Archive for the 'War and Health' Category
Add a comment August 1st, 2010 by martindonohoe
- Homecoming
“Our only hope today lies in our ability to recapture the revolutionary spirit and go into a sometimes hostile world declaring eternal hostility to poverty, racism, and militarism. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.” -Martin Luther King, Jr.
This is to introduce an open-access powerpoint Slide Show Covering War and Peace in Literature and Photography at http://phsj.org/wp-content/uploads/2007/10/War-and-Peace-in-Literature3.ppt. The slide show includes famous quotes, poems, suggested readings (including novels), and photography from 20th Century conflicts. For those interested, there is an accompanying list of Readings in War and Peace at http://phsj.org/wp-content/uploads/2007/10/war-and-peace-literature3.doc, and a copy of Mark Twain’s “War Prayer” at http://phsj.org/wp-content/uploads/2007/10/The-War-Prayer.doc. Other content covering war and peace are at http://phsj.org/war-and-peace/.
Add a comment November 10th, 2009 by bronxdoc
Our colleague Minh Ha, a Vietnamese social worker, passed on this information about the New York premiere of “Don’t Burn it – It’s already on fire” a Vietnamese film based on the war diary of Dang Thuy Tram, a Vietnamese physician. Dr. Tram’s diary has been published in English under the title: Last Night I Dreamed of Peace.
Publisher’s Weekly described the book in these terms: “In 1970, while sifting through war documents in Vietnam, Fred Whitehurst, an American lawyer serving with a military intelligence dispatch, found a diary no bigger than a pack of cigarettes, its pages handsewn together. Written between 1968 and ’70 by Tram, a young, passionate doctor who served on the front lines, it chronicled the strife she witnessed until the day she was shot by American soldiers earlier that year at age 27. Whitehurst, who was greatly moved by the diary and smuggled it out of the country, returned it to Thuy’s family in 2005; soon after, it was published as a book in Vietnam, selling nearly half a million copies within a year and a half. The diary is valuable for the perspective it offers on war—Thuy is not obsessed with military maneuvers but rather the damage, both physical and emotional, that the war is inflicting on her country. Thuy also speaks poignantly about her patients and the compassion she feels for them.”
The film will be shown from 7pm – 9.30pm on Saturday November 14th, 2009 in Room 200. Cantor Film Center, 36 East 8th Street & 5th Ave, NYC.
New York University. The director, Dang Nhat Minh, will be present for a discussion after the film.
posted by: Matt Anderson, MD
Add a comment October 7th, 2009 by bronxdoc
Social Medicine, our open-access, online academic journal has just published its latest issue. Here is a brief summary of the articles all of which are available for free at www.socialmedicine.info and www.medicinasocial.info (in Spanish).
Children in post-Civil War Nepal singing revoutionary songs
Special Theme: Social Medicine & War
For this special theme issue on Social Medicine & War, Dr. Vic Sidel served as guest editor. His lead editorial (co-authored with Dr. Barry Levy) examines the diversion of resources to war and the preparation for war.
Quoting from their introduction to the three original research articles about war, Drs. Sidel and Levy write: ”Dr. Andrea Angulo Menasse, a researcher from Mexico City’s Autonomous University, documents the very personal story of how the violence of the Spanish Civil War affected one family. In her case study the trauma suffered by Spanish Republicans is traced through three generations and crosses the Atlantic Ocean as the family moves is exiled in Mexico. Dr. Sachin Ghimire from the Centre of Social Medicine and Community Health of the Jawaharlal Nehru University reports on his fieldwork in Rolpa, Nepal, the district from which the Nepal Civil War (also called the People’s War) originated in 1996. Based on 80 interviews, he documents the difficulties faced by health care workers as they negotiated the sometimes deadly task of remaining in communities where control alternated between Nepalese Special Forces and the Maoist rebels. Finally, Colombian researcher, Carlos Iván Pacheco Sánchez, from the University of Rosario in Bogota, brings an epidemiologist’s tools to examine the impact of the ongoing armed conflict in the border Department of Nariño. His discussion is informed by the current debate over health care in Colombia where a recent Constitutional Court decision has found that the current health care system violates the right to health.”
