Living in long-term conflict areas like Kashmir leads to long-term health issues. Fact does not change if a foreign journal or an Indian one points it out.
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The Lancet, one of the premier clinical journals in the world, has recently raised concerns about the consequences of fear and uncertainty in Kashmir in an editorial in its latest issue. It was published after the Narendra Modi government abrogated Article 370, which gave special status to Jammu and Kashmir.
In the editorial, the deaths of over 50,000 Kashmiris since the start of insurgency in1989, sexual violence, terrorism and widespread violence have also been highlighted. Of immediate concern is the well-being of the people currently held in a lockdown state, thus exacerbating their sense of helplessness and distress.
In a related development, another reputed medical journal, the BMJ, in its editorial has raised similar concerns about medical emergencies in Kashmir. It is based on a letter from 18 physicians across India with warnings about the lack of access to healthcare.
Scientific journals on conflict
This is hardly the first time when scientific journals have issued editorials on conflict areas. Earlier, the Lancet has also waded into the matters of health with reference to changing geopolitics. In 2004, the Lancet published an article about the invasion of Iraq, civilian mortalities and political responsibilities that led to a death toll of 98,000 civilians.
In 2019 alone, the Lancet has published countless articles commenting on the refugee crisis and the political failure leading to the Syrian civil war, Brexit, Canadian prisons, Israel’s health agenda being inferior to security concerns prior to elections, recent tugs between Iran and the US that may lead to Donald Trump sending security forces to Iran, and the Turkish government jailing doctors for an anti-war statement. While the Turkish medical fraternity honoured their Hippocratic oath by stating that “war is a man-made public health problem”, Turkish President Recep Tayyip Erdoğan responded by saying that the “group was a gang of unthinking slaves”.
In stark contrast, the Indian Medical Association (IMA), Association of Surgeons of India (ASI) and the Indian Academy of Pediatrics (IAP) issued statements condemning the Lancet editorial on the Kashmir. While the IMA stated that it will be “withdrawing its esteem of the Lancet”, the IAP went even further to dispel the Lancet and said that it had no understanding of the history of ethnic cleansing of the Kashmiri Pandits in the 1990s and called it “totally biased”, “in bad taste” and “lowly”. The state of patients was not mentioned in any of these righteous rebuttals issued by these organisations.
Scientists objecting to facts presented in a scientific journal not only represent a disappointing trend, but a dangerous one. History is fraught with examples of scientists colluding with populist movements leading to eventual disasters such as the eugenics movement in the Nazi era. Scientific facts are not bound by political sensibilities and this is well understood by nations with progressive and inclusive welfare policies. The lack of empathy in the letter from the Indian Academy of Paediatrics is particularly distressing because recently a report in The Caravan carried a photo of a five-year-old girl in Kashmir who was injured when a CRPF jawan catapulted a stone at her.
Dr Sumaiya Shaikh:
If the aim of communication clampdowns and long-term curfews is to reduce incidents of terror, research in violent extremism has shown that this may be paving way for the exact opposite. As a neuroscience researcher in violent aggression, I can report that there is an overlapping pattern observed with ‘addiction to substance’ and ‘addiction to violent aggression’ in our neural pathways.
This phenomenon is specifically true for motivated, rewarding violence, which closely resembles violent extremism, as opposed to retaliatory violence. The conflict conditions in the Valley are making sure that this ‘addiction to violence’ is maintained.
Furthermore, research on exposure to trauma and long-standing fears show that the likelihood of both psychiatric and physiological disorders increases in such situations. Reports of substance abuse and addiction are quite common in the Kashmir valley. We are observing a similar situation in Afghanistan, where despite the US trying to negotiate with the Taliban, the latter has no intentions of ensuring peace. Large groups of young people with post-traumatic stress disorders, peer victimisation of Kashmiris, in combination with basic combat training can lead to even more instances of violence. Even if the medical fraternity ignores the past instances of violence, this prediction of increased violence in itself a public health issue.
Dr Amit Gupta:
As someone who manages a refugee grant for doctors and nurses caught up in conflict zones such as Syria seeking refuge and rehabilitation in the UK, I often hear stories of people living with a sense of perpetual doom, the fear of the impending knock on the door, or the sheer panic when a loved one is late by a few minutes.
Access to healthcare in conflict zones is heavily rationed towards treating maiming injuries. Refugee doctors in conflict zones tell me of the guilt they feel even when suggesting that they feel constantly anxious and live in a state of heightened alertness and consequent burnout. Children suffer in large numbers and immensely. They often develop odd behaviours – one parent told me how his three-year-old son rushed to hide beneath a bed every time an ambulance passed by, this went on till he was six. There are other children who wake up screaming with recurrent nightmares. The list is endless.
In my similar and first-hand experience in Gujarat during the 1994 riots, I was proud that my colleague doctors tended to the wounded in Surat, oblivious to the religion or politics of their patients. We were angry and frustrated at the human pain and destruction of the riot, and not towards those who wrote about it.
Professor Rajiv Kumar:
Being born in Srinagar and having lived there till the 1990s, and leaving Kashmir during the 1990s, I can identify with the ethnic Kashmiris, for whom, this is not anew distressing state to live in.
I personally remember my days as a faculty member in Kashmir University during the peak instability of the 1990s – every waking hour would be characterised by a gnawing pit in the stomach, with a wish that the political situation would get better. I was fortunate enough to be able to leave, but for those who could not, decades of political instability and militancy, besides physical violence, has understandably increased cases of psychiatric and mental health issues. These issues must have only aggravated under the current conditions of deliberate fear and isolation.
People living in long-term conflict areas suffer long-term health consequences. That is a fact does not change if a foreign journal or an Indian one points it out. If not advocacy, it deserves basic acknowledgement by the leading body of medical professionals in India. We should resist the temptation of letting our medical bodies become politically weaponised.
As doctors, our core business is humanity. Irrespective of political turmoil, war and riots, our duty to care applies to all – friends and enemies alike.
Sumaiya Shaikh is an Australian neuroscientist in Sweden who studies the human brain in aggression, violent extremism and pain processing. Amit Gupta is a neonatal clinician in Oxford, UK and manages a refugee fund for those seeking care and rehabilitation in the UK post conflicts. Rajiv Kumar is a professor in cancer genetics in Germany, and was born in Srinagar, Kashmir.
The article was originally published on The Print, India https://theprint.in/opinion/lancet-has-always-written-on-conflict-zones-health-why-should-kashmir-be-an-exception/281370/