In the line of fire-Medical practice in times of war ISSUE 3
january 2007 1
editorial
by sunita DE SOUSA
1
by gail brenda cross
Mind over War
mind over war
2
BY KARL RUHL
2
BY DR ANDREW PERRY
3
IHN UPDATE
interview with PHILIPPE TANGUY BOOK REVIEW
BY KARL RUHL
3-4 NEWS REVIEW BY JACQUI MCDONNELL 4
links & resources
BY KATHRYN LOON
Editorial W
ar is a battle of physical and technological might. Armed forces attack each other to push a political regime whether it be totalitarianism or puppet democracy. Regardless of the political drama, the civilians of invaded countries are the most brutally harmed. Whilst the big governments waging war will undoubtedly ride through these troubling times like guntooting cowboys, the citizens of nations in war will continue to be under siege. What these people need might be democracy, but it is so much more than that. Citizens of nations under fire need refuge, food, clean water and healthcare. It is time governments set aside some gun money and put this toward healthcare initiatives such as the refugee social interventions spoken of in this Issue’s Feature Article. Through reading this Issue of Vector, I hope you will understand how doctors can assist such healthcare initiatives and save lives in the line of fire
by Sunita De Sousa,
Editor of Vector
The incidence of frank psychiatric illness does however increase in conflict. Because much of the research is conducted on refugees in post-conflict settings, it is noted that Post Traumatic Stress Disorder (PTSD) and anxiety are the most frequent problems, but depression and somatoform disorders also feature. In fact, 5 million of the 50 million refugees worldwide in 1999 were found to have chronic mental disorders. Another 5 million had psychosocial dysfunction affecting how they lived. The WHO insists that psychological support should be delivered along side the provision of food, water, basic health care, shelter and security. Unfortunately, such psychological interventions are limited by the capacity and training of field workers and resources. In addition, without adequate assessment and understanding of the socio-cultural undercurrents in a particular region, cultural differences can and have been mistaken for psychiatric illness. Collaborating with local non-government agencies and indigenous healers can alleviate this problem and make primary mental health care more sustainable. Here in Australia, we have not been immune to the psychological impact of war. Media accounts of suicide, self harm and depression amongst asylum seekers manifest the disgraceful conditions in detention centers from Woomera to Port Headland. The Medical Journal of Australia recently published data which shows that those granted temporary protection visas had levels of anxiety, PTSD and depression much more severe than those granted permanent asylum. Australia’s policy of mandatory detention for ‘illegal’ refugees and asylum seekers in stark penal like conditions, further deteriorating already traumatised minds, is in breach of the 1951 Refugee Convention to which Australia is a signatory. It is plainly inhumane. As members of the medical community, we must not rest on our laurels and remain ignorant of the moral and social consequences of war. The inevitable violation of human rights that follows from conflict, regardless of whose war it is, has an undeniable physical and psychological impact. Whether we advocate for the end of war altogether or fight for the right of refugees and asylum seekers to be treated with dignity, we need to mobilise as a profession to protect and prevent state-sponsored oppression here on our seemingly safe shores and beyond.
W
ars often destroy the fabric of society by generating terror to control populations. The trauma of forced killings, witnessed massacres, torture, sexual violence, detention and uprooting remain in personal and collective memories long after peace agreements and repatriation. Conflict needlessly inflicts its wrath on the most vulnerable and on the psyche of both combatants and civilians. As Kofi Annan leaves his office this month, he lamented that the situation in Iraq is much worse than civil war. Besides the conflict-related death and disease, the violence in the streets of Baghdad is symptomatic of the aggregated psychosocial trauma suffered by Iraqis. After three wars, routine human rights abuses under Sadam’s dictatorship and the abominable failed attempt to rebuild Iraq, it is no surprise that the Iraqi Ministry for Health records high rates of depression, anxiety and somatisation. Besides frank mental illness, family violence such as spouse and child abuse in these tense times also contributes significantly to the burden of disease. The distress most people experience in times of conflict is not in fact psychopathology, but a normal reaction to extraordinarily violent events. The use of psychiatric assessments and therapy in refugee camps is therefore often redundant. The World Health Organisation (WHO) accordingly advises aid groups to institute social interventions such as reuniting families, developing cultural spaces and restarting schools as a means of bolstering psychological defenses. People who operate as a community in cooperative solidarity are more likely to recover than an individual in a dingy room with a volunteer counselor.
by Gail Brenda Cross
“Empowering medical students in creating sustainable health improvements in developing communities”
[ ihn@amsa.org.au ]