Closing the Gap: Where are we one year later
In August of 2009, the WHO’s Commission on the Social Determinants of Health issued a bold call to eliminate health disparities within a generation. Three articles in this issue look at what has – and has not – happened in the intervening year. Our second editorial examines the international response to the Commission’s call. José Carlos Escudero explores the meaning of the report for the WHO and underscores the report’s limitations. A detailed critique of the report, along with an alternative approach to addressing health inequities, is offered by Dr. Anne-Emanuelle Birn. Dr. Birn’s critique is especially important for offering important historical background by exploring how Europeans in the 19th century – notably Louis-René Villermé, Edwin Chadwick, and Friedrich Engels – each approached the social disparities that arose during the Industrial Revolution.
The Peckham Experiment
We are also very pleased to publish three classic texts describing the Peckham Experiment, an innovative community center built in England during the Depression. The Pioneer Health Center was designed around the idea of studying (and fostering) what makes people healthy, rather than what makes them sick. Imagine that!
Please visit the journal and explore the breadth, depth and scope of social medicine past and present. Along with some suggestions for the future.
posted by Matt Anderson, MD
Add a comment May 21st, 2009 by bronxdoc
In April of 2009, the Obama Administration complied with a Freedom of Information request by the American Civil Liberties Union and released four secret memos outlining the Bush Administration’s justification for various “interrogation techniques” that amounted to torture. These memos are available at the ACLU website. They are essential reading for Americans who want to understand what has been done in the name of our country.
Shortly after the release of these memos, New York Review of Book’s journalist Mark Danzer posted the entire text of the February 2007 report by the International Committee of the Red Cross regarding the interrogration of 14 “high value” detainees by the CIA. The report was published as part of two excellent articles (“US Torture: Voices from the Black Sites” and “The Red Cross Torture Report: What It Means“) written by Danzer.
The report is of particular interest to health care personnel because it details the alleged roles of medical personnel in the torture of the 14 detainees. Rather than summarizing the contents of the ICRC report, we excerpt below the entire text of Section 3 entitled: Health Provision and the Role of Medical Staff.
During the course of their detention, detainees described three principal roles for health personnel whom they encountered. Firstly, there was a direct role in monitoring the ongoing ill-treatment which, in some instances, involved the health personnel directly participating while certain methods were used. Secondly, there was a role in performing a medical check just prior to, and just after, each transfer. Finally, there was the provision of healthcare, to treat both the direct consequences of ill-treatment detailed in previous sections, and to treat any natural ailments that arose during the prolonged periods of detention.
Throughout the course of the initial phase of the detention, the ICRC received allegations that health personnel were directly involved in monitoring the health effects of ill-treatment. In some cases it was alleged that, based on their assessments, health personnel gave instructions to interrogators to continue, to adjust, or to stop particular methods. As with other personnel within the detention facilities, the health personnel did not identify themselves, but the detainees presumed from their presence and function that they were either physicians or psychologists.
For certain methods, notably suffocation by water, the health personnel were allegedly directly participating in the infliction of the ill-treatment. In one case, it was alleged that health personnel actively monitored a detainee’s oxygen saturation using what, from the description of the detainee of a device placed over the finger, appeared to be a pulse oxymeter. For example, Mr Khaled Shaik Mohammed alleged that on several occasions the suffocation method was stopped on the intervention of a health person who was present in the room each time this procedure was used.
Other detainees who were shackled in a stress standing position for prolonged periods in their cells were monitored by health personnel who in some instances recommended stopping the method of ill-treatment, or recommended its continuation, but with adjustments. For example, Mr Bin Attash (the detainee has had a right-sided below knee amputation) alleged that while being held in a form of stress standing position with his arms shackled above his head, and his feet touching the floor, had his lower leg measured on a daily basis with a tape measure by a person he assumed to be a doctor for signs of swelling; the health person finally ordered that he be allowed to sit on the floor, albeit with his arms still shackled above his head. Mr Hambali alleged that, after a period of the same form of prolonged stress standing, a health person intervened to prevent further use of the method, but told him that “I look after your body only because we need you for information”.
As well as the monitoring of specific methods of ill-treatment, other health personnel were alleged to have directly participated in the interrogation process. One detainee, who did not wish his name to be transmitted to the authorities, alleged that a health person threatened that medical care would be conditional upon cooperation with the interrogators.
The second alleged role of the health personnel was to perform a medical check prior to and after each transfer from one detention location to another. The purpose and results of this medical examination appear not to have been divulged to the detainees.
