Medicine, Conflict and Survival, 2014 Vol. 30, No. 2, 75–80,

GUEST EDITORIAL On the 30th anniversary of Medicine, Conflict and Survival

This journal has reached the respectable age of 30 years. At the age of 25 (in 2009), an excellent, wide-ranging review of the journal’s contribution to health and peace was published. So it would be wrong to mull over that ground again. But it has been a highly eventful five years since then, including a global economic depression; uprisings in North Africa and the Middle East – the Arab Spring; a fierce, merciless civil war in Syria; nuclear power catastrophe in Japan; and overwhelming hurricanes in the USA and the Philippines. All these events impinge on health – and the health consequences of these events and others like them have been fully addressed within the pages of MCS. There now comes the unenviable task of choosing articles, commentaries and book reviews which stand out in the last five years. The following is of course a personal choice and I apologize in advance to the numerous authors whose excellent contributions I have omitted. Alan Patterson and Craig McLean, in their article in 2010 ‘Misleading and dangerous: the use of the precautionary principle in foreign policy debates’ (Vol. 26:1), discussed the tragic and deeply flawed decision to invade Iraq. The US administration had embraced the Precautionary Principle (PP) to formulate its policy on Iraq. Patterson and McLean argued that the PP is justifiably used in the sphere of environmental policy, although it is often flawed in the field of military policy: some studies such as Friedman for example appear to choose a formulation of the PP (one that specifies action should be taken even though evidence of a risk is uncertain) that would promote immediate action without first gathering and analysing evidence of a threat. (Patterson and McLean 2010, 51)

Their article helps us to understand the reasoning and motives which led to the Iraq war. Had the decision been made on sounder, better researched facts perhaps that war, so costly in human life, could have been avoided. The Programme Director of International Physicians for Prevention of Nuclear War (IPPNW), and North American Corresponding Editor of this journal, John Loretz, has kept us regularly informed of IPPNW conferences and activities over the years. In 2010, he and Maria Valenti reported on IPPNW’s 19th World Congress, which was held in Basel, Switzerland. It was attended by more than 700 doctors, medical students and IPPNW supporters from

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Guest Editorial

45 countries. The Congress demanded fulfilment of the pledge for a nuclear weapon-free world. Ambassadors from the US and Russia contributed to the discussions, but their words did not satisfy the audience, and former IPPNW Co-President Gunnar Westberg expressed the feeling of the Conference when he said to them You have at great length told us the steps of disarmament your countries have taken. But we are not satisfied. It is of little importance if there are 60,000 nuclear warheads in the world, or just 10,000. You can still destroy human civilisation. You must go for zero … (Loretz and Valenti 2010, 254)

In memory of the late editors of MCS, Douglas Holdstock and Jack Piachaud, a Holdstock–Piachaud Student Essay Prize was established in 2010. It has two objectives: firstly, to encourage student engagement with the medical peace movement; and secondly, to tap the vision, idealism and understanding of the younger generation. The 2010 competition was organized by Mareeni Raymond and Camille Gajria, both GP Specialty Trainees at the time, and three excellent essays were published in MCS 27:1. These were: ‘Climate change-induced conflict: a threat to human health’ by Cook (2011); ‘Health, peace, conflict: challenges to maternal and child health in the occupied Palestinian territories’ by Matthews (2011) and ‘Border-controlled health inequality: the international communities neglect of internally displaced persons’ by Rae (2011). These three well-researched essays showed us the complexity and interconnection of many factors: the economic, political and environmental; the stability or fragility of states, and how all these impact on health. Health professionals are conscious of their responsibilities and many have become engaged in efforts through the medical peace movements to tackle these diverse and pervasive problems. It is most encouraging that medical students can continue to make such valuable contributions, including through this ongoing annual essay prize. The journal has maintained its links with Medact, the UK affiliate of IPPNW. The Medact agenda has been – and remains – a broad one, with concerns far greater than just the avoidance of war. It is also concerned with the protection of the environment, human rights, maternal and child health, health ethics and many other aspects of health which are related to conflict. These interconnections were well illustrated in another student-led piece, this time a commentary by Alexandra Martiniuk and Shannon M. Wires, titled ‘Reflections on peace-through-health: the first Canadian, Israeli and Palestinian maternal and child health programme for medical students’ (Martiniuk and Wires 2011). This project brought together Israeli and Palestinian medical students with the dual aim of providing education in an area of medical speciality (in this case paediatric oncology) while fostering community contact, understanding and dialogue. A comment by a Palestinian participant reported by the authors illustrates the positive, beneficial benefits of the programme:

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As a Palestinian doctor, participating in such a workshop with other Israeli colleagues, this made [the programme] different. I think this gave everybody [the feeling] that people can have a chance for peace if they sit down with each other, trust each other and respect each other, this is the change in the mentality. (Martiniuk and Wires 2011, 202–203)

