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Archive for the ‘Conflict’ Category

By Devika Nadkarni

On October 3rd, 2015, a Médecins Sans Frontières’ (MSF) Trauma center was bombed during an airstrike in Kunduz, Afghanistan (1). Ten patients and twelve staff members were killed at the facility – the only medical center operating in north-east Afghanistan that treated all people in need of trauma care regardless of political affiliation and ethnicity. MSF mobilized and launched a campaign for an independent investigation of the attacks that overtly thwarted the Geneva Conventions set forth to protect civilians and prisoners of war in regions of conflict. The organization drew attention to the patients that burned in their beds in the hospital, to the medical personnel that were forced to operate on their colleagues, to the MSF staff that had to carry on with their work while their team members died. They demanded nothing less than a transparent investigation without involvement from NATO, nor from Afghan and US forces to find an answer for their losses. The tragedy faced by MSF in Afghanistan shows the worst possible outcome of military intervention interfering in global health initiatives and emergency medical care (1).

The United Nations Security Council uses “humanitarian intervention” as a legitimate justification for armed intervention. The use of foreign military force (including unilateral state troops deployed on behalf of the United Nations) in conflict areas has had mixed effects on medical humanitarian initiatives – ranging from improvement to severe exacerbation of an already dire situation. In 2002, British troops were able to facilitate an end to the civil war in Sierra Leone – eventually allowing for elections to be held in the long divided nation. However, for every Sierra Leone there are countless genocides and civil wars where allegedly humanitarian troops encouraged and supported the perpetrators of violence (2). In his book, An Imperfect Offering, former MSF president Dr. James Orbinski highlights in excruciating and consuming detail instances of this occurring in Rwanda, Cambodia, and Kosovo, among many others (3). A telling excerpt from the book, detailing intervention by French forces in the Rwandan genocide in 1994, reads as follows:

“Some French officers were so disgusted by what their force was doing and not doing that they saw themselves as accomplices to a genocide that they had been told did not exist.”

France had provided arms and military training to the Hutu-led Interhamwe – the perpetrators of the genocide. Medical personnel from MSF and the Red Cross, among aid workers from other non-governmental organizations, witnessed the Interhamwe systematically slaughter 800,000 Tutsis and the mutilation of countless others – all of whom required medical treatment by increasingly small medical teams. When French troops were deployed to establish a safe zone – the Turquoise Zone – to end the genocide, they established a means of escape from justice for the Interhamwe and their supporters (3). It is clear that veiling armed force as humanitarian intervention can not only further war crimes and conflict fueled by states seeking out their own interests, but also hurt and overburden humanitarian operations that are already stretched to their limits. The purpose of the military is to put the interests of the state first – a purpose that in times of war can directly conflict with the purpose of humanitarianism – which is to put the basic needs and safety of people first. This difference in purpose is why unilateral military interventions are not humanitarian. It is time that states and inter-governmental organizations – including and especially the United Nations Security Council – stopped allowing states to use armed force under the guise of humanitarianism.

Following the outcry raised by MSF, the United States admitted to the airstrike in Kunduz – dismissing it as collateral damage before attempting to write it off as the responsibility of the Afghan government. MSF no longer operates the hospital in Kunduz, at a time when “the medical needs are immense”. The relationship between humanitarian agencies and the military forces is a complicated one (1). Indeed, the efforts of military forces have also had incredibly positive impacts on certain global health initiatives – most notably during the Ebola crisis, where the intense training of United States’ and British military personnel to withstand extreme conditions and in logistical command was essential to streamlining efforts to tackle the crisis (4). However, even in cases such as these it must be noted that while the military may provide for support existing humanitarian efforts, military interventions themselves are not humanitarian.

