Violent conflict: protecting the health of civilians

Abstract

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. 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.