Web of Life

The argument has been made that peace work is the domain of elites, formal leaders and diplomats. The primary task of health workers is health and why they should involve themselves in the work of peace? In answer to this question, there is the need to understand that war is a major cause of mortality and morbidity among the civilian population, of whom at least half, are children below the age of 18 years. Furthermore, a large proportion of this suffering is not the result of direct violence, but through collateral effects such as destruction of health-sustaining infrastructure and the increased vulnerability of millions of displaced people. Protection of health, therefore, by prevention, termination or mitigation of war or other conflict situations, seems an obvious concept for health workers to advocate.

Such work has been undertaken in recent decades under the framework of peace through health or ‘health as a bridge to peace’, by many individuals and institutions with WHO playing a lead role. Among the institutions involved, to name a few, are the International Physicians for Prevention of Nuclear War (IPPNW), which was co-founded by Dr. Bernard Lown, an American and Dr. Evgeni Chazov, a Russian, twenty two years ago and awarded the Nobel Peace prize in 1985; the Medical Action for Global Security, (MEDACT) formed in 1992, is a UK organization of health professionals seeking to promote the right to health and peaceful existence worldwide; the McMaster University, Ontario, Canada, noted for its War and Health Programme.

The key concepts: The key concepts of peace through health, are discussed in two recent articles, one from the Centre For Peace Studies, McMaster University, published in the medical journal ‘The Lancet’ and the other in ‘Medicine, Conflict and Survival" (MCS), which is the International journal of IPPNW, for those interested in health aspects of violence and human rights.

It would be of interest to highlight some of these concepts as gleaned from these articles.

1. Redefinition of the conflict situation: The meaning of war is not obvious. Its meaning for a population is established by particular groups - social classes, military elites, media and so on. Health workers can refuse to accept these understandings and definitions and can promote different ones, such as was as a public-health problem leading to a population health disaster.

2. The discovery and dissemination of facts: There is an old saying that truth is the first casualty in war. The run up to the latest Gulf war suggests, moreover, that truth suffers well before hostilities begin. Misinformation is essential to fuel or prolong a conflict. It can be countered effectively only through the dissemination of accurate information. Health care personnel are often in a good position to provide such information based on statistical and epidemiological studies, with careful mortality projections. They could alert the international community to war crimes, crimes against humanity and genocide and they might be in a position to describe the health consequences particular forms of weapons, such as nuclear, landmines, etc.

3. Healing of trauma: The physical and psychosocial trauma caused by war can slow down society’s recovery from war. They can also contribute to demoralization and lack of initiative, as well as lead to rigid patterns of thinking that could continue conflict and make it chronic. The health care professionals could be especially useful, if they can use methods of healing and rehabilitation that are linked to social processes of reconciliation and peace building. I wish to record here the study done in our own country by the Faculty of Medicine, Jaffna, on the physical and psychosocial consequences of landmines on civilians in the area and determine the priorities for rehabilitation of victims. (Reference. MCS - July September 2003).

4. Contribution to human security: Health is a crucial domain of security. Therefore, an adequate and equitable health-care system which addresses people’s basic needs give them an essential form of security. Health equity strengthens the sense of belonging to the society or state that has provided it for them. Without it they might resort to violence or war to achieve it by joining insurgencies.

5. Extension of altruism: It is said that health care is an institutionalized expression of human altruism. During armed conflict, this altruism tend to shrink, in that it is limited to compatriots. However, when health care can be extended to opposition groups, with the same compassion and professionalism as one’s own wounded or through variety of other means, a major inroad is made into the dehumanizing effects of conflict, which are essential for the prolongation of war.

6. Use of health superordinate goals: It has been documented that delivery of health care has been the basis for significant co-operation between parties divided by violence. A superordinate goal is defined as one that transcends the separate goals of parties to a conflict and can best be achieved when the parties join efforts.

A classic example is where UNICEF has pioneered the promotion of humanitarian cease-fires for immunization campaigns for children. Here, the superordinate goal is health of children. Brokering of ‘corridors of peace’ again by UNICEF, to allow the transport of medical supplies, is another. WHO has demonstrated the potential for health to be a unifying influence also through research action programmes and health-education programmes in conflict torn areas.

7. Conflict transformation: In this role, health workers are not unique in developing the skills in diplomacy, mediation and conflict resolution, but they will have unique opportunities to use them. They can bring together groups around superordinate goals associated with health, or to work with groups struggling to assure their security in a devastated environment.

For most part peace through health workers, preferred the analysis of particular case studies relating to conflict situations, to concepts and theory. The advantage of this approach has been that they have kept the work quite ‘close to the ground’. However, the need for a theoretical framework is being realized and the list of concepts outlined ‘does not yet constitute a theory, but represents a step towards a creation of one’.