 

Works Cited

  1. “Kunduz Hospital Airstrike Share.” Médecins Sans Frontières. Médecins Sans Frontières, 05 Nov. 2015. Web. 22 Feb. 2016.
  2. “Intervention That Worked.” The Economist. The Economist Newspaper, 2002. Web. 22 Feb. 2016.
  3. Orbinski, James. An Imperfect Offering: Humanitarian Action for the Twenty-first Century. New York: Walker, 2008. Print.
  4. Lancet, The. “National Armies for Global Health?” The Lancet 384.9953 (2014): 1477. Web.
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By Annalee Mueller

The Syrian refugee crisis is not a new problem. Turkey alone has approximately 2.5 million refugees, and while the political implementations are consistently a media focus, the health issues are less obvious to the rest of the world. Efforts are being made to deal with health needs, though improvements still need to be made. I am naturally drawn to examine Turkey in this case, as it is the bridge that so many have chosen in order to enter other European countries.

Syria Refugee Population

 

Syrian Refugee Population in Turkey – Human Rights Watch 2015

 

The Current State

The majority of Syrian refugees, approximately 300,000, reside in refugee camps near the Turkish/Syrian border. In response to the lack of available health care, several international health organizations pushed and successfully established field hospitals within these camps. Data shows that these health facilities are quite efficient, serving 90 percent of those staying there. On the domestic side, the Turkish government provides refugees free primary care if registered and free emergency care regardless of registration status.[1]

 

However, there are two major problems with this current solution. First, while those within the camps are served well, those who are scattered throughout Turkey face challenges accessing the current community centered health care system. In response to this issue, the Turkish government agreed to assist the construction of ten additional outpatient clinics, despite their initial reluctance to work alongside international aid organizations.[2] Evaluations of this response show that only 60 percent of refugees actually use these outpatient clinics, leaving 880,000 out of a total of 2.2 million Syrian refugees in Turkey without adequate care.[3]

 

The issue is that continuous arrivals of refugees in 2015 have widened the gap between the demand for services and the capacity of the health infrastructure to respond, resulting in a decrease in quality. The WHO has helped, providing training to Syrian doctors working in Turkey, technical support for outbreak response and immunization campaigns, equipment and medications, and information materials.[4] These have been helpful, but health care workers have continued to face many challenges, including a language barrier and shortage of resources.

 

The Response Plan

The most recent information, published by the Office of the United Nations Commissioner for Refugees (UNHCR) and the United Nations Development Program, outlines where resources are currently going to improve the health situation.[5] There are five main points to the response plan, highlighting the need for mental health services, medication for chronic diseases, and improved disease surveillance. It also discusses strengthening health promotion and streamlining decision-making on behalf of the various players involved in these efforts.

 

In addition to examining overall themes of interest, the report also discusses specific issues affecting Turkey. The first examines the fact that vaccine-preventable diseases are a major concern to those living in communities. Another important reality is that 25 percent of Syrian refugees in Turkey are women of child-bearing age. 15 percent of child-deliveries are high-risk, highlighting the need for improved women’s health services. Thirdly, it addresses the concern of increased mental health issues shown by those coming from high conflict areas.[6] These, along with other health issues, are the driving force behind the plan’s objectives.

 

Relevance to a Global Health Student

As a student, it is easy to look at this information and be overwhelmed at the amount of work that needs to be done to solve such a long list of issues. However, there is much to be learned from the way the Turkish government is handling the crisis. As implementers of policy, it has provided a framework for other organizations to build off of. WHO and the UN Refugee Agency have taken the lead while also partnering with others to provide solutions for ongoing problems. The cooperation amongst these organizations is vital for providing both effective and efficient health care. Though the response has by no means been perfect, it has been largely successful, likely due to a burden shared amongst several organizations.