The third alleged role was to provide medical care to detainees, either for injuries resulting directly from the various forms of ill-treatment employed, or treatment for common ailments that arose throughout the course of the detention.
With regard to this third role, when such medical treatment was necessary it appears from the descriptions given that the care was appropriate and satisfactory. In two specific cases, detainees indicated that exceptional lengths were taken to provide very high standards of medical intervention.
Medical ethics are based on a number of principles’ which include the principle of beneficence (a medical practitioner should act in the best interest of the patient—salus aegroti suprema lex), non-malefiance (first do no harm—primum non nocere) and dignity (the patient and the person treating the patient have the right to dignity). These principles guide any relationship between a medical doctor and a person whom he or she is relating to as a medical doctor.
There are accepted roles for health professionals working in recognised, official, places of detention such as police stations and prisons wherein the health professionals have the health care and best interests of the detainee as their primary consideration.’ To this end, when a person enters an official detention facility or system, a medical assessment of their medical status is required in order to meet their current and ongoing health needs. In the case of a normal, lawful interrogation, a physician may be asked to provide a medical opinion, within the usual bounds of medical confidentiality, as to whether existing mental or physical health problems would preclude the individual from being questioned. Secondly, a physician may rightly be requested to provide medical treatment to a person suffering a medical emergency during questioning. This accepted role of the physician, or any other health professional, clearly does not extend to ruling on the permissibility, or not, of any form of physical or psychological ill-treatment. The physician, and any other health professionals, are expressly prohibited from using their scientific knowledge and skills to facilitate such practices in any way. On the contrary, the role of the physician and any other health professional involved in the care of detainees is explicitly to protect them from such ill-treatment and there can be no exceptional circumstances invoked to excuse this obligation.”
With the exceptions detailed in the above paragraph, any interrogation process that requires a health professional to either pronounce on the subject’s fitness to withstand such a procedure, or which requires a health professional to monitor the actual procedure, must have inherent health risks. As such, the interrogation process is contrary to international law and the participation of health personnel in such a process is contrary to international standards of medical ethics. In the case of the alleged participation of health personnel in the detention and interrogation of the fourteen detainees, their primary purpose appears to have been to serve the interrogation process, and not the patient. In so doing the health personnel have condoned, and participated in ill-treatment.
Commentary on the ICRC Report
Medical participation in torture has been discussed in several articles in the medical literature over the past several years. Stephen Mile’s 2004 Lancet article entitled “Abu Ghraib: its legacy for military medicine” pointed to multiple ill effects of medical participation in torture. These included damage to the reputation of the US Army and its medical corps as well as “[t]he eroded status of international law has increased the risk to individuals who become detainees of war since Abu Ghraib because it has decreased the credibility of international appeals on their behalf.“ Calls arose the same year for an investigation of doctors who had been involved in torture.
As of today no health care personnel have been prosecuted or lost their license to practice for these breaches not only of basic ethical principles, but also of international law. Of course, the problem does not reside in a “few bad apples” who did wrong, but rather in the larger system that was designed to torture and abuse. Medical personnel were one part of that machine.
In a 2003 chapter in the book Military Medical Ethics, Volume 1, Drs. Vic Sidel and Barry Levy argued that the concept of a physician-solider contained an irreconcilible ethical dilemma: that of divided loyalties or dual agency.
The overriding ethical principles of medical practice in our view are “concern for the welfare of the patient” and “primarily do no harm.” As we understand them, the overriding principles of military service are “concern for the effective function of the fighting force” and “obedience to the command structure.” Although there may be rare exceptions to these principles, they have been the fundamental bases of medical practice and military service over the centuries. In our view, the ethical principles of medicine make medical practice under military control fundamentally dysfunctional and unethical.
In making this critique Drs. Sidel and Levy were speaking of primarily physician-soliders who were caring for other soldiers. But the situation of the medical personnel operating at the CIA “black sites” is the ultimate expression of the problems of dual agency in military medicine.
