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Irish Iitigation soars
THE LANCET
POLICY AND PEOPLE
Court ruling means that Egypt embraces female circumcision again Education to introduce a new section in the school curriculum stating that female circumcision is prohibited. The issue peaked 3 years ago when the International Conference on Population was held in Cairo. During the conference, the television channel, CNN, broadcast a programme
Panos Pictures
ast week, the Court of Administrative Law in Egypt overturned the decision of the country’s Minister of Health, Ismail Salaam, that female circumcision should be banned. This ruling has brought to a head the long-running debate on the legal and religious questions surrounding this issue. In its ruling, the court stated: “the decision to prohibit circumcision was unconstitutional and the minister has exceeded his powers”. It upheld the rights of parents to decide whether or not their daughter should be circumcised.Yousif El-Badri, the lawyer who brought the case before the court, supported by eight doctors, welcomed the ruling, stating that it complied with Islamic tradition and that the government’s stance was “an insult to women”. The ruling is regarded as a significant defeat for the Health Ministry, which has been ordered to pay legal costs, and to allow the procedure in public hospitals. The Ministry will appeal. This is the first of two such legal cases facing the government. On July 30, another court is to hear a challenge to the right of the Ministry of
L
Subject of legal and religious dispute
featuring a young girl being circumcised by a barber in Cairo. Worldwide outrage put pressure on the President to ban the procedure. But the government immediately came up against opposition from religious groups. In search of a compromise, the former Health Minister, Ali Abdul Fatah Omaar, stated: “We have no plans to ban this operation
by introducing legislation, but we are looking for ways for it to be carried out by qualified doctors and under proper medical supervision”. This change of policy was thought to reflect the power struggle between the two main sections of Egypt’s religious establishment. The government then formed a special committee to advise on the legislation. One of the prominent members of that committee, the Mufti of Egypt came out in favour of a ban on the operation stating: “This is a tradition and has no basis in Islamic law”. But, countering this, the Sheikh of Al Azhar stated that “Islamic law supports both male and female circumcision”. The government finally decided to ban circumcision, only to be blocked by the judiciary. It is clear that whatever is decided by the High Constitutional Court, which is to hear the appeal, the pressure for female circumcision remains very strong. One prominent Egyptian doctor was reported as saying “If my daughter is not circumcised, no man is going to marry her”. Peter Kandela
Irish litigation soars
Malaria outbreak hits refugees in Tanzania
M
D
edical lawsuits are so prevalent in Ireland that the country is now known as “America’s 51st state of the union” in medicolegal circles. So said Denis Cusack, director of the legal medicine section at University College Dublin, at an international conference in that city on June 24–26. Cusack pointed out that Irish doctors are four times more likely to be sued than doctors in England; eight times more likely than Scottish doctors, and 11 times more likely than doctors in Hong Kong. If an Irish plaintiff is successful, the level of damages for “pain and suffering” is two to three times more than in England. Despite the many lawsuits, most cases do not succeed. But the cost to the taxpayers for medical-indemnity premiums for non-consultant house doctors and public consultants works out to about £7 per person. Although the medical insurance companies refuse to give official figures, there are about 1000 cases pending.
Karen Birchard
Vol 350 • July 5, 1997
octors and aid workers are struggling to control an outbreak of malaria among Burundian refugees at a camp in Kibondo, north-west Tanzania. Worst affected is Nduta camp, home to 22 000 refugees who have been crossing the border 20 km away since Major Pierre Buyoya’s Tutsi faction returned to power last July. Doctors first noticed malaria mortality rising steeply in mid-March, especially among children under 5 years old. Before the outbreak, under-5 mortality from malaria and anaemia was stable at about one death per week. It is now around ten deaths per week. Total mortality from malaria has been running at 18–20 deaths per week, and has only begun to fall in the past 2 weeks. Malaria incidence peaked at 37 cases per 1000 in June (about 800 cases), before falling to about half that figure 2 weeks ago. “The rise we saw began quite quickly, and has risen to well above acceptable numbers”, said Shairose Mawji, team leader for the International Rescue Committee, which provides medical services to
the four camps in the area. “These people are coming from an area where there is not much malaria, so that’s why we have a problem with the under-5s who may have no immunity.” She added that many refugees’ nutritional status was poor because they are used to a diet rich in fresh fruit and vegetables. In the camp they receive 30 g of fortified corn-soya blend daily. One problem is that there are few data on resistance to chloroquine, which Tanzanian Ministry of Health guidelines say should be first-line treatment. Mawji said that a crude evaluation of 369 people who had been treated with chloroquine and fansidar, and who were still febrile, revealed that 46% still had parasites. The International Red Cross has formed a malaria task force, involving other agencies in the camp as well as local health officials in vector control. However, Mawji said that some agencies had clearly felt it was not a multifactorial problem, but primarily the responsibility of health workers. Sam Crowe