This commentary gives rise to the hope that compassionate, friendly actions in the community – including the medical and health community – can contribute to peace-making between states. The tragedy of the civil war in Syria was first highlighted in an editorial back in 2012 (Kett and Rushton 2012). Popular demand for democracy and human rights had brought about a political impasse which quickly turned into a humanitarian catastrophe involving disproportionate civilian casualties and the targeting of medical facilities and health care workers. In the same issue, Bradley T. Kerridge and colleagues focused on the global burden of disease brought about by terrorism, civil and one-sided violence (Kerridge, Khan, and Sapkota 2012). These tragedies pose a huge challenge to health professionals, but it is heartening to read of their efforts and commitment in the pages of MCS. In 2013, a special issue of MCS edited by Michele Moore and Heather Brunskell-Evans (Vol. 29:1) was devoted to the story of the Council for Assisting Refugee Academics (CARA), to mark its 80th anniversary. The concept originated in 1933, when ‘Sir William Beveridge envisaged a two-year “mission” driven by the imperative to save persecuted academics from the rise of Nazism and Fascism and preserve their knowledge and expertise for the benefit of mankind’ (Robertson 2013, 5). The efforts of the Council did indeed save the lives of many academics over the years, including philosophers, physicists and mathematicians, as well as many medical scientists. Kate Robertson, CARA Deputy Executive Director and Iraq Programme Manager, gave the example of Sir Ludwig Guttman, a German neurosurgeon who, along with his family, was helped to escape Nazi Germany. As Robertson noted, ‘His work at the renowned Stoke Mandeville National Spinal Injuries Centre revolutionized the treatment of patients with spinal injuries … Sport was central to his regime’ (Robertson 2013, 5). His ideas led eventually to the creation of the Paralympic Games. Kate Robertson went on to explain that CARA not only cares for refugee academics, but also supports those that have returned to their country of origin or have stayed in a crisis-affected country. In the special issue, the five articles and two commentaries gave a picture of the current medical landscape in Iraq after years of warfare. Among the subjects presented were: how health has been affected by depleted uranium; the prevalence of birth defects; and post-conflict health reconstruction. The final commentary by May Witwit is heart-warming: an Iraqi academic, she expresses her gratitude in an article titled ‘CARA Changed my Life’, telling of how the organization helped her to escape the violence of Baghdad and, importantly, resume her career in media studies in the UK (Witwit 2013).


Guest Editorial

A major dilemma in today’s techniques of warfare – the use of aerial drones – was imaginatively and comprehensively discussed in the editorial in Vol. 29.3, ‘Killing Machines’ (Rushton and Kett 2013). Their use has become commonplace in Afghanistan, Pakistan, Yemen and other regions, and their strategic benefits appear to be considerable. The use of troops on the ground can be limited and lives of our own troops and pilots safeguarded. But civilian casualties cannot be avoided – raising questions around who can be held responsible for such atrocities – including what could amount to war crimes. In May 2013, the United Nations Human Rights Council called for a moratorium on their use until such a time as some of the ethical questions surrounding them have been addressed (BBC 2013). Yet, they continue to be used in Pakistan, Afghanistan and elsewhere. To create a culture of peace requires more than goodwill. It needs knowledge and understanding (in much the same way that sound treatment in medicine relies on evidence-based research) and this has been provided by the many excellent book reviews in MCS. One example is Arnold’s 2010 review of Voices against war – a century of protest by Lyn Smith (MCS 26:2). Arnold praises the book for its account of protest against war from many standpoints – political, religious and ethical. The book’s author had drawn on the extensive archive of oral history held by the Imperial War Museum, and Arnold points to an intriguing anomaly: ‘The IWM bristles with military hardware and may seem an unlikely venue but it pays a lot of attention to the victims and opponents of war as well as the participants’ (Arnold 2010, 173). He ends his review by reminding us that ‘The practice of protest and its ethical strength is the essential antidote to the follies of our leaders (as Henry David Thoreau saw 150 years ago) – now it is needed for the survival of our species’ (Arnold 2010, 174). In the same issue, Robin Stott reviewed Peace: a world history by Anthony Adolf. Adolf envisaged a hierarchical pyramid of peace: the foundation of the pyramid is the obvious need for the basics of human survival; at the apex, world peace. Stott praises the book for giving a picture of ‘The diverse ways in which humans have sought to create peaceful societies’ – and goes on to note that ‘This perspective gives cause for optimism, and Adolf’s book is indeed an optimistic one’ (Stott 2010, 181). Having read the book, I would concur with this view. A rational approach to countering terrorism is set out in Chapter 10, including: ‘Recognising and addressing terrorist motives as well as acts’; and ‘Preventing terrorism through rather than around legal systems’. I would argue that for this chapter alone the book is well worth reading. Also in the same issue, the book WMD terrorism – science and policy choices edited by Stephen M. Maurer was reviewed by Peter Karamoskos. The reviewer asks ‘Why are terrorists targeting the US? Overt motives are clearly influenced by more fundamental deeply rooted grievances, with the threat often home grown’ (Karamoskos 2010, 240).