More on the ICRC
This posting excerpts only a small portion of the ICRC report which is worth reading in full for its careful documentation of the conditions of detention in the CIA black sites. It is worth pointing out that the ICRC’s involvement in defending prisoners extends far beyond this report. The Committtee’s work can be appreciated on their website. Finally, the ICRC has provided some background in response to the publication of the report. The ICRC statement concludes with the following:
The ICRC is concerned that any information it divulged about its findings in places of detention could easily be exploited for political purposes. It deplores the fact that confidential information conveyed to the US authorities has been published by the media on a number of occasions in recent years. The ICRC has never given its consent to the publication of such information.
posted by Matt Anderson, MD
Add a comment April 24th, 2009 by Claudia Chaufan
In the aftermath of the attack on Gaza, the Israeli Military conducted an investigation in reply to accusations of human rights violations, and concluded that it had “maintained a high professional and moral level” during the 22-day war, which ended Jan. 18, though it faced “an enemy that aimed to terrorize Israeli civilians whilst taking cover” among Palestinian civilians and “using them as human shields.”
The New York Times promptly reported on this with the headline “Israeli Military Says Actions in Gaza War did not Violate International Law“. The article, consistent with New York Times reporting on the Israel-Palestine conflict, had the usual tone “he said she said” , which at best aims at “a balanced view” and parrots claims from “both sides”, yet assesses the claims against no independent standard. This is likely to leave readers who are unfamiliar with international law or lack an independent knowledge of the conflict as clueless about what to make of the particular story as they were before reading the New York Times. (moreover, somebody who reads nothing but the headlines would assume that the issue is fully settled).
To fill this gap, let us note that from the standpoint of international law, the occupation continues to be as illegal in 2009 as it was in 1967, when the UN Security Council passed UN Resolution 242, declaring it inadmissible for countries to acquire territory by war, and emphasizing “the need to work for a just and lasting peace in which every State in the area can live in security”. So whatever the Israeli Military does in this context is prima facie illegal.
(For those who wonder about Israel’s “disengagement” from Gaza in 2006, click here to find out what Jerome Slater, from the John Kennedy School of Government at Harvard University, says about the attack on Gaza given its particular status, or what Neve Gordon, chair of the Department of Politics and Government of Ben Gurion University says about the alleged disengagement).
In this same spirit, B’Tselem, an Israeli-based human rights organization, published a “response to the Israeli Military’s investigations of operation “Cast Lead”". (The fully developed principles can be accessed here):
“On the 22.4.08, the Israeli Military made public the conclusions of five internal investigations held by teams headed by officers, who “were not a direct part of the chain of command, and who were appointed by the chief of staff to investigate several issues in regards to which questions were raised during the fighting.” The military did not publish the investigations themselves .
The chief conclusion of the investigations is that “the “IDF acted in accordance with the principles of international law, while keeping a high professional and moral standard; all of this, against an enemy that was deliberately engaging in terror activities against Israeli civilians.” However, “the investigations shed light on a very small number of mistakes and incidents in which intelligence or operational mistakes occurred during the fighting.”
However, the IDF spokesperson is quick to qualify the military’s responsibility for these cases. Thus, it determines in its statement, “the fighting in Gaza took place in a complex battlefield against an enemy who chose, as a conscious part of its doctrine, to position itself in the midst of the civilian population, booby trapping their houses with explosives, firing from schools attended by their own children and even using their own people as human shields.”
These are only some of the issues investigated by the military, and the IDF spokesperson stated that a central operational investigation is still being conducted, and is expected to be finalized in two months. However, even at this stage it is possible to point out several central problems in the way the military investigates the suspicions of violations of international humanitarian law (IHL) during operation “Cast Lead”.
Problems of principle
- The military cannot investigate itself (this is like giving somebody accused of murder the task of assessing whether in fact he or she is guilty of murder and taking the results at face value).
- The standards obligating the military were ignored, and specific accusations about targeting civilians were not investigated.
- The report ignored whether there was a policy set by high-ranking officials and focused on alleged misdeeds of individual soldiers. However, there is much evidence to believe that there was, indeed, a policy of destroying civilian infrastructure and targeting civilians (or not caring enough whether or not civilians were harmed).
- The investigation into the harming of civilians is vague
- The investigation regarding harm to medical teams and hospitals is inaccurate
- The investigation regarding white phosphorus focuses on the theory and ignores the horrific consequences on the ground during the operation, which the military was in a perfect position to anticipate.
- The investigation regarding destruction of houses and harm to infrastructure is flawed. It fails to explain the need to massively destroy public buildings, whole neighborhoods, and extensive agricultural areas.”
For a good website on international humanitarian law and human rights click here.
For weekly updates on human rights violations in the West Bank, Gaza and East Jerusalem (yes, they continue), click here.
