COMMENTARY
which showed the health impact of the
The Interesting Times We Live In
American-led war in Iraq. The cross sectional study, conducted during September 2004, compared mortality during C Sathyamala the period of 14.6 months before the
Public health issues are inextricably linked with human rights and it is only apt that many health professionals will involve themselves in such issues. The response of governments and the corporate sector to the work of such professionals suggests how they are seen as threats to the established order.
An earlier version of this article was discussed in the annual meet of the Medico Friend Circle, December 28-29, 2007, at Dallihara, on the theme ‘Role of the Health Professionals in Times of Social Violence and Conflict’.
C Sathyamala (csathyamala@gmail.com) is an epidemiologist based in Delhi.
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Health and Human Rights
Socially sensitive public health professionals find it difficult to ignore issues of human rights as they are inextricably linked to the health and well-being of a population. And the state, in turn, finds it vital to suppress any evidence that points to such linkages. Riyadh Lafta is a professor of medicine at Al-Mustansiriya University of Baghdad, who led the Iraqi ministry of health’s Unicef funded immunisation campaign for 14 years. In May 2007, he was denied visa to visit the US where he was to give a talk and then was denied a transit visa in UK en route to Canada to deliver the same lecture in Vancouver since Canada agreed to issue him a visa [Woodward 2007]. His crime: he had coauthored a study published in the Lancet American invasion and occupation with the 17.8 months that followed [Roberts et al 2004]. The study found that the risk of death was 2.5 folds higher, the risk of death from violence was 58 folds higher after the invasion and most individuals killed by the coalition forces were women and children. The major causes of death before invasion were myocardial infarction, cerebro-vascular accidents, while after the invasion, violence was the primary cause of death with most of the deaths attributed to coalition forces. The authors estimated an excess of 1,00,000 deaths or more in the one year following invasion. This estimate was 20 times higher than the number used by the Bush admini stration. For all of these “crimes”, his home in Iraq has been searched by the coalition forces, and his life is under threat, from both the pro-government people and anti-government people, according to Les Robert, his co-author from Johns Hopkins University [Woodward 2007]. Lafta has also collected data to show an increase in birth defects and a tenfold increase in childhood cancers that could be ascribed to the war and he was to have used his visit to work on completing the paper. Lafta continues to live and work under these severe conditions as he believes that it is his “duty to concentrate on the things that are alarming and disastrous to our population”.
But it is not necessary that a medical professional directly involved in raising “sensitive” human rights issues for the state to perceive a threat; conducting scientific studies which bring out evidence of adverse health outcomes and points to state policies/interventions as a source is sufficient. For instance, after the Bhopal gas leak disaster of December 1984, the activities of several organisations involved in relief and rehabilitation of the victims came under surveillance. Doctors and other health workers engaged in providing injections sodium thiosulphate as an antidote, were arrested in a midnight swoop and several of the activists had
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COMMENTARY
serious charges (attempt to murder for example) filed against them by the Madhya Pradesh government. This was because acceptance of sodium thisosulphate as a rational treatment for the gas affected population (a remedy that had the approval of the Indian Council of Medical Research) would have meant that the state recognised that the victims were suffering from chronic cyanide poisoning and that the gases had crossed the lung blood barrier to produce multi-systemic effects. Activists attending meetings discussing the medical consequences of the toxic gases in Bhopal were arrested. The Medico Friend Circle study on pregnancy outcome which was planned initially for June 1985 had to be postponed as the MP government declared that all “outsiders” working with the gas victims would be treated as “terrorists”. Finally when the study was carried out, the survey team was under constant surveillance and it became necessary to shift the completed schedules every night to a safe place. The reason was that the government wished to minimise damages and any independent study meant to assess health impact was viewed as a threat.
Corporations and Whistle-blowers
It is not merely the state that is antagonistic to public health professionals who are involved in highlighting disturbing associations through their studies. Depending on where they find themselves, the corporate sector deals with whistleblowers in other ways. In countries where the rule of law is upheld, the corporate sector uses legal means to settle its score. Frank Nicklason and others, who spoke about the health hazards posed by a major logging company in Tasmania (Gunns Limited) were sued for damages worth $A6.3 million by the company [Zinn 2005]. Nicklason is a staff physician at the Royal Hobart Hospital, Tasmania, whose research showed that legionella bacteria, fungal organisms, and wood dust, all of which were present in the stockpiles of shredded wood at the wharf posed potential health risks to the exposed population. Nicklason said that the Hippocratic oath required him to prevent illness not just in patients but in society as well.
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Closer home, on December 19, 2007, the Madras High Court was reported to have restrained two farmers’ associations and their office bearers (the Sathankulam Regional Agriculture Association and the association for users of irrigation water, 145, left main canal sub-channels I and II) from making any “derogatory remarks and baseless allegations against the Titanium unit project being planned by the Tata Steel in Tuticorin district of Tamil Nadu” (The Hindu, December 20, 2007). The company had filed a civil suit seeking Rs 50 lakh damages caused to the company “due to defamatory remarks, comments and false allegations” made against the project. Due to these “unfounded remarks”, the company had alleged that it faced many hurdles while executing its project and that the company would suffer heavy financial hardships, and loss if the respondents were not restrained. The crime: the two farmers’ associations had raised questions about the degradation of land and water supply and environmental damage due to the setting up of the Tata unit and were successful in mobilising the local people against the industrial unit. Titanium is indicted as potential occupational carcinogen [The National Institute for Occupational Safety and Health 2007].
Extraordinarily Political
The discipline of epidemiology is extraordinarily political as it has the ability