In an article last week, the Economist reported that the ferocity of ethnic violence in Karachi, Pakistan, has forced the city’s paramedics to adopt an unusual policy in order to safely operate in the city:
ETHNIC warfare in Pakistan’s most populous city has reached such a level that Karachi’s ambulance service now has to send out a driver matching the racial make-up of the destination district to pick up the victims of gang attacks. Otherwise, the district’s gunmen will not let the ambulance through. Now ambulances themselves are coming under fire, as gangsters try to stop them saving the lives of their enemies.
Health workers, particularly paramedics, operating in areas of insecurity often have to adapt their standard operating procedures. However, this is the first time I have come across “ethnic matching” medics to patients in order to insure their safety during sectarian strife.
The International Red Cross and Red Crescent has a short interview on their website with a Mexican doctor working in the city of Juarez, at the heart of Mexico’s ongoing drug conflict. Here is the first question of the interview, you can read the entire interview here.
What sort of violence have you experienced?
The clinic where I work is in an ordinary neighborhood but it has been attacked three times. Two of the attacks were armed robberies that left people wounded. The criminals even got into the area where the patients are treated. They also came and kidnapped a gynecologist who was working at the clinic.
For more insights into the risks to health workers in the city, check out this video by Borderland Beat on the life of paramedics in Juarez:
Today, a doctor at Tripoli’s central hospital gave Al Jazeera reporter James Bay a list of medical drugs and supplies needed by the hospital. The doctor hoped aid agencies could provide some of the supplies. Not only do I feel that is it important to get to word out, the list is also an important example of the types of supplies most needed by hospitals facing widespread irregular combat in large urban areas.
It has long been suspected that Nepalese peacekeepers serving under UN mission in Haiti (MINUSTAH) were the cause of a devastating cholera epidemic that killed more than 6000 people and made more than 300,000 fall ill. Immediately after the epidemic, the United Nations denied that peacekeepers were to blame, arguing in November that “from a medical point of view, there has been no direct connection established between cholera and this contingent of soldiers”. However, mounting scientific evidence has eroded that claim. In May, a panel appointed by the Secretary-General concluded that the Nepalese peacekeepers were the cause of the epidemic. Furthermore, last month a study in the CDC’s Infectious Diseases journal tracked the outbreak back to the MINUSTAH camp in Meille, Haiti where the Nepalese peacekeepers were based.
Now, a new study provides definitive proof of the Nepalese peacekeepers’ involvement in the cholera epidemic. The article, Population Genetics of Vibrio cholerae from Nepal in 2010: Evidence on the Origin of the Haitian Outbreak, in the open-access (i.e. not gated) journal mBIO, collected bacterial samples from 24 cholera patients around Nepal and compared their genomes to those of ten previously studied cholera genomes, including three from Haitian patients. Their results: the genomes of the Haitian and Nepalese cholera strains are nearly identical. The study provides conclusive evidence that the strain of cholera found in Haiti originated in Nepal.
It is unclear what practical effects the study will have on the ground in Haiti. Given that the Nepalese cholera strain is likely to continue to impact the health of Haitians for years — even decades — to come, the damage to the reputation of the UN peacekeepers in Haiti has already been done. Hopefully this new study will prompt the UN to increase anti-cholera efforts in the beleaguered country and to give serious thought about how to prevent peacekeepers from being unwitting disease vectors in the future.
On paper, the concept of 3D — integrating US defense, diplomacy, and development efforts — promises to elevate the latter two “D’s” into real policy alternatives to military force. However, it seems clear now that despite the hype, 3D is failing to strengthen the role of development and diplomacy in US foreign policy.
In recent months both the US State Department and USAID have faced seriousthreats to their budgets, while the Defense Department has been spared. US foreign policy is (and will likely be in the foreseeable future) highly military-centric. In this environment, the reality of 3D is that it is less about putting diplomacy and development in their proper place in foreign policy discussions and more about making both of them underfunded auxiliaries of the US military (something many in the DoD oppose). If 3D is to be a viable foreign policy strategy, the budgets of USAID and State must be expanded, not cut.
Caption: Navy Lt. Hoan Nghiem and Cpl. Caroline Winters of the Canadian Army extracts a tooth at a medical civic action project for Pacific Partnership 2011. Pacific Partnership 2011 is a five-month humanitarian assistance initiative that will make port visits to Tonga, Vanuatu, Papua New Guinea, Timor-Leste, and the Federated States of Micronesia. Photo By Kristopher Radder.
Though even a single civilian casualty ought not to be taken lightly, the focus on alleged collateral damage distorts the essence of the drone program. In reality, technology allows highly trained operators to observe targets on the ground for as much as 72 hours in advance. Software engineers typically model the blast radius for a missile or bomb strike. Lawyers weigh in on which laws apply and entire categories of potential targets—including mosques, hospitals and schools—are almost always off bounds.
All these procedures serve one overriding purpose: to protect innocent civilian life. The New America Foundation’s database of strikes shows it’s working. This year civilians made up only about 8% of the 440 (at most) people killed in drone strikes in Pakistan down from about 30% two years ago. As for affecting U.S. popularity on the ground, according to the Pew Global Attitudes survey, the U.S. favorability rating—long battered by conspiracy theories and an anti-American media—hovers at about 12%, almost exactly where it stood before the program’s advent seven years ago.
Whether you agree or disagree, it is an interesting argument. I am interested to see what Conflict Health’s readers think. Do drones make for more humane wars?
Last week, Human Rights Watch published an excellent report on the attack against health workers, health facilities, and patients by Bahrain’s government during the country’s recent democratic unrest. Here is the punchline:
“Since the start of the crisis in Bahrain, Human Rights Watch has documented an alarming pattern of attacks, mainly by Bahraini troops and security forces, against medical workers, medical institutions, and patients suspected of participating in protests, primarily on the basis of the injuries they had sustained. At first the attacks appeared aimed at preventing medical personnel from treating injured protesters, but once the crackdown revived in mid-March security forces increasingly targeted medical personnel and institutions themselves, accusing some doctors, nurses, and paramedics of criminal activity as well as involvement with anti-government protests.”
The report goes on to provide detailed accounts of the allegations, and it is damning. I encourage you to read the report for yourself. One point worth noting: from the accounts it is clear is that the attacks were not the result of unclear rules of engagement or overzealous security officers, but rather a sanctioned operation by the government of Bahrain to treat its own health system as an enemy of the state. This type of official “civil war” against one organ of a government is rare in middle income, functioning states and speaks to the brutality of the crackdown. In the long term, we should expect to see the quality of Bahrain’s health workforce decline as health workers avail themselves of the global demand for medical professionals and emigrate.
Christopher R. Albon Political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy. Homepage, Contact, Twitter.