Add a comment April 10th, 2009 by Claudia Chaufan
Posted by Claudia Chaufan
It may be that the corporate media does not talk about Gaza anymore, in the hope that reality goes away. And because it is not talked about, it feels as if, well, the war is over. Whether or not this is true is a matter of debate, but the effects of the 22 days of the invasion are not. At least according to an Israeli group Physicians for Human Rights-Israel, which has recently published the results of a fact-finding mission conducted by a team of medical experts. For a summary see below. For an abbreviated, 25-page version of the full report click here.
When reading the report, it is at hard to find the claims of the IDF credible, that they did “everything to avoid civilian casualties”. Indeed, it is hard even to find the words to describe the destruction the invasion left behind.
In the meantime, Gaza’s economy is in shambles. Amy Goodman reports that “unemployment and poverty rates are among the highest in the world” and that “despite international pledges of over $5.2 billion to rebuild Gaza, in the four months since Israel’s assault the siege has not been lifted and only one truck carrying cement and other construction materials has been allowed entry into the Gaza Strip”.
And the Israeli newspaper Haaretz informs that John Ging, head of the UN Relief and Works Agency in Gaza, declared that the amount of goods Israel permits even today into the territory, where some 1.5 million people live, is “wholly and totally inadequate” and that “the United Nations aid official in the Gaza Strip urged Israel on Friday to ease restrictions on the flow of goods into the conflict-torn territory, saying they were “devastating” for the people”. Yet Israeli security forces claim that restrictions cannot be eased because Hamas can use whatever materials it gets to build rockets. Including pasta. Yep, pasta, which accroding to Haaretz and even other mainstream media until last month was not allowed into the Strip, until an international outcry eased its entry.
Finally, writer and film maker Philip Risk points out that while over 1400 were killed during the invasion, “Gaza wears a face of misery” on a regular basis, and “Gazans die because of all sorts of causes that we don’t hear sufficiently about in the media. The sewage system is horrible, water is polluted and diseases are becoming an increasing phenomenon in Gaza. Hospitals can’t cope because they face electricity shortages; a lot of Palestinians are in desperate need of kidney dialysis, the kinds of diseases that are out there are getting worse, it’s simply not a livable space”.
Fact-finding mission into medically-related violations in the Gaza Strip during 27.12.08-18.01.09
In their report, the experts detail 44 testimonies by civilians who came under attack and by medical staff who were prevented from evacuating the wounded. The report provides first-hand evidence regarding the broader effects of the attacks on a civilian population that was already vulnerable on the eve of the offensive.
The experts collected samples of human tissue earth, water, grass and mud suspected to be contaminated by unidentified chemicals. These were sent by the team to laboratories in the UK and South Africa for analysis.
During the military operation in January, Physicians for Human Rights-Israel called for an external independent investigation into the events, for the rehabilitation of the Gaza Strip and for the opening of the Crossings.
Five independent experts in the fields of forensic medicine, burns, medical response to crises and public health, from Germany, Denmark, South Africa and Spain, immediately answered the call and traveled to Gaza between 29 January and 5 February 2009 for their first fact-finding investigation, and then to hospitals in Egypt, where some of the most seriously wounded were being treated.
The medical experts are: Professor Jorgen Thomsen from Denmark, expert in Forensic pathology; Dr. Ralf Syring from Germany, an expert in Public Health in crisis regions; Professor Shabbir Ahmed Wadee from South Africa, an expert in Forensic pathology; Professor Sebastian Van As from South Africa, an expert in Trauma surgery and Ms. Alicia Vacas Moro from Spain, an expert in International health.
From the conclusion of the report:
“…Besides the large-scale, largely impersonal destruction that the team witnessed and heard of, it was especially distressing to hear of individual cases in which soldiers had been within seeing, hearing and speaking distance of their victims for significant stretches of time, but despite the opportunity for ‘humanisation’, had denied wounded people access to lifesaving medical care, or even shot at civilians at short range…”
One of the testimonies in the report describes the aftermath of an attack. Muhammad Saad Abu Halima had lost two brothers and a young sister; his wife and daughter were wounded. He told the delegation his experience of evacuation:
“…We were going down the street Kamal Adwan, and we had almost reached the school when the soldiers halted us. A tank appeared on the street and stopped close to the school. The soldiers were occupying the second floor of a building which was only 20 meters away from the street. They could see that we were all wounded and dirty from the explosions, because the tractor was open at the back. They shot at us, killing my cousins Matar Saad Abu Halima and Muhammad Hikma Abu Halima, who were driving us to the hospital. The soldiers ordered us to get out of the tractor, and they asked me to take off my clothes. I did it and they checked all my body. I think they were looking for explosives, but we were all injured and in pitiful conditions. How could we think of carrying explosives when my younger siblings and my own children were dying? Then, when I was almost expecting death, they shouted at me: “you can get dressed and go”. They did not allow us to use the tractor.
