Ncayiyana, Daniel J

English

South African Medical Journal (SAMJ)

Should general medical journals concern themselves withpolitical debates and political conflicts around the world?The World Association of Medical Editors (WAME) maintainsan electronic forum for editors from around the world toexchange information, present and discuss editorial dilemmas,and debate the perennial topics of editorial independence, peerreview, conflict of interest, copyright, funding of journals and soforth. Once in a while, someone throws in a topic that raisestempers and results in a few resignations from WAME, such aswhen Ian Roberts, editor of the Cochrane Injuries Group, wrote inrecently to call for more debate in medical journals about theimpending attack on Iraq.Against those who believe that medical journals are aninappropriate medium for the politics of the Iraqi conflict,Roberts countered that medical journals have already played animportant if unwitting propaganda role in preparing the publicfor the Iraqi conflict. To persuade ordinary people to support themilitary attack on Iraq, he argues, ‘it is necessary to whip themup by making them feel that they are being attacked … andmedical journals have, I believe, played an importantpropaganda role in persuading the public that they are beingattacked’. As evidence, Roberts cites the growth in the numberof articles on bio-terrorism published in the leading five medicaljournals, from 2 in 1999 to 72 in 2002 (presumably followingSeptember 11 and the anthrax scare), as opposed to only 56articles on road traffic crashes. In real life, traffic accidents havea much greater relative public health impact, killing 3 000 peoplea day worldwide.So then, how should medical journals deal with worldpolitical conflicts?  A common-sense approach comes fromAfrica. Malcolm Molyneux of the Malawi Medical Journal writes:‘Medical journals should provide a forum for presenting war’shealth consequences, but not for discussing the political (orpoetic, or religious) aspects. Similarly, the risk that excessivelyloud music may impair hearing is a legitimate topic. The artisticmerit of the music is not.’ However, it is not always possible tomake that sort of distinction.Medical journals certainly have given much attention to thehealth and medical fall-out of the Iraqi conflict. A BMJ searchhas produced no less than 187 references – news, letters,commentary – on Iraq in that journal in the last 2 years. Whereasthe focus has mostly been on the effects of the economicsanctions on Iraqi child mortality and morbidity, prompting theresignation of some high-level UN aid officials in Iraq, it has alsoincluded the fate of doctors who have been executed orimprisoned for refusing to amputate limbs and ears oflawbreakers.On television recently, I watched with horror as an Israeli tankblasted uniformed Palestinian firefighters desperately trying todouse a burning block of flats in a residential neighbourhood inthe occupied territories. Dropping their fire hoses, thefirefighters scampered away for dear life. A few days earlier, Ihad been equally horrified by the devastation at the scene of asuicide bombing in Haifa which cost 11 lives and causednumerous injuries.The Israeli-Palestinian conflict is historically convoluted andpolitically complex, and it would be foolish to view the contextof these events in simplistic terms. These horrors reflect theintensity of the strife that has been with us since the founding ofthe state of Israel in 1948. In that sense, nothing has changed.What has changed is the current image of Israel in the eyes ofthe larger world. The ‘old’ Israel of Ben Gurion, Golda Meir,Moshe Dayan and Yitsak Rabin was perceived to adhere to theWestern values of chivalry, fair play and a human rights culture.The Israeli army was the stuff of which legends were made. Forthese and other reasons, Israel enjoyed the almost unquestioningsupport and goodwill of the democratic nations of the world.Whether the Israelis are truly more secure now than beforeAriel Sharon is for them to decide. What is clear, however, is thatin the ‘new’ Israel of Sharon and Benjamin Netanyahu, thatreservoir of goodwill and trust is steadily drying up. And thekilling has not stopped. Over 700 Israeli and 2 100 Palestinianlives have been lost since September 2000, and the World Bankestimates the economic regression (housing, infrastructure,joblessness) in the occupied territories at 5 billion US dollarsduring this period. Indeed, the dominant TV images nowadaysare of Israeli bulldozers demolishing home after home, and ofF15 bombers, helicopter gunships and tanks unleashing theirwrath on seemingly unarmed communities who can only throwstones in return. All of this infrastructural devastation and social disruptionhas had a serious impact on the health of the Palestinians, and itis for this reason that Israel has been in the spotlight in leadingmedical journals recently – particularly in the BMJ and theLancet – including a debate in the BMJ about whether or notthere should be a boycott of Israeli universities and Israeliscience. In a development reminiscent of NAMDAin the days ofMASA, a group of Israeli doctors has formed the ‘Physicians forHuman Rights-Israel’ to expose state human rights abuses, andto ‘protest the Israeli policy of siege which makes it impossiblefor the Palestinian health system to function’. The IMAhasapparently consistently declined to condemn the use of torturefor political purposes.If we learned one lesson during the years of apartheid, it wasthat where health and medical issues are concerned medicaljournals must not avoid dealing with politically sensitive topics.The SAMJ certainly has not hesitated to publish articles with apolitical dimension domestically in the last decade. We havehowever given scant attention to the health consequences of theconflict right across our borders in Zimbabwe, where ordinarypeople are facing unprecedentedstarvation from food shortages andother deprivations due to economiccollapse.The consequences for health andmedical ethics of political conflictare our business, wherever theymay occur.Daniel J NcayiyanaEditorSOUTH AFRICAN MEDICAL JOURNAL –FIRST PUBLISHED JANUARY 1884April 2003, Vol. 93, No. 4 SAMJIsrael, Iraq, Zimbabwe — should we care?Mini ed.qxd  01/09/2003  8:59  Page 229

Israel, Iraq, Zimbabwe - should we care?

http://samj.org.za/index.php/samj/article/download/2118/1397

Israel, Iraq, Zimbabwe - should we care?

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South African Medical Journal (SAMJ)