- Email: [email protected]
Syria: a health crisis too great to ignore
Editorial
AFP/Stringer/Getty
Syria: a health crisis too great to ignore
For the evidence update see http://webtv.un.org/search/idcommission-of-inquiry-on-syria20th-meeting-32nd-regularsession-of-human-rights-council/ 4962898194001?term=Human% 20Rights%20Council&languages= &sort=date#full-text For the statement by PHR see http://physiciansforhumanrights. org/press/press-releases/deadlyaleppo-airstrikes-damage-twosyrian-hospitals.html For the report on crimes against Yazidis see http://www.ohchr.org/ Documents/HRBodies/HRCouncil/ CoISyria/A_HRC_32_CRP.2_en.pdf
Last week, the Independent International Commission of Inquiry on the Syrian Arab Republic gave an evidence update to the 32nd session of the UN Human Rights Council in Geneva, Switzerland. It reported that the Syrian Government was conducting daily air strikes in the country amid indiscriminate attacks by militant groups, including ISIS. Paulo Pinheiro, chair of the Commission, said that schools, hospitals, mosques, and water stations “are all being turned into rubble” and tens of thousands of people were trapped between front lines and international borders. He noted that the attacks on medical facilities have left access to health care impossible in some areas and, since the start of the conflict 5 years ago, 700 doctors and medical workers have been killed, many in air strikes. As the needs of civilians in Syria increase, medical assistance is being decimated and, in many cases, deliberately targeted. On June 8, two more hospitals were attacked. Aerial strikes damaged the al-Bayan trauma facility and al-Hakim paediatric hospital in opposition-controlled areas of Aleppo. Both facilities are now out of service, according to Physicians for Human
Rights (PHR) and their partners on the ground. In total, PHR has documented 365 attacks on 259 medical facilities during the Syrian conflict. Violence against civilians continues, including the deliberate targeting of some minority groups. On June 15, the same Independent Commission on Syria released a report on ISIS’s crimes against the Yazidis in Syria. It concludes that ISIS has committed, and continues to commit, genocide against the Yazidis through not only killings but also sexual slavery, enslavement, torture, and inhumane and degrading treatment. Attacks on medical personnel, facilities, and civilians in conflicts are unacceptable, and they are war crimes. What has become frighteningly apparent is that such crimes are a prevailing and increasing feature of the Syrian conflict. The UN Security Council and international community need to return to the negotiating table to find solutions for peace, stability, and upholding of humanitarian law in this war-devastated nation. The horrors of Syria are too great to ignore. The Lancet
Maskot/Getty
Substance use in young people
For the American Academy of Paediatrics’ new guidance on adolescent substance use see http://pediatrics.aappublications. org/content/pediatrics/ early/2016/06/16/ peds.2016-1211.full.pdf For the Lancet Psychiatry Series on Substance use in Young People see http://www. thelancet.com/series/adolescentsubstance-misuse
2
Last week the American Academy of Paediatrics published new guidance for clinicians treating adolescents and children who misuse substances, including alcohol, marijuana, and tobacco. The report focuses on the public health impact of substance use on this high-risk population group, and recommends a cycle of substance use screening, brief intervention, and referral to treatment (known as SBIRT). By their final school year (17 or 18 years old) 68% of American children have tried alcohol, and more than half report that they have been drunk at least once. Marijuana use is on the increase; with 45% of 15–18 year olds having used this drug, and 24% in the past 30 days; tobacco use remains fairly stable at 41% of this group having smoked, and more than half of 17–18 year olds report previously using an alternative illicit drug. Confidentiality and trust are sensitive areas and need to be considered on a case-bycase basis. According to the report, heavy use of substances leading to frequent blackouts or dangerous behaviour could necessitate disclosure to a child’s parents. This guidance complements established confidentiality position
statements from professional bodies, including the American Medical Association and the American College of Obstetricians and Gynecologists. Screening is the first SBIRT step to identify individuals at risk, and can be used to define ongoing clinical care. The guidance includes tables that link frequency of substance use with corresponding follow-ups, and provides standard pathways for alcohol, marijuana, and tobacco. Positive reinforcement is recommended for adolescents who report no substance use, as evidence shows it delays onset of eventual use. This guidance is brief and clear, and will provide practical help to clinicians. Against a backdrop of liberalisation of cannabis laws in some states, clinicians face increased pressure to make correct assessments. Further evidence is still needed to support intervention, as research has shown that brief interventions are not always effective. Until then, clarifying implementation of risk assessments and recommendations for subsequent treatment options will be welcomed by paediatricians in the USA. The Lancet www.thelancet.com Vol 388 July 2, 2016
