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The casualties of war
EDITORIAL
THE LANCET Volume 361, Number 9363
The casualties of war On March 20, 0316 h GMT, US President George W Bush announced that “American and coalition forces are in the early stages of military operations to disarm Iraq, to free its people, and to defend the world from grave danger”. After 4 months of intense diplomatic efforts by many governments and the leaders of the United Nations to avoid this moment, the divisions between those countries in favour of a pre-emptive war as a means to disarm Saddam Hussein and those against such conflict had proven too great to bridge. The consequences of this war are likely to be with us for a long time to come. But even now the bright light focused on Iraq casts dark shadows elsewhere. Ironically, Doha in Qatar, now the US central command centre, was not long ago a place of great hope for developing countries. It was there that the fourth World Trade Organisation Ministerial Conference was held to make progress on increasing access to essential medicines where they are most needed. Progress was stalled by the US government’s decision to block a draft plan agreed by all other WTO members. The impasse rests on the definition of what constitutes a public-health emergency, which would allow developing countries compulsory licensing and parallel importing of patented medicines. No new proposals were put forward at the latest meeting in February. The lack of urgency in these negotiations contrasted sharply with the arguments pressing the case for war in Iraq. Meanwhile, among those governments supporting the present war in Iraq are countries such as Eritrea and Ethiopia. Eritrea is one of the poorest nations in the world, at 157 out of 173 countries in the United Nations Development Programme’s Human Development Index for 2002. It is now, after a 2-year border conflict with Ethiopia, experiencing a period of severe drought with 2·3 of its 4·4 million people classified as vulnerable to famine according to UN representatives. Yet only a small percentage of the aid money asked for by the UN and pledged by rich nations has been given. At the end of April, Eritrea’s current stock of food aid will run out. Its willingness to be part of the coalition might come at a price. In the report Coalition of the willing or coalition of the coerced?, released on Feb 26 by the Institute for Policy Studies, a Washington-based think tank, the authors THE LANCET • Vol 361 • March 29, 2003 • www.thelancet.com
write: “almost all [coalition partners], by our count, join only through coercion, bullying, bribery, or the implied threat of US action that would directly damage the interests of the country”. If this assessment is proven to be correct, giving emergency and development aid to poor countries on the basis of such bilateral agreements is divisive and will not serve its true aim—to stabilise the security and economies of the world by combating disease and poverty. France’s President Jacques Chirac, much vilified in the UK and USA because of his belief that UN weapons inspectors should have been given more time to do their work, recently wrote in the International Herald Tribune: “globalization is a force for growth and development, yet its power to destabilize threatens the environment and poor countries . . . It is intolerable that billions of poor people are without access to medicine”. France, which has taken over the presidency of the Group of Eight nations and which chairs the next meeting in Evian in June, has put tackling disease, promoting sustainable development, and rolling back poverty top of its agenda for the forthcoming gathering. Against the grain of much present criticism of France, Chirac has led global efforts to secure justice for those peoples whose survival is under greatest threat. The French President argues that an evergrowing division between healthy and ill people will make the world a more dangerous place. Chirac is right. Disease and poverty are as much security issues as they are matters of health. Whatever divisions exist today, and they are deep, all western nations must find a way to work together in the future to bridge their differences. Winning peace through protecting the health of vulnerable peoples is a strategy that works, as experience in the Bosnian civil war showed. One can only hope for a speedy end to the present conflict in Iraq with the minimum number of injuries and casualties on all sides. But in searching for a resolution to the present war, which is likely to dominate our attention for many more weeks to come, physicians and public-health workers must not diminish their efforts to bring and advocate health—and peace—to disadvantaged peoples elsewhere in the world. The Lancet 1065
For personal use. Only reproduce with permission from The Lancet Publishing Group.
THE LANCET Volume 361, Number 9363
The casualties of war On March 20, 0316 h GMT, US President George W Bush announced that “American and coalition forces are in the early stages of military operations to disarm Iraq, to free its people, and to defend the world from grave danger”. After 4 months of intense diplomatic efforts by many governments and the leaders of the United Nations to avoid this moment, the divisions between those countries in favour of a pre-emptive war as a means to disarm Saddam Hussein and those against such conflict had proven too great to bridge. The consequences of this war are likely to be with us for a long time to come. But even now the bright light focused on Iraq casts dark shadows elsewhere. Ironically, Doha in Qatar, now the US central command centre, was not long ago a place of great hope for developing countries. It was there that the fourth World Trade Organisation Ministerial Conference was held to make progress on increasing access to essential medicines where they are most needed. Progress was stalled by the US government’s decision to block a draft plan agreed by all other WTO members. The impasse rests on the definition of what constitutes a public-health emergency, which would allow developing countries compulsory licensing and parallel importing of patented medicines. No new proposals were put forward at the latest meeting in February. The lack of urgency in these negotiations contrasted sharply with the arguments pressing the case for war in Iraq. Meanwhile, among those governments supporting the present war in Iraq are countries such as Eritrea and Ethiopia. Eritrea is one of the poorest nations in the world, at 157 out of 173 countries in the United Nations Development Programme’s Human Development Index for 2002. It is now, after a 2-year border conflict with Ethiopia, experiencing a period of severe drought with 2·3 of its 4·4 million people classified as vulnerable to famine according to UN representatives. Yet only a small percentage of the aid money asked for by the UN and pledged by rich nations has been given. At the end of April, Eritrea’s current stock of food aid will run out. Its willingness to be part of the coalition might come at a price. In the report Coalition of the willing or coalition of the coerced?, released on Feb 26 by the Institute for Policy Studies, a Washington-based think tank, the authors THE LANCET • Vol 361 • March 29, 2003 • www.thelancet.com
write: “almost all [coalition partners], by our count, join only through coercion, bullying, bribery, or the implied threat of US action that would directly damage the interests of the country”. If this assessment is proven to be correct, giving emergency and development aid to poor countries on the basis of such bilateral agreements is divisive and will not serve its true aim—to stabilise the security and economies of the world by combating disease and poverty. France’s President Jacques Chirac, much vilified in the UK and USA because of his belief that UN weapons inspectors should have been given more time to do their work, recently wrote in the International Herald Tribune: “globalization is a force for growth and development, yet its power to destabilize threatens the environment and poor countries . . . It is intolerable that billions of poor people are without access to medicine”. France, which has taken over the presidency of the Group of Eight nations and which chairs the next meeting in Evian in June, has put tackling disease, promoting sustainable development, and rolling back poverty top of its agenda for the forthcoming gathering. Against the grain of much present criticism of France, Chirac has led global efforts to secure justice for those peoples whose survival is under greatest threat. The French President argues that an evergrowing division between healthy and ill people will make the world a more dangerous place. Chirac is right. Disease and poverty are as much security issues as they are matters of health. Whatever divisions exist today, and they are deep, all western nations must find a way to work together in the future to bridge their differences. Winning peace through protecting the health of vulnerable peoples is a strategy that works, as experience in the Bosnian civil war showed. One can only hope for a speedy end to the present conflict in Iraq with the minimum number of injuries and casualties on all sides. But in searching for a resolution to the present war, which is likely to dominate our attention for many more weeks to come, physicians and public-health workers must not diminish their efforts to bring and advocate health—and peace—to disadvantaged peoples elsewhere in the world. The Lancet 1065
For personal use. Only reproduce with permission from The Lancet Publishing Group.