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Amineh
The Lancet,
Volume 373, Issue 9658,
Page 95,
10 January 2009 Next Article
>doi:10.1016/S0140-6736(09)60015-5Cite or Link Using DOI
Violent conflict: protecting the health of civilians
The Lancet
As the world watches the terrible events unfolding in Gaza, several other conflict zones around the globe continue to be ignored. Since Israel's air and ground offensive against the Hamas regime in Gaza captured international political and media attention, hundreds of people—400 in one day alone—have been killed in the Democratic Republic of the Congo and many more lack the medical attention they so desperately need.
Major difficulties in bringing assistance to people affected by conflict is a prominent feature of the top ten most neglected humanitarian disasters, compiled annually by Médecins Sans Frontières. According to the list, massive forced civilian displacements, violence, and unmet medical needs in Somalia, which is top of the list for the third consecutive year, the Democratic Republic of the Congo, Iraq, Sudan, and Pakistan are some of the worst humanitarian and medical emergencies in the world.
It is a scar on society that some lives are still deemed more important than others, especially when viewed through a lens distorted by politics, economics, religion, and history. The perceived worth of a country—including its economic, trading, and political value—and the degree of media coverage should not determine the value of the lives of its citizens lost to war. Unfortunately, few political leaders consistently share this view and the UN has failed miserably to uphold its founding principle—that every life has equal value.
In a recent speech, UN Secretary General, Ban Ki-moon said "we [the UN] have not been able to protect innocent people from violence". Although such an admission is refreshingly honest, it does not make this deplorable fact any more acceptable. The UN Secretary General and political leaders have called repeatedly for ceasefires to such conflicts to no avail. The UN's credibility is seriously undermined by the complete lack of any mechanism to hold those who break international law to account. How can the UN system be fit for purpose when it does not even attempt to uphold agreed international codes such as protecting civilians, ensuring that those injured and sick during conflicts receive medical attention, and that medical personnel, establishments, transport, and equipment are spared? Governments involved in recent and current conflicts have repeatedly shown a flagrant disregard of such principles yet there have been no reprisals whatsoever. Additionally, the recent events in Gaza, and last year's uprising—and brutal quashing—in Burma, show that the organisation of the UN Security Council, where the powerful few are allowed to make unilateral decisions to suit their own political interests, is disgracefully inadequate.
Perhaps in the days to come, as the world continues to reel from the political and humanitarian fall-out of the situation in Gaza, the international community could use this catastrophe as catalyst for change to improve the medical and humanitarian response during conflicts. Global reaffirmation of the Universal Declaration of Human Rights, which enshrines the equal value of human life, and the Geneva Convention, which protects civilians and medical personnel during conflict, would be a good starting point. Although this suggestion does not require a reinvention, it is only worth doing if combined with the rather revolutionary notion that countries, territories, regions, and leaders that breach these codes should be held to account. Non-governmental organisations and civil society groups should play a crucial part in such a proposal. But perhaps it is time for a different group to step in and sign up to be the guardians of, and advocates for, the humanitarian health needs of civilians caught up in conflict. Who better to take up this role than the medical profession?
Just as the UN was founded in the spirit of shared humanity, so was medicine. The Hippocratic Oath, and its popular modern equivalents, puts caring for human beings and treating each life as equal at their very heart. Surely it is not just the brave few health professionals in the firing line who have the responsibility for meeting the health needs of civilians injured in conflict. Médecins Sans Frontières—doctors without borders—should not just be the name given to one medical humanitarian organisation. If the Hippocratic Oath means anything, all doctors whatever their situation, specialty, or seniority should live up to this name by calling on their national governments and the international community—perhaps through their national medical organisations—to ensure that civilians injured or affected by conflict receive the medical attention they need, wherever these people may be in the world. Such action is not being a so-called humanitarian—it is what being a member of the medical profession should be all about.
The Lancet, Early Online Publication, 12 January 2009
doi:10.1016/S0140-6736(09)60042-8
Cite or Link Using DOI
Cite or Link Using DOIIn solidarity with Gaza
Simeon Kimmel b
, , on behalf of 753 other medical students
, , on behalf of 753 other medical studentsWith sadness and urgency we, medical students, express our outrage at the brutal Israeli attacks and subsequent humanitarian disaster that is occurring in Gaza. As we write, more than 600 Palestinians have been killed and more than 2700 wounded in Israel's disproportionate assault that began on Dec 27, 2008. Not just as medical students, but as Christians, Jews, and Muslims; as Arabs, Americans, Israelis, and Palestinians, we write in solidarity with the people of Gaza as they suffer yet another major humanitarian disaster.
On Dec 10, 1948, the General Assembly of the UN proclaimed that access to medical care is an inalienable human right. More than 60 years later, as medical supplies in Gaza's overstretched and underequipped hospitals dwindle, this right is far from realised. The international community has been slow to respond with aid and even that which is offered is not reaching those in need.
Hospitals scramble to operate with-out power, medicines, and clean water as medical equipment and health workers are prevented from crossing the border. WHO reports that health personnel have been targeted in breach of medical neutrality and in violation of international human-itarian law. Testimonies gathered by Physicians for Human Rights—Israel report that patients wait in vain for treatment that cannot be provided by overwhelmed medical personnel in paralysed clinics. This massive influx of seriously injured civilians would overwhelm even the best of the hospitals in which we train.
Meanwhile, the bombardment of Gaza—one of the most densely populated regions in the world—continues unabated and the international com-munity refuses to address Israel's ab-horrent policy of collective punishment. Israel claims only to target militants, yet the lists of wounded and dead are rife with civilians, many of them children.
Irrespective of the complex dynamics of this conflict, human rights, medical neutrality, and the protection of non-combatants always demand respect. Israeli "high-precision" weapons have destroyed a UN school in Jabaliya, which was being used to house refugees, killing 40 civilians alone. We do not dismiss Hamas's role, nor condone its targeting of Israeli civilians. How will the slaughter of Israeli or Palestinian civilians bring peace to this region? We fear this will instead breed new generations of hate, distrust, and misunderstanding. Yet the numbers of lives lost tell the story: Israel's response is disproportionate and unacceptable.
We cannot sit idly in silence as this violent assault on a civilian population kills and maims hundreds of people. The principles we accepted on entering the medical profession compel us to speak out in the face of these gross violations of basic decency and respect for human life. We implore the international community to shoulder its responsibility to the people of Gaza. We are embarrassed at US complicity and regret that many of the weapons fired come from our own country.
As members of the medical pro-fession, we call for an immediate ces-sation of hostilities, the immediate and comprehensive provision of human-itarian aid, and recognition of the neu-trality guaranteed to medical providers by international law. Israel has only now approved limited humanitarian corridors, but this is insufficient and has proven ineffective. We stand united in opposing the health and human rights disaster inflicted on the citizens of Gaza. As we hope for a return to civility, dialogue, compromise, and resolution, our hearts go out to all of the victims of this tragedy. The violence must stop.
We declare that we have no conflict of interest.
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