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Doctors must act against violence

By Sandhya Srinivasan

What is the role of the health professional in a world torn apart by war and strife? This theme dominated discussions at the International Health Forum which preceded the World Social Forum in Mumbai

The impact of war and neo-liberal economic policies on public health was the focus of the Third International Health Forum for the Defence of People's Health in Mumbai, organised by the People's Health Movement on January 14 and 15 as a run-up to the World Social Forum.

Testimonies from people facing the effects of war came from Palestine , Africa, Afghanistan , and Equador. Dr Jihad Mashal, a neurosurgeon from Palestine , noted that military occupation is preventing access to health facilities. Palestinians seeking emergency care must be carried to checkpoints - ambulances are rarely allowed to reach the person's home. Women have been forced to deliver at checkpoints because they cannot reach the hospital in time. "People are dying because they are prevented from getting treatment."

'Continuing Collateral Damage: the health and environmental costs of war on Iraq ', published by the international health charity MEDACT, confirms that the war which killed tens of thousands of civilians continues to affect the already compromised health of generations of Iraqis. The US attack has exacerbated poverty, malnutrition and the limited access to clean water and sanitation, and disrupted public services.

The health profession did not live up to its responsibilities when caring for victims of state-sponsored communal killings in Gujarat, noted Renu Khanna of SAHAJ, Baroda . While most doctors did not discriminate against Muslims, and several stuck their necks out to work in risky conditions, most failed to record obvious signs of violence in their patients - damaging the cases filed against the assailants in some of the most brutal crimes imaginable.

The health effects of war and the responsibilities of health professionals in conflict were among the themes which dominated the IHF where more than 700 activists, academics and health professionals from around the world gathered to take stock of the People's Health Movement's accomplishments since the People's Health Assembly in Savar , Bangladesh in 2000.

The PHM is preparing for the next stage of the struggle to achieve Health For All - which the WHO's 1978 Alma Ata Declaration promised by the year 2000, through comprehensive primary health care to all.

Two delegates at the IHF give their views on violence, conflict and the role of medical professionals.

Renu Khanna, SAHAJ Baroda, on violence by the state in Gujarat, and its effect on people's health.

The Gujarat violence saw horrifying examples of violence, especially sexual violence. Several health professionals stuck their necks out but as a whole the medical profession and the police did not do their job. Speaking of doctors, they failed to recognise violence. Many vulnerable women did not approach providers for fear of mistreatment. Most doctors did not discriminate and a few were pro-active. There were a few heroes. But hospitals discharged patients prematurely rather than ensure their safety. Doctors need to recognise violence and act.

It was difficult in Baroda . Gujarat was such a difficult situation. Communalism is so deeply internalised by individuals, you forget your profession and think only of community and caste. We were blind to this earlier. We should have seen decades ago that caste is important in Gujarat . When for example I would be asked routinely: "What caste are you?" it didn't strike me as dangerous. But we realised in 2002 that caste concerns were always there. Among professionals the communal mindset is deeply internalised.

We compared doctors' responses after the earthquake and after the riots. After the earthquake doctors swung into action overnight and organised emergency care. This time, when I called friends at the medical college in Baroda for information on the numbers of Hindus and Muslims injured, they refused to give this. We expected our friends who have been with us in other struggles to be with us in this one as well. But we expected them to be more than doctors, to be activist doctors.

On the other hand, tonnes of doctors came from outside Gujarat . During the earthquake, the response was from within the state. After the communal killings, the response was from outside the state. Donations were from non-Gujaratis. The MFC people came.

What could we have done?

We could have documented the injuries properly, in accordance with the duties of the doctor. We could have provided care, more sustained care.

Dr Bert De Belder is co-ordinator of Medical Aid for the Third World, an organisation founded partly in response to the felt need to go beyond the work being done by Medicins Sans Frontiers, the international relief organisation. He is author of Kasama: The Philippine Struggle for Health and Liberation Through the Eyes of Two Belgian Doctors . He believes that medical professionals can do more than treat illness with medicine, especially in a world torn apart by war.

What roles can a health professional have?

As medical doctors we know that prevention is better than cure. So our first task in a militarised world is the prevention of war, the prevention of death and suffering.

We are opinion-makers, we can form public opinion on the health effects of war, we can mobilise health workers against the occupation. In times of conflict, we can testify to the negative effects of war, give feedback to the general public.

You may have seen that some medical professionals have come out in favour of the war. What do you have to say to this?

If a health professional says s/he is in favour of war for any reason he is mistaken. The question is: whose interests are served by this war? Clearly it is oil, the military trade, the deepening US influence in strategic regions.

How did you arrive at this perspective on the social responsibilities of the health professional?

I got involved as a medical student in Belgium in the late-'70s when I went to central America and worked in medical support camps in El Salvador . I later worked in a number of places including a Palestinian refugee camp in Lebanon where I was confronted with the people's liberation struggle against colonisation. Later I spent eight years in the Philippines where as health workers we felt the need to mobilise people, to organise them on issues such as land and jobs, which were obviously related to their health. My wife and I are full-time workers of Medical Aid for the Third World . My wife is a medical doctor in a poor neighbourhood in Brussels , working with migrants.

Do you see reason for concern, reason for hope?

(Gatherings such as the People's Health Movement and the World Social Forum) give us reason for hope. There is a large mobilisation against the war. The new generation, especially health professionals, should be part of that mobilisation. The concern is the superpower arrogance of US imperialism and the rampage of new colonialism. But if we get together we can change things.

(The introduction to these interviews is condensed from Sandhya Srinivasan's article in Terraviva , an independent publication for IPS-Inter Press Service.)

InfoChange News and Features, January 2004