I held my sister Shahed in my arms … but the soldiers said that the baby was already dead, so they forced me to leave her in the car. I tried to help my wife Ghada, who was completely burned, and they forced us to walk to the hospital. For about 300 meters the soldiers were shooting at our feet as we walked, raising so much dust that the wounds of my wife became full of dirt. After a while we saw a lorry on the road. It was overcrowded with people going to the hospital after the heavy attacks, but they made us room and we arrived at Shifa’ Hospital….”
Another testimony in the report tells the story of the Abed Rabbo family. Souad Abed Rabbo, 54, told the team that the soldiers called to the family to exit their house. She, her daughter-in-law and her three granddaughters exited the house holding white flags:
“Outside the house there was an Israeli tank. It had come from the west towards the house that was facing north. It was 11.30 – 12.00. The tank was in the garden about ten meters from her, when she stopped to receive permission to leave unharmed. On her right side were the three girls; behind her was the daughter in law close to the door of the house. The soldier on the tank never replied. They were looking into each others´ eyes for 7-10 minutes, when suddenly a soldier opened fire and shot the granddaughter of the witness, Souad, in the neck and chest. She died immediately. They also shot Amal. She was hit in the chest and abdomen, and the interviewee saw her intestines come out. Amal died a little later. The daughter in law ran immediately into the house and was not hurt. The witness Souad Abed Rabbo was hit twice, as she turned around in a clockwise movement. She was hit in the left arm and in the left buttock. She did not see who shot. She assumed that the shots were fired from gun(s) not from the tank, but she was not certain. She saw three soldiers on top of the tanks holding weapons…Samar was hit in the chest with the bullet coming out of the back…at the time of the interview she was in a hospital in Belgium suffering paralysis.”
In their concluding remarks, the experts say:
“The underlying meaning of the attack on the Gaza Strip, or at least its final consequence, appears to be one of creating terror without mercy to anyone. Nearly all the people we spoke to slept cuddled together with the other members of their family in a central room of the house during the three weeks of attack. No one knew where or when the next bomb or explosion would occur. It appears that the wide range of attacks with sophisticated weaponry was predominantly focussed on terrorising the population. …”
Hadas Ziv, Executive Director of Physicians for Human Rights-Israel:
The military was well aware that such an attack on a densely populated area would exert a terrible toll on the civilian population. It was the Israeli Army’s responsibility to secure a way for the civilian population to flee the zone of combat.
At the moment, three things need to be done:
- A rigorous, transparent, and independent investigation should be conducted, one in which the victims’ voices will be heard. The newly appointed investigative committee of the Human Rights Council is an important step in this direction. We hope Israel will fully cooperate with it.
- There is also an urgent need to open the Crossings and to allow the rehabilitation of Gaza.
- Israeli society needs to understand and assert its responsibility to end the culture of impunity so that such severe violations of international law and medical ethics will not occur in the future.
Add a comment March 26th, 2009 by Claudia Chaufan
If anybody is around, this looks like an interesting event, addressing an unfortunately very current topic:
March 26, 2009, 05:00 PM – 06:30 PM
NYU Wasserman Center – Presentation Room A
133 East 13th Street (in between 3rd and 4th)
(this event requires RSVP — click here)
Join us as Victor Sidel, world renowned expert on the public health consequences of war, outlines the important role health workers have to play in a century increasingly defined by ongoing warfare and global discord.