 

 

[1] “Regional Refugee and Resilience Plan 2015-2016: Turkey, in Response to the Syria Crisis.” 3RP. http://reliefweb.int

[2] Samari, Goleen. “The Response to Syrian Refugee Women’s Health Needs in Lebanon, Turkey and Jordan and Recommendations for Improved Practice.” Humanity in Action. http://www.humanityinaction.org/

[3] “Regional Refugee and Resilience Plan 2015-2016: Turkey, in Response to the Syria Crisis.” 3RP.  http://reliefweb.int

[4] “Syrian Refugees in Turkey.” Word Health Organization. http://www.euro.who.int

[5] “Regional Refugee and Resilience Plan 2016-2017: Turkey, in Response to the Syria Crisis” 3RP.

http://www.3rpsyriacrisis.org/

[6] “Regional Refugee and Resilience Plan 2016-2017: Turkey, in Response to the Syria Crisis” 3RP.

http://www.3rpsyriacrisis.org/

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-By Selin Thomas

For more than two years, the Syrian conflict has been intensely growing in historic scale and scope, with the United Nations estimating more than 100,000 dead and millions displaced. In the last two weeks, the U.N. Security Council has been urged to act on humanitarian aid to Syria because the only achievement to come out of peace talks has been a cease fire in Homs, leaving many aid workers still risking their lives daily. Today, more than two million have fled the country, an estimated 4.25 million have been displaced within the country. (more…)

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-By Babi Bose

Since the outbreak of the Syrian Civil War, nearly 2.5 million people have fled Syria to seek safety elsewhere. Many have relocated to Syria’s bordering countries: Turkey, Iraq, Jordan, Israel, and Lebanon. The quality of life in the refugee camps varies from location to location. In one camp in Kilis, Turkey, residents have to scan their fingerprints for entry, sanitation problems are nonexistent, schools have been established, and electricity is present (New York Times, 2014). Unfortunately, this is not the case with most refugee camps. As more people flee with each passing day the problems within refugee camps become more severe. Overcrowding has amplified sanitation problems contributing to the resurgence of once-rare diseases. In addition to rampant malnutrition, diseases like polio and measles have reemerged, and there have been outbreaks of tuberculosis, typhoid, hepatitis and dysentery (The New York Review of Books, 2014). However, it is not just the physical ailments of Syrian refugees that merit our attention. The need for mental health care among Syrian refugees is greater than ever, as many people struggle to cope with the overwhelming reality inflicted by the Syrian Civil War. It is truly an invisible crisis affecting an enormous amount of people. (more…)

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-By Nina Misra

In mid-December 2013, violence erupted in South Sudan, the world’s youngest country. The president, Salva Kiir, accused his former vice-president Riek Machar of planning to upstage the presidency. Kiir had eleven people associated with this planned coup arrested. Fighting first started in the capital, Juba, amongst Presidential guards. This conflict between Kiir and Machar turned into a war between ethnic groups. Kiir is somewhat followed by the Dinka people, while Machar is fully supported by the Nuer.  Machar says that “the conflict is not yet over”, and refuses to stop fighting until the eleven politicians are released from detention.  Machar says, “these are events of war”- events that include “extrajudicial killings, sexual violence, and massacres committed by both sides”. The death toll is unknown, and the violence unspeakable. The effects of the fighting are felt by all the citizens of South Sudan, even those who are not directly in the line of fire.  (more…)

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-By Grace Lillibridge

“You can never win a war against terror as long as there are conditions in the world that make people desperate — poverty, disease, ignorance.” – Nobel Peace Prize Laureate Archbishop Desmond Tutu

Since September 11, 2001, the government and the citizens of the United States have become obsessed with fighting the “War on Terror”. Thirteen years and billions of dollars later, the success of the operation is questionable. A majority of the United States’ effort in fighting terrorism focuses on the Middle East and Southeast Asia, where the number of Islamic extremist groups and anti-Western groups have increased since the twentieth-century, coinciding with the decolonization, westernization and increased involvement of the United States in the political and economic affairs of many countries in these regions. (more…)

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By Ambereen Baig

Polio, a highly infectious viral disease that causes permanent paralysis within a few hours has been largely eradicated throughout the world since the discovery of the vaccine. The only three countries in which polio remains an endemic is in Pakistan, Nigeria, and Afghanistan. The eradication of the few cases of polio left has been a worldwide effort since these three countries are at risk of threatening to spread polio once again.Video (Polio activities suspended in Dec. 2012 due to attacks on workers) (more…)

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