AFP/Stringer/Getty
Syria: a health crisis too great to ignore
For the evidence update see http://webtv.un.org/search/idcommission-of-inquiry-on-syria20th-meeting-32nd-regularsession-of-human-rights-council/ 4962898194001?term=Human% 20Rights%20Council&languages= &sort=date#full-text For the statement by PHR see http://physiciansforhumanrights. org/press/press-releases/deadlyaleppo-airstrikes-damage-twosyrian-hospitals.html For the report on crimes against Yazidis see http://www.ohchr.org/ Documents/HRBodies/HRCouncil/ CoISyria/A_HRC_32_CRP.2_en.pdf
Last week, the Independent International Commission of Inquiry on the Syrian Arab Republic gave an evidence update to the 32nd session of the UN Human Rights Council in Geneva, Switzerland. It reported that the Syrian Government was conducting daily air strikes in the country amid indiscriminate attacks by militant groups, including ISIS. Paulo Pinheiro, chair of the Commission, said that schools, hospitals, mosques, and water stations “are all being turned into rubble” and tens of thousands of people were trapped between front lines and international borders. He noted that the attacks on medical facilities have left access to health care impossible in some areas and, since the start of the conflict 5 years ago, 700 doctors and medical workers have been killed, many in air strikes. As the needs of civilians in Syria increase, medical assistance is being decimated and, in many cases, deliberately targeted. On June 8, two more hospitals were attacked. Aerial strikes damaged the al-Bayan trauma facility and al-Hakim paediatric hospital in opposition-controlled areas of Aleppo. Both facilities are now out of service, according to Physicians for Human
Rights (PHR) and their partners on the ground. In total, PHR has documented 365 attacks on 259 medical facilities during the Syrian conflict. Violence against civilians continues, including the deliberate targeting of some minority groups. On June 15, the same Independent Commission on Syria released a report on ISIS’s crimes against the Yazidis in Syria. It concludes that ISIS has committed, and continues to commit, genocide against the Yazidis through not only killings but also sexual slavery, enslavement, torture, and inhumane and degrading treatment. Attacks on medical personnel, facilities, and civilians in conflicts are unacceptable, and they are war crimes. What has become frighteningly apparent is that such crimes are a prevailing and increasing feature of the Syrian conflict. The UN Security Council and international community need to return to the negotiating table to find solutions for peace, stability, and upholding of humanitarian law in this war-devastated nation. The horrors of Syria are too great to ignore. The Lancet
Maskot/Getty
Substance use in young people
For the American Academy of Paediatrics’ new guidance on adolescent substance use see http://pediatrics.aappublications. org/content/pediatrics/ early/2016/06/16/ peds.2016-1211.full.pdf For the Lancet Psychiatry Series on Substance use in Young People see http://www. thelancet.com/series/adolescentsubstance-misuse
2
Last week the American Academy of Paediatrics published new guidance for clinicians treating adolescents and children who misuse substances, including alcohol, marijuana, and tobacco. The report focuses on the public health impact of substance use on this high-risk population group, and recommends a cycle of substance use screening, brief intervention, and referral to treatment (known as SBIRT). By their final school year (17 or 18 years old) 68% of American children have tried alcohol, and more than half report that they have been drunk at least once. Marijuana use is on the increase; with 45% of 15–18 year olds having used this drug, and 24% in the past 30 days; tobacco use remains fairly stable at 41% of this group having smoked, and more than half of 17–18 year olds report previously using an alternative illicit drug. Confidentiality and trust are sensitive areas and need to be considered on a case-bycase basis. According to the report, heavy use of substances leading to frequent blackouts or dangerous behaviour could necessitate disclosure to a child’s parents. This guidance complements established confidentiality position
statements from professional bodies, including the American Medical Association and the American College of Obstetricians and Gynecologists. Screening is the first SBIRT step to identify individuals at risk, and can be used to define ongoing clinical care. The guidance includes tables that link frequency of substance use with corresponding follow-ups, and provides standard pathways for alcohol, marijuana, and tobacco. Positive reinforcement is recommended for adolescents who report no substance use, as evidence shows it delays onset of eventual use. This guidance is brief and clear, and will provide practical help to clinicians. Against a backdrop of liberalisation of cannabis laws in some states, clinicians face increased pressure to make correct assessments. Further evidence is still needed to support intervention, as research has shown that brief interventions are not always effective. Until then, clarifying implementation of risk assessments and recommendations for subsequent treatment options will be welcomed by paediatricians in the USA. The Lancet www.thelancet.com Vol 388 July 2, 2016