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The journal must be grateful to Frank Barnaby for his many book reviews over the years, including his review of British Nuclear Weapons and the Test Ban 1954–73 by John R. Walker. The book contains a reference to US President Barack Obama who, on 5 April 2009, announced the support of his administration for a world free of nuclear weapons. The present UK government also claims to be committed to the same goal. Many will scrutinize decisions about the future of Trident with this commitment in mind. (Barnaby 2011, 86)

Likewise, the journal must thank Leo van Bergen for his many reviews of books on the history of medicine in the two Great Wars of the twentieth century. One such is his review of A Companion to World War I, edited by John Horne in Vol. 27:2. We learn about ‘the way war affects medical care, the sheer medical consequences of weapons used, and so on’ (van Bergen 2011, 137). It is often asserted that innovations in medical treatment resulted from methods developed in the treatment of the war-wounded. However, these claims are only partially justified. Anne Rasmussen, one of the contributors to the book quoted by van Bergen, wrote that ‘While WWI did produce real technological change, it did not result in any scientific revolution’ (Rasmussen 2010, 308). Such views help counterbalance still held notions that war and conflict are drivers of improvements and advances – which may sometimes be the case, but at what cost? Finally we must thank our brilliant editors. After the tragic loss of Douglas Holdstock and Jack Piachaud, who had been the greatly admired editors for many years, in 2008 and 2009, the chair of our Editorial Advisory Board, Michael Pountney, helpfully and efficiently filled the gap until Simon Rushton, Maria Kett and Alan Ingram were appointed. This trio brought with them a devotion to peace, a youthful energy and a wide-ranging experience in international health, geopolitics, disability, human rights, the role of the UN in postconflict peace-making and many other health-related subjects. Alan Ingram resigned from the post in 2012, but we remain in good hands. Notes on contributor Alex Poteliakhoff is a long-standing member of the MCS Editorial Advisory Board and a Vice President of Medact UK.

References Arnold, R. H. 2010. “Voices against War – A Century of Protest. By Lyn Smith. Book Review.” Medicine, Conflict and Survival 26 (2): 173–174. Barnaby, Frank. 2011. “The Future of Trident.” Medicine, Conflict and Survival 27 (2): 85–90.


Guest Editorial

BBC. 2013. “UN Mulls Ethics of ‘Killer Robots’.” Accessed 14 June. http:// van Bergen, L. 2011. “A Companion to World War I.” Medicine, Conflict and Survival 27 (2): 137–138. Cook, Sam. 2011. “Climate Change-induced Conflict: A Threat to Human Health.” Medicine, Conflict and Survival 27 (1): 17–24. Karamoskos, Peter. 2010. Review of Stephen M. Maurer, ed. “WMD Terrorism – Science and Policy Choices.” Medicine, Conflict and Survival 26 (3): 239–241. Kerridge, B. T., M. R. Khan, and A. Sapkota. 2012. “Terrorism, Civil War, One-sided Violence and Global Burden of Disease.” Medicine, Conflict and Survival 28 (3): 199–218. Kett, M., and S. Rushton. 2012. “Depressingly Familiar.” Medicine, Conflict and Survival 28 (3): 191–194. Loretz, J., and M. Valenti. 2010. “IPPNW’s 19th World Congress Demands Fulfillment of Pledge for a Nuclear-weapons-free World.” Medicine, Conflict and Survival 26 (4): 252–258. Martiniuk, A. L. C., and S. M. Wires. 2011. “Reflections on Peace-through-health: The First Canadian, Israeli and Palestinian Maternal and Child Health Programme for Medical Students.” Medicine, Conflict and Survival 27 (4): 197–204. Matthews, A. 2011. “Health, Peace, Conflict: Challenges for Maternal and Child Health in the Occupied Palestinian Territories.” Medicine, Conflict and Survival 27 (1): 25–32. Patterson, A., and C. McLean. 2010. “Misleading and Dangerous: The Use of the Precautionary Principle in Foreign Policy Debates.” Medicine, Conflict and Survival 26 (1): 48–67. Rae, F. 2011. “Border-controlled Health Inequality: The International Community’s Neglect of Internally Displaced Persons.” Medicine, Conflict and Survival 27 (1): 33–41. Rasmussen, Anne. 2010. “Science and Technology.” In A Companion to World War I, edited by John Horne, 307–322. Chichester: Wiley-Blackwell. Robertson, K. 2013. “Preface.” Medicine, Conflict and Survival 29 (1): 5–6. Rushton, S., and M. Kett. 2013. “Killing Machines.” Medicine, Conflict and Survival 29 (3): 165–168. Stott, R. 2010. “Peace: A World History. Book Review.” Medicine, Conflict and Survival 26 (2): 181. Witwit, M. 2013. “CARA Changed My Life.” Medicine, Conflict and Survival 29 (1): 82–83.

Alex Poteliakhoff

On the 30th anniversary of Medicine, Conflict and Survival.

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