As this issue of Medicine, Conflict & Survival was being finalized efforts to contain outbreaks of diphtheria and cholera continued in Yemen, the Organisation for the Prohibition of Chemical Weapons (OPCW) was given the responsibility of attributing responsibility for attacks (not just establishing whether they had happened), two more people in Wiltshire, UK, had been exposed to a nerve agent and one had tragically died, more than 200 people drowned in the Mediterranean in 3 days as they tried to reach Europe and there were reports of medical posts being bombed in the Syrian city of Daraa. Appropriately – and tragically – these events are relevant for several of the articles in this issue.
The need for international agreements on how to investigate and verify the use of prohibited weapons, including in charged political environments, has never been clearer. Whether the recent agreement that the OPCW can attribute responsibility as well as establish use is a positive step or simply exposes it to more political pressure remains to be seen. As Leo van Bergen said when he spoke at a subsequent OPCW conference on the Medical Treatment of Victims of Chemical Weapons at the end of June 2018, the epidemiology around the use of such weapons can be complicated – despite the impressive work the organization has done over the years.
The abolition of other weapons with unimaginably dire health consequences took significant steps forward when 122 countries voted for the Treaty for the Prohibition of Nuclear Weapons in July 2017 and when the International Campaign to Abolish Nuclear Weapons (ICAN) was awarded the Nobel Peace Prize in October 2017 (see issue 33.4). One of the objections to the Treaty raised by the states that did not sign – a list that included all the nuclear weapon states – was that the Treaty would undermine the Non-Proliferation Treaty. Egeland, Hugo, Løvold and Nystuen’s clear and incisive article in this issue lays out and then refutes objections to the Treaty made on these grounds. It makes it clear that objections to the Treaty by the nuclear weapons states is not surprising as it is ‘specifically designed to delegitimize all nuclear weapons’ and ‘revokes any “natural right” to possess nuclear weapons on the grounds that these weapons are inherently inhumane’ (P6).
The study of physical violence is one crucial aspect of the study of peace. In their article on levels of combatant control and patterns of insurgent violence in Iraq, Poulson and Burke isolate one social–structural variable ‘control over communities during the Iraq civil war’ (P1) and use it to show trends in the type and extent of violence used by insurgents. Their detailed and qualified analysis of data from the Iraq Body Count makes a significant addition to understanding the types and consequences of violence civilians experience when territory is contested and control shifting between different combatants.
The link between sickness, death and conflict is as old as the hills, but there can be a tendency to forget. Flecknoe’s article on the ‘Spanish’ flu epidemic as a lesson from history reminds us that these links can be related not just to the destruction of infrastructure but also the movement of troops and the reluctance of those in power to admit what might damage their chances of success. History can also warn against what can happen with the best motives. In the second article in our ‘Lest we Forget’ series, Leo van Bergen highlights the history of the Dutch Committee for War Prophylaxis which existed in the 1930s – a reminder of previous attempts to draw the medical profession into defining war as a disease and taking a stand against its inevitability, and the dangers that lurk if medical neutrality becomes a dogma and turns into an instrument of defence of the status quo and social injustice.
Europe’s policies on refugees trying to cross its borders continue to urgently raise issues of international justice. Abbas’s insightful commentary on working as a doctor in the Calais ‘Jungle’ sheds both a clear light on the medical and humanitarian problems that result from global inequalities and war, and also the challenges for the volunteers – the devastating ‘emotional response of seeing our peers in such conditions’ which ‘we cannot relay’ (P5).
Books reviewed in this issue echo some of the article themes. The secret biological and chemical weapons programme developed by the apartheid government in South Africa between 1981 and 1995, and the devastating consequences of Britain’s nuclear weapons testing in Oceania between 1952 and 1958, emphasize the lessons of history. Others cover the experience and roles of Liberia’s women veterans, the multiple influences that have impacted on the development Iraq’s health system and its influence on state building, and the many aspects of epidemics in the age of globalization. A review of Preventing War and Promoting Peace: A Guide for Health Professionals concludes with the importance of embedding the concepts covered in public health training.
As well as many reasons to be worried about the future, this issue provides some reasons to be optimistic. We hope our readers will find it useful in their quest for a more peaceful world.