Victor Sidel is a graduate of Princeton University with honors in physics and of Harvard Medical School with honors in biophysics. After training in internal medicine and in biophysics at Harvard Medical School and at the National Heart Institute in Bethesda, he headed the Community Medicine Unit at the Massachusetts General Hospital and studied epidemiology and biostatistics at the Harvard School of Public Health, the Centers for Disease Control and the London School of Hygiene and Tropical Medicine. He moved to the Bronx in 1969 to chair the Department of Social Medicine at Montefiore Medical Center and the Albert Einstein College of Medicine and was appointed Distinguished University Professor of Social Medicine in 1984. He is also Adjunct Professor of Public Health at Weill Medical College of Cornell University.
Dr. Sidel served as president of the American Public Health Association in 1985 and of the Public Health Association of New York City in 1980-81 and in 2000-1. He has also been a member of the Board of Directors of Physicians for a National Health Program. Since 1974 Dr. Sidel has been chair of the Institutional Review Board for Protection of Human Subjects at Montefiore and has lectured and published on topics in medical ethics.
Dr. Sidel is also deeply involved in international health work and in 1971 was a member of the first U.S. medical delegation invited to the People’s Republic of China in 20 years; he has studied health care in a dozen other countries, and has been a consultant for the World Health Organization and the United Nations Children’s Fund (UNICEF). He was one of the founders of Physicians for Social Responsibility (PSR) in 1961 and was its president in 1987-88.
In 1980 he was one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW), the recipient of the 1985 Nobel Prize for Peace, and was its co-president from 1993 to 1998. He has spoken and published widely on the economic, social, environmental and health consequences of the arms race, on the risks posed by the proliferation of nuclear, chemical and biological weapons and on the diversion of resources and the curtailment of human rights entailed in responses to the threat of bioterrorism.
Dr. Sidel is co-editor with Dr. Barry Levy of War and Public Health (Oxford University Press, 1997; updated paperbound edition, American Public Health Association, 2000) and of Terrorism and Public Health (Oxford University Press, 2003)
1 Comment March 10th, 2009 by bronxdoc
In the latest issue of Social Medicine we have published an article by Howard Waitzkin and Marylou Noble describing the Civilian Medical Resources Network. The Network is an association of health care providers who give free or very low cost care to active duty GI’s who feel unsatisfied with the care they receive in the military. The article reviews some of the difficulties with military medicine. These include dual agency (a conflict of interest between duty to the patient and duty to the military) and the privitization of military health care services. In addition the article describes the clinical presentations – often dramatic – of soliders seeking assistance from the network.
We reprint here the abstract. The full article is available at this link. Readers interested in further information may want to visit the News and Resources page of the Network’s website.
Abstract
Due to the wars in Iraq and Afghanistan, the unmet medical and psychological needs of military personnel are creating major challenges. Increasingly, active duty military personnel are seeking physical and mental health services from civilian professionals. The Civilian Medical Resources Network attempts to address these unmet needs. Participants in the Network include primary care and mental health practitioners in all regions of the country. Network professionals provide independent assessments, clinical interventions in acute situations, and documentation that assists GIs in obtaining reassignment or discharge. Most clients who use Network services come from low-income backgrounds and manifest psychological rather than physical disorders. Qualitative themes in professional-client encounters have focused on ethical conflicts, the impact of violence without meaning (especially violence against civilians), and perceived problems in military health and mental health policies. Unmet needs of active duty military personnel deserve more concerted attention from medical professionals and policy makers.
posted by Matt Anderson, MD
Add a comment March 5th, 2009 by bronxdoc
Our on-line journal Social Medicine has issued a call for papers on the theme War and Social Medicine. Dr. Victor Sidel (vsidel@montefiore.org) is serving as guest editor for this issue. The deadline for articles is 5/15/2009. The full call for papers is as follows:
War and militarism are important topics for social medicine theory and practice. As former U.S. President Jimmy Carter writes in his introduction to War and Public Health: “War and militarism have catastrophic effects on human health and well-being. These effects include casualties during war, long-lasting physical and psychological effects on noncombatant adults and children, the reduction of human and financial resources available to meet social needs, and the creation of a climate in which violence is a primary mode of dealing with conflict.”
Relevant topics include the role that the principles and practice of social medicine may play in the prevention of war and in reduction of its health and social consequences, the roles that health workers play in war and its prevention, the impact of war injuries and deaths on the practice of social medicine, and the impact of the diversion of resources to war and militarism from education and training of health workers and from health and social programs.
Authors describing original research, practical applications, or historic information relevant to the theme of this special issue are invited to submit their work in either Spanish or English. We are also interested in audio interviews, photographs and short films describing the daily experience of healthcare workers. Social Medicine is an international, open-access, peer-reviewed academic forum for the development and promotion of Social Medicine. The journal is published quarterly in English & Spanish.
