Peace through health

Medical students have a part to play

Medical students from McMaster University in Canada have been studying a new discipline called peace through health.¹ They believe that medicine brings peace to the world and have proposed a study module which will include understanding the many causes of conflict and exploring the approaches to resolving conflicts and the possible mechanisms of peace building. They want to learn more about the link between health and peace. In a world full of conflict the students were confident that this module would equip them with skills that would be as applicable in their own country as in Afghanistan.

At present such ideas are very attractive, and a recent conference on “Peace through Health” at McMaster University explored the role that health professionals can play in preventing war. Doctors and academics from the department of peace studies and health science have worked together to develop interdisciplinary theories on the relationship of conflict, peace, and health and outlined these at the conference (www.humanities.mcmaster.ca/peace.health) The main theory behind this new discipline is to conceptualise war as a disease process.² Like other diseases, war has risk factors, which can be targeted. They can be prevented from developing (primordial prevention) or modified (primary prevention), and the effects of war can be treated (secondary prevention). Once war has caused damage then rehabilitation is required (tertiary prevention). It is suggested that just as health professionals play a role in the process of disease, they can also play a role in the process of war.

The possible roles of health professionals have been formulated into five health peace mechanisms ³ (see box).These mechanisms are possible because of the unique characteristics of health care. Firstly, health care is provided for altruistic reasons. As such it goes beyond any political, religious, or ethnic differences. Secondly, health care is based on science, which means it can be more objective about the consequences and effects of war and not biased by the views of one group of another. All this is good in theory, but can it be put into practice?

A healthcare worker gives a Rwandan patient a hug to calm him down

There have been examples of health being used as a means to mediate conflict. The most striking are cease fires in the 1980s in Sudan, Afghanistan, and the Philippines. Breaks in the fighting were negotiated by aid agencies and the United Nations to carry out vaccination programmes and to be able to deliver humanitarian aid. In El Salvador, these so called “days of tranquillity” took place three times a year. Three hundred thousand children were immunised against measles, tetanus, and polio with the incidence of polio dropping to zero. All sides believed in the benefits of vaccination despite their other differences. After the war ended in Bosnia.Herzegovina in 1995, the healthcare system lay in ruins and was divided between the Bosnian Croats and Bosnian Serbs.⁴ There were even two health ministers. By forming just one health system—a programme led by the United Nations and the UK's Department for International Development—where doctors trained together, it was claimed that health professionals became more willing to work together and patients less concerned about ethnic differences. However, the problem with such programmes is that they have not been properly evaluated. This makes it difficult to be sure if the initiatives worked as was claimed. New ideas on ways of evaluating these programmes are being developed and these could allow more accurate evidence based appraisal in the future.

Another important consideration is the possibility that health initiatives could do more harm than good. It is now accepted that aid can actually aggravate conflict rather than always help to defuse it. For example, in Sudan in 1998 large amounts of relief grain were taken by the military thereby strengthening their ability to fight.⁵ In addition, if doctors begin to get involved in conflict mediation they could be seen to be acting politically so favouring a particular group or nation. This could have a knock on effect of reducing the ability of doctors to gain access to conflict areas.

The effects of war go beyond bombs and bullets. Famine and disease often follow and healthcare systems are disrupted. There are also the psychological scars of war that last longer than any physical ill. Health professionals already provide their help and skills in all these areas.

By 2020 the World Health Organization and the World Bank predict that war will be one of the top 10 causes of disability and death. Recent events may bring this date forward. Students are the ones who will be dealing with the reality of these predictions. Is it not time for health professionals to go beyond simply caring for the fall out from war?

1. MacQueen G, Santa.Barbara J, Neufeld V, Yusuf S, Horton R. Health and peace: time for a new discipline. Lancet 2001; 357: 1460.1.
2. Yusef S, Anand S, MacQueen G. Can medicine prevent war? BMJ 1998; 317: 1669.70.
3. MacQueen G, Santa.Barbara J. Peace building through health initiatives. BMJ 2000; 321: 293.6.
4. World Health Organization. WHO/DFID peace through health programme. Copenhagen: WHO, 1999.
5. Report on the evaluation of Danish humanitarian assistance to Sudan, 1992.98. Vol 7. Copenhagen: Danida, 1999:42.