Huma, Shafqat

Kazim, Syed Faraz

Naqvi, Haider A.

eCommons@AKU

eCommons@AKUDepartment of Psychiatry Medical College, PakistanMay 2010Terrorism and health: the responsibility ofintellectualsHaider A. NaqviAga Khan UniversitySyed Faraz KazimAga Khan UniversityShafqat HumaAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_psychiatryPart of the Mental and Social Health Commons, and the Psychiatry CommonsRecommended CitationNaqvi, H., Kazim, S., Huma, S. (2010). Terrorism and health: the responsibility of intellectuals. Journal of the Pakistan MedicalAssociation, 60(5), 403-5.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_psychiatry/11In contemporary times loss of skilled health carestaff by suicide-terrorism is a matter of grave concern. Theprime example of this tragedy is death of Surgeon GeneralPakistan, General Mukhtar Ahmed Baig, in an incidence ofSuicide Bombing.1 No place is immune from suchincidences; acts of suicide bombing have been carried out inhospitals, private clinics and places of worships. Accordingto most widely accepted definition, suicide attacks are "anoperational method in which the very act of attack isdependent on the death of the perpetrator".2Pakistan has seen a steady rise in the incidence ofsuicide bombing. Various government departments givecontradictory statistics on suicide bombings. According toFederal Investigation Agency (FIA), in 2007 there were 32suicide attacks, while the Interior Ministry claimed therehad been 43 attacks.3 According to data released by the USgovernment, 1,335 Pakistanis and 19 US citizens lost theirlives in terrorist attacks in 2007. This number is the thirdhighest after Iraq and Afghanistan.4 SB attacks increasedfrom 22 between 2002 and 2006 to 71 in 2007 alone.Though the number was less in 2008 (67) the mortalitystatistics was higher; there were 973 deaths related toincidences of suicide bombing.5 2009 saw the highestincidence of SB in which around 1,286 individuals werekilled across the country involving 171 events of suicide-terrorism.6In a periodical, scientific American, Susser et al.writes 'Terror does not always come out of the barrel of agun or in the shape of a bomb or grenade. Intimidation,harassment, threat of violence or the creation of anenvironment of imminent violence can be enough toparalyze civil life and kill enterprise and creativity. Suchtactics can also lead to violent retaliation by thoseoppressed.'7 Suicide-terrorism is a multifaceted problem; ithas various social, psychological and geo-politicaldeterminants.8 Islam as a religion has nothing to do withsponsoring terrorism while Muslims have everything to dowith it. They are the victims as well as the perpetrators of403 J Pak Med AssocOpinion and DebateTerrorism and Health: The Responsibility of Intellectuals?Haider A. Naqvi,1 Syed Faraz Kazim,2 Shafqat Huma3Department of Psychiatry,1,3 Department of Surgery,2 Aga Khan University Hospital, Karachi.this terrible form of violence. Statistics would bear out thefact that more Muslims are killed then Christians, Jews orindividuals from other faiths. This is applicable to Iraq,Afghanistan or United States of America.9 Why then Islamis credited with the rising trend of suicide terrorism? Thereare certain common denominators which should be kept inmind while reviewing the scholarly work in this area. Suicide bombing is a symptom of a disorder. Thereis a dire need to treat the cause rather than control thesymptoms alone. Fighting terrorism with force is anexercise in futility. Lack of education and development area breeding ground for extremist ideologies. There is a dearthof Education in most of the Muslim countries. ConsiderPakistan as a case scenario. Education is not a priority whenit comes to budgetary allocation. A mere 1.8 per cent ofPakistan's GDP is spent on government schools. Thestatistics are dire: 15 per cent of these schools are without aproper building; 52 per cent without a boundary wall; 40 percent without water; 71 per cent without electricity.10 Thereis frequent absenteeism of teachers; indeed, many of theseschools exist only on paper. The rise in religious extremismhas affected health related initiatives in many ways. In immunization programmes, the refusals of poliovaccines have been a recent source of concern. Self-styledclerics in North West Frontier Province (NWFP) of Pakistanhave passed a religious decree boycotting the immunizationcampaign launched by the government. They believe thatvaccines have been donated by "western" countries with thecovert agenda of harming the "faith" of their futuregeneration. It is of prime importance that officials in theministry of health, Government of Pakistan, initiate adialogue with these religious leaders in order to find animpasse.11 The child health related indices in Pakistan reada sorry picture; the neonatal mortality of 57 per 1000 livebirths and infant mortality rate (under one) of 78 per 1000live births is a source of persistent concern.12In terms of burden of disease, Pakistan isbeleaguered with a double burden of Infectious and Non-communicable diseases. In terms of economic resources weare classified as a Low- Middle Income Country whilehealth related variables are at par with Sub-Saharan LowIncome Countries.13 Community based studies reportprevalence estimates of depression and anxiety disorders tobe around 30%.14 This estimate is almost double the figuresreported from the industrialized western countries. Armedconflicts lead to migration and internal displacement ofpopulation, pushing marginalized individuals towardsmental illness. Post Traumatic Stress Disorder (PTSD) isone of the common conditions in such instances. Thoughthere are no representative figures, of 1020 Afghan refugeespresenting to a psychiatric clinic in Peshawar, North WestFrontier Province, Pakistan, 76.1% (n=776) met DSM-III-Rdiagnostic criteria of PTSD.15Suicide bombing and terrorist activities areparticularly more devastating in the context of restrictedMedical resources of Pakistan.16Unfortunately, an organizedEmergency Medical Services (EMS) does not exist inPakistan. The initial help to such trauma victims is usuallyprovided by people at the scene of the terrorist activity,which mostly is nothing more than sending the victims to thenearby hospital in any available transportation.Transportation of these victims to the hospitals is alsodelayed by the traffic congestion; though the situation hasimproved in major cities due to the combined efforts ofgovernment and NGOs. In-patient care for suicide bombingvictims is also not very effective. The doctors andparamedical staff in the emergency department across thecountry, even in tertiary care hospitals, are not well trainedfor the care of suicide bombing victims. The situation ofmedical services is even worse in less developed, rural areas.Training and education in the field of EMS is quite nascentin Pakistan. Additionally hospital accident and emergencysections are staffed by generalists rather than specialists.Only handful of centers have skilled trauma teams. Recent development in terms of conflicts is use of"non-lethal" weapons. Trauma surgeons and Emergencycare staff has been outraged with its use. It is difficult if notimpossible to draw a distinction between lethal and non-lethal weapons. The term non-lethal implies zero fatalities,but such an objective is acknowledged to be unrealistic. Thedevelopment of this new generation of weaponsincorporates knowledge from the remarkable advancesmade in medical science. A buried antipersonnel minecontaining explosives is designed to blow off or disrupt thefoot; few victims die from this injury if treatment isavailable. Eye attack laser weapons and other opticalammunitions have been produced in line with the non-lethalconcept, supported by the argument that it is better to blindenemy soldiers than to kill them. It is the responsibility ofthe scientists to be proactive in unveiling the dangerousconsequences of such weapon system and not be dissuadedby the terms like non-lethal or sub-lethal.17The gravest issue with terrorism is that it impedesdevelopment in all facets of life, health care sector in not anexception. Terrorism also affects the mental health of themasses direct as well indirectly. The stress of uncertaintyleads to state of compromised functioning among those whoare vulnerable. In a larger frame of reference, the lack ofdevelopment - in terms of human capital - is the biggest lossinflicted by terrorism. In the twenty first century, when stem cell researchhas opened new avenues of research and inquiry, we cannotafford relegation to deep waters of ignorance. CliniciansVol. 60, No. 5, May 2010 404and researchers need to initiate dialogue on public healthissues. Universities need to play their part in bringing all thestakeholders together. Leadership in academia should stepout of their traditional roles and confront the bigger issues.Noam Chomsky, the famous American cognitive scientist,linguist and philosopher in his famed essay, 'TheResponsibility of the Intellectuals', commented on theprevailing situation after the second World War: "…Onlythose who are willing to resist authority themselves when itconflicts too intolerably with their personal moral code,only they have the right to condemn the death-camppaymaster." The question, "What have I done?" is one thatwe may well ask ourselves, as we read each day of freshatrocities…as we create, or mouth, or tolerate thedeceptions that will be used to justify the next defense offreedom'.18 The same question confronts many intellectualsin this country beleaguered by suicide-terrorism. Reference1. NYT. Blast Kills Surgeon General of Pakistani Army. The New YorkTimes. (Online) 2008. Cited 2008 February 26. Available from URL:http://www.nytimes.com/2008/02/26/world/asia/26pstan.html.2. Haddad, S. A comparative Study of Lebanese and Palestinian Perceptions ofSuicide Bombings: The Role of Militant Islam and Socioeconomic Status. IntJ Comparative Sociology 2004; 45: 337-63.3. Human Rights Commission of Pakistan. The Annual Report. (Online) 2010.[Cited 2009 March 2]. Available from URL: http://www.hrcp-web.org.4. 2007 Report on Terrorism: National Counterterrorism Center, US Govt; 30April 2008.5. Pakistan: civilians continue to pay the price of conflict. (Online) September,2008 [Cited 2009 12 May]. Available from URL:http://www.icrc.org/web/eng/siteeng0.nsf/html/pakistan-interview-050908?opendocument.6. 2009 - Year of Terrorism. A report by SAAMA television. (Online) 2010(Cited 2009 Dec 29]. Available from URL: http://www.hrcp-web.org.7. Susser E, Herman DB, Aaron B. Combating the terror of terrorism. SciAm2002; 287: 70-7. 8. Aggarwal N. Rethinking suicide bombing. Crisis 2009; 30: 94-7. 9. Kassem SH. The Role of Religion in Generation of Suicide Bombers. BriefTreatment and Crisis Intervention 2008; 8: 204-8.10. Dalrymple W. Wahhabi radicals are determined to destroy a gentler, kinderIslam. The Guardian; 8th March, 2009. (Online) 2009. (Cited 2009 13 May).Available from URL: http://www.guardian.co.uk/world/2009/mar/08/islam-pakistan-rahman-baba.11. Ahmad K. Pakistan struggles to eradicate polio. Lancet Infect Dis 2007; 7: 247.12. Bhutta ZA. Why has so little changed in maternal and child health in southAsia? BMJ 2000; 321: 809-12. 13. Sharan P, Levav I, Olifson S, Francisco AD, Saxena S. Research capacity formental health in Low- and middle-income countries: Results of a mappingproject. Geneva, World Health Organization & Global Forum for HealthResearch, 2007. 14. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety anddepressive disorders in Pakistan: systematic review. BMJ 2004; 328: 794.15. Naeem F, Mufti KA, Ayub M, Haroon A, Saifi F, Qureshi SM, et al.Psychiatric morbidity among Afghan refugees in Peshawar, Pakistan. J AyubMed Coll Abbottabad 2005; 17: 23-5.16. Zafar H, Rehmani R, Chawla T, Umer M, Mohsin-e-Azam. Suicidal busbombing of French Nationals in Pakistan: physical injuries and managementof survivors. Eur J Emerg Med 2005; 12: 163-7. 17. Coupland RM. "Non-lethal" weapons: Precipitating a new arms race. BMJ1997; 315:72.18. Chomsky N. In: The Responsibility of the Intellectuals. The New YorkReview of Books, 1967; 8:7.405 J Pak Med Assoc

Terrorism and health: the responsibility of intellectuals

http://ecommons.aku.edu/cgi/viewcontent.cgi?article=1010&context=pakistan_fhs_mc_psychiatry

Terrorism and health: the responsibility of intellectuals

Abstract

Similar works

Full text

Available Versions

eCommons@AKU