Deadline for submissions for this special edition is May 15, 2009. For more information on this special issue authors should contact guest editor:
Dr Victor Sidel (vsidel@montefiore.org)
General guidelines for submission to the journal are available at www.socialmedicine.info.
1 Comment December 31st, 2008 by bronxdoc
Year end is time for taking stock. So it seems an appropriate moment to remember what Project Censored has called one of the top 25 stories censored stories of 2008, namely the massive death toll that has come in the wake of the 2003 US-led invasion of Iraq. Some have estimated this death toll to be well in excess of 1 million (see counter).
It is clearly difficult to make a precise measure of the deaths that can be attributed to the invasion and occupation of Iraq. In this posting we would like to review some of the attempts to come up with an estimate.
Two peer reviewed papers estimating the mortality impact of the war have been published in the Lancet. The first, from October 29, 2004, is entitled Mortality before and after the 2003 invasion of Iraq: cluster sample survey. The authors conducted in-depth interviews with 998 households during the month of September 2003. They compared mortality in the 14.6 months before the invasion with that of the 17.8 months afterwards, finding that the risk of dying was 2.5 times higher after the invasion. Much of this increased risk reflected deaths in Fallujah. But even if these were excluded, the risk of death was still 1.5 times higher after the invasion. In terms of absolute numbers this meant “about 100,000 excess deaths.” This study was updated in an October 11, 2006 paper “Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey” in which 1849 households were interviewed. This study concluded that “[t]he number of people dying in Iraq has continued to escalate” and calculated the excess mortality as 654 965 (CI: 392 979–942 636).
These studies came under both considerable criticism as well as marked media silence (particularly in the US). The controversy surrounding the papers is well summarized on Wikipedia. Concerns about a US media blackout can be found at Project Censored and were the subject of a paper by Lila Gutterman in the Chronicles of Higher Education entitled “Researchers Who Rushed Into Print a Study of Iraqi Civilian Deaths Now Wonder Why It Was Ignored“. (Gutterman’s article provides a non-technical description of the study).
There are three other relatively official estimates of the Iraqi death toll:
In January of 2008 the New England Journal of Medicine published “Violence-Related Mortality in Iraq from 2002 to 2006.” This paper was produced by the Iraq Family Health Survey Study Group, a joint effort of the Iraq Ministry of Health and the WHO. The study looked at 1086 families and estimated that there had been 151,000 (95% CI 104,000 to 223,000) violence-related deaths from March 2003 through June 2006. In their conclusions the authors note: “Violence is a leading cause of death for Iraqi adults and was the main cause of death in men between the ages of 15 and 59 years during the first 3 years after the 2003 invasion. Although the estimated range is substantially lower than a recent survey based estimate, it nonetheless points to a massive death toll, only one of the many health and human consequences of an ongoing humanitarian crisis.” Editorial comment and responses to the study were published in the same issue.
Also in January of 2008 ORB (Opinion Research Business), a London-based firm released revised death figures based on polls conducted in Iraq. They calculated a death rate of 1,033,000 (CI: 946,000 to 1,120,000). This is the largest estimate so far.
Finally, the Iraqi Body Count Project attempts to follow the civilian death toll through media reports. When we checked on their website today (12/31) that estimate was 90,147 to 98,413. Since it is highly likely that the media under-report civilian deaths, it’s hard to know exactly what to make of these numbers.
The number shown in the counter in this posting is derived from the Lancet 2006 study and a rate of increase calculated from the Iraqi Body Count data. See here for more details.
A recent draft history of the War by the Special Inspector General for Iraqi Reconstruction (SIGIR) concluded the War was (in the words of the New York Times) “a $100 billion dollar failure.” The SIGIR draft report closes by quoting Charles Dickens:
“We spent as much money as we could and got as little for it as people could make up their minds to give us.”
This, of course, is the monetary cost. The loss of human life is incalculable. And whether the death toll is merely 151,000 plus or 1 million plus, it’s a horrendous way to spend $100 billion. Who has profited from this? Surely not the people of Iraq or the United States.
Readers interested in anti-war activism and news may want to visit the website of the American Friends Service Committee.
Pax tecum.
posted by Matt Anderson