41
POLICY AND PEOPLE
Court ruling means that Egypt embraces female circumcision again Education to introduce a new section in the school curriculum stating that female circumcision is prohibited. The issue peaked 3 years ago when the International Conference on Population was held in Cairo. During the conference, the television channel, CNN, broadcast a programme
Panos Pictures
ast week, the Court of Administrative Law in Egypt overturned the decision of the country’s Minister of Health, Ismail Salaam, that female circumcision should be banned. This ruling has brought to a head the long-running debate on the legal and religious questions surrounding this issue. In its ruling, the court stated: “the decision to prohibit circumcision was unconstitutional and the minister has exceeded his powers”. It upheld the rights of parents to decide whether or not their daughter should be circumcised.Yousif El-Badri, the lawyer who brought the case before the court, supported by eight doctors, welcomed the ruling, stating that it complied with Islamic tradition and that the government’s stance was “an insult to women”. The ruling is regarded as a significant defeat for the Health Ministry, which has been ordered to pay legal costs, and to allow the procedure in public hospitals. The Ministry will appeal. This is the first of two such legal cases facing the government. On July 30, another court is to hear a challenge to the right of the Ministry of
L
Subject of legal and religious dispute
featuring a young girl being circumcised by a barber in Cairo. Worldwide outrage put pressure on the President to ban the procedure. But the government immediately came up against opposition from religious groups. In search of a compromise, the former Health Minister, Ali Abdul Fatah Omaar, stated: “We have no plans to ban this operation
by introducing legislation, but we are looking for ways for it to be carried out by qualified doctors and under proper medical supervision”. This change of policy was thought to reflect the power struggle between the two main sections of Egypt’s religious establishment. The government then formed a special committee to advise on the legislation. One of the prominent members of that committee, the Mufti of Egypt came out in favour of a ban on the operation stating: “This is a tradition and has no basis in Islamic law”. But, countering this, the Sheikh of Al Azhar stated that “Islamic law supports both male and female circumcision”. The government finally decided to ban circumcision, only to be blocked by the judiciary. It is clear that whatever is decided by the High Constitutional Court, which is to hear the appeal, the pressure for female circumcision remains very strong. One prominent Egyptian doctor was reported as saying “If my daughter is not circumcised, no man is going to marry her”. Peter Kandela
Irish litigation soars
Malaria outbreak hits refugees in Tanzania
M
D
edical lawsuits are so prevalent in Ireland that the country is now known as “America’s 51st state of the union” in medicolegal circles. So said Denis Cusack, director of the legal medicine section at University College Dublin, at an international conference in that city on June 24–26. Cusack pointed out that Irish doctors are four times more likely to be sued than doctors in England; eight times more likely than Scottish doctors, and 11 times more likely than doctors in Hong Kong. If an Irish plaintiff is successful, the level of damages for “pain and suffering” is two to three times more than in England. Despite the many lawsuits, most cases do not succeed. But the cost to the taxpayers for medical-indemnity premiums for non-consultant house doctors and public consultants works out to about £7 per person. Although the medical insurance companies refuse to give official figures, there are about 1000 cases pending.
Karen Birchard
Vol 350 • July 5, 1997
octors and aid workers are struggling to control an outbreak of malaria among Burundian refugees at a camp in Kibondo, north-west Tanzania. Worst affected is Nduta camp, home to 22 000 refugees who have been crossing the border 20 km away since Major Pierre Buyoya’s Tutsi faction returned to power last July. Doctors first noticed malaria mortality rising steeply in mid-March, especially among children under 5 years old. Before the outbreak, under-5 mortality from malaria and anaemia was stable at about one death per week. It is now around ten deaths per week. Total mortality from malaria has been running at 18–20 deaths per week, and has only begun to fall in the past 2 weeks. Malaria incidence peaked at 37 cases per 1000 in June (about 800 cases), before falling to about half that figure 2 weeks ago. “The rise we saw began quite quickly, and has risen to well above acceptable numbers”, said Shairose Mawji, team leader for the International Rescue Committee, which provides medical services to
the four camps in the area. “These people are coming from an area where there is not much malaria, so that’s why we have a problem with the under-5s who may have no immunity.” She added that many refugees’ nutritional status was poor because they are used to a diet rich in fresh fruit and vegetables. In the camp they receive 30 g of fortified corn-soya blend daily. One problem is that there are few data on resistance to chloroquine, which Tanzanian Ministry of Health guidelines say should be first-line treatment. Mawji said that a crude evaluation of 369 people who had been treated with chloroquine and fansidar, and who were still febrile, revealed that 46% still had parasites. The International Red Cross has formed a malaria task force, involving other agencies in the camp as well as local health officials in vector control. However, Mawji said that some agencies had clearly felt it was not a multifactorial problem, but primarily the responsibility of health workers. Sam Crowe
41