iraq published a leaked United Nations document that predicted as many as 100000 deaths in the event of a war.

The “strictly confidential” document, dated 10 December 2002 and entitled Likely Humanitarian Scenarios, predicts high numbers of civilian deaths, a nutritional crisis, and an outbreak of disease on “epidemic if not pandemic proportions.” The document was leaked to the Cambridge University based Campaign against Sanctions on Iraq, which published it on its website (see www.cam.ac.uk/societies/casi/).

The UN document's estimates are based on the World Health Organization's predictions of 100000 direct and 400000 indirect casualties. Over two million children and one million pregnant women are expected to be malnourished. Two million Iraqis will need shelter. It is predicted that the United Nations will be unable to cope even with the 130000 refugees already living in Iraq.

The scenarios are gloomier still if the conflict is long drawn out, and biological, chemical, or nuclear weapons are used. Similarly, the picture is worse if the conflict spreads beyond Iraq's borders. The death tolls suggested by the UN document confirmed estimates of casualties published late last year in Collateral Damage by Medact, a UK charity of health professionals (BMJ 2002;325:1134, and http://www.medact.org/).

In response to the UN document, over 500 staff and students from the London School of Hygiene and Tropical Medicine—many of whom have lived and worked in developing nations and countries in conflict—sent an open letter to UK Prime Minister Tony Blair. The letter, which is being published today in the BMJ (p 220) and the Lancet, predicts disastrous social and public health consequences if war occurs and states that military action in Iraq will only escalate violence internationally.

Rather than initiate military intervention for disarmament, Mr Blair should support peaceful measures, the letter says. Dr Carolyn Stephens, a representative of the London School of Hygiene's campaign, concedes that this is “hardly a radical position,” but she considers that as academics and doctors are not reputed to be politically active, it is a significant one.

Other doctors' groups agree. In recent weeks, health professionals from around the world protested against the planned attack on Iraq. The International Physicians for the Prevention of Nuclear War sent a petition to the UN Security Council, NATO ministers, President George Bush, and more than 20 other international leaders. Hundreds of doctors from across Europe, Africa, Russia, and the Middle East had signed the petition, in which the physicians' group set out four goals. International leaders should:

• Do no harm by rejecting war as a legitimate means to disarm Iraq

• Prevent further suffering by facilitating public health in Iraq

• Prohibit pre-emptive military action

• Provide sufficient resources to support effective weapons inspections.

Australia's Medical Association for Prevention of War produced two briefings for parliament and organised public protests, including delivering a “prescription for peace” to Prime Minister John Howard. The US based Physicians for Social Responsibility initiated major advertising and letter writing campaigns opposing US planned attacks, stating that “it is immoral and illegitimate for the only superpower to launch a first strike against Iraq.” Similar petitions were circulated by the New York based Doctors for Peace.

The Canadian group Physicians for Global Survival, comprising 5000 health professionals, lobbied Prime Minister Jean Chrétien, asserting that the planned attack is illegal under UN charters, inhumane, and unconscionable because other means exist to achieve legitimate goals in the conflict. Dr David Swann, a public health specialist and peace activist who has spent months in Iraq investigating the country's preparedness for war, said that physicians must speak out against the planned attacks: “Physicians carry tremendous moral and technical expertise that are needed to influence public policy.”

If begun, the 2003 war is expected to be far worse than previous US assaults in the region. Corroborating Medact's claims, the leaked UN document rejects comparisons with the outcomes of the 1991 Gulf conflict, as the existing sanctions against Iraq have produced an extremely vulnerable and impoverished population. Sixty per cent of the population is dependent on government food rations for basic needs. Child mortality has more than doubled and the incidence of low birthweight babies has quadrupled since sanctions began.

The Iraqi health infrastructure is said to be unable to bear further assault. Current medical supplies are insufficient for war, and any primary healthcare system is likely to be non-existent in the wake of a conflict. Mike Rowson, director of Medact, said: “Even a few casualties can completely overwhelm health systems.”

Tam Dalyell, Labour MP for Linlithgow, who last week hosted an emergency meeting of health professional groups at the House of Commons, acknowledged the “repulsive” nature of Saddam Hussein's regime. But he insisted that it would be “quite wicked to have a 21st century war with no clear military objective,” in the light of the evidence of the dire humanitarian costs.

Substantiating these concerns, scenarios of war have emerged from various other sources in recent weeks. Oxfam, the American Academy of Arts and Science, Unicef Baghdad, Save the Children UK, and Yale University all produced estimates. Particular concern was expressed about the rise of collective violence, which includes state and group terrorism, rape as a weapon of war, and gang warfare. Collective violence produced enormous suffering and social instability, several groups said, as documented by WHO's World Report on Violence and Health (BMJ 2002;325:731, and http://www.who.org/).

Anti-war sentiments are becoming more visible in Europe and North America. Mass protests took place in the United States on 18 January, marking the anniversary of the death of civil rights leader Martin Luther King. Protests around the world are expected to continue, many coinciding with mass anti-war rallies scheduled across Europe for 15February.

An Iraqi child at a Baghdad school holds an anti-war drawing, done by an American child, which was brought to the school by a US delegation of the National Council of Churches

(Credit: EPA /PA PHOTOS)