Editorial

This issue of Medicine, Conflict & Survival was completed in the week the United States formally withdrew from the Intermediate-Range Nuclear Forces (INF) Treaty, tensions in the long-disputed region of Kashmir once again reached dangerous levels, not least because both India and Pakistan possess nuclear weapons, and the 74th Hiroshima & Nagasaki commemorations took place. Even those in positions of great influence at the time had doubts about the destruction of these cities: ‘It wasn’t necessary to hit them with that awful thing’ (Newsweek 1963) according to General Dwight Eisenhower speaking in 1963 but claiming this had always been his position. The unravelling of the INF Treaty, the latest step in the gradual unpicking of the post-World War 2 architecture for the prevention of nuclear war, should be a key time for governments to sign and ratify the Treaty on the Prohibition of Nuclear Weapons. Instead as John Loretz points out in his review of The 2017 nuclear ban treaty – a new path to nuclear disarmament, the nuclear weapons states are busy with ‘multibillion dollar programmes to restock their nuclear arsenals with more dangerous and more useable weapons’ (Loretz 2019), highlighting the urgency of the strategies suggested in this book.

As Frank Boulton points out in his article on Ionizing radiation and childhood leukaemia revisited there have been reports of radiation-associated leukaemia since early in the 20^th century, even before the studies following the bombing of Hiroshima and Nagasaki. Since then this association at lower levels of radiation has been the subject of much research and debate, and Boulton’s article follows others published in this journal on the subject.

From the scientific detail of ionizing radiation to the everyday clinical practice of those trying to address the health consequences of forced migration, the articles in this issue reflect the breadth of conflict and health research. Gargavanis et al. clearly describe their response to a trauma incident during the influx of refugees into Greece in 2015, analyse what was behind its shortcomings and share their improvements for future practice – a clear lesson in constructive learning.

An insight into the personal and medical challenges of carrying out surgical work during war and conflict is described in Shirley Hodgson’s review of War Doctor, Dr David Nott’s account of his twenty-five years’ experience as a surgeon. This includes some honest considerations of his motivations for working in such challenging environments. Why health professionals choose to go to work in dangerous situations is a question that is also asked historically in this issue – holding up a mirror to the past perhaps makes it easier to ask difficult questions and Sietske van der Veen does just that in her article on the Dutch nurses who chose to work with the Easternfront Ambulance of Dutch SS-volunteers during World War II. She sheds a fascinating light on women taking the opportunity to expand their lives under the twin constraints of tradition and occupation, while at the same time they must have been aware they were supporting the German war machine. Leo van Bergen’s review of Las Mamas Belgas about a different set of Dutch and Belgian nurses – many refugees themselves – who joined the International Brigades in Spain and then took different paths on returning home during World War II – highlights similar gender issues, all within their own particular historical context.

One solution to the dilemma for health professionals expected to support their national armed forces fills the Lest We Forget slot in this issue. Fiona Reid, who in her Medicine in First World War Europe (Reid 2017) showed a keen eye for the dilemmas of healing in times of destruction, describes the activities of the Friends Ambulance Unit (FAU) in World War I, including the ‘compromises and complexities involved in medical pacifism’ (Reid 2019) and the efforts made by those organizing the FAU to maintain its autonomy.

Enhancing the skills of health professionals in the area of peace prevention and conflict mitigation has been the subject of several previous articles in MCS. In this issue the commentary Rethinking medical education: introducing peace curricula in medical schools by Amini & Arya describes the growing movement focused on achieving this. They cover the competencies needed to be a health professional who can work towards peace, imaginative teaching techniques that have been used to date and what should be included in future curricula. It is an important and timely reminder of the often still latent peace potential of health workers in a world increasingly viewed as unstable, with new more ‘usable’ nuclear weapons (Borger 2019) and 70-year old legislation designed to keep the peace being abrogated (Times of India 2019). On the positive side the consistent and growing use of online resources such the MOOCs (Massive Open Online Courses) provided on the Medical Peace Work website (http://www.medicalpeacework.org/home.html) show the increasing popularity of this discipline.

A review of Humanitarian Action & Ethics edited by Ayesha Ahmad and James Smith gives a taster of the contributions of the thirty-seven authors representing a rich mix of experience and academic expertise in this area. They make it clear that ethics – too often seen as an added extra to practical action – need to be seen as integral to humanitarian action while at the same time allowing for the flexibility that challenging and specific contexts demand if health needs are to be met.

All these issues – whether lessons from history or being actively promoted today – are highly relevant in today’s context when the Stockholm International Peace Research Institute (SIPRI) Yearbook 2019 states that ‘The trends revealed in recent yearbooks have been broadly negative’ (SIPRI 2019). We hope our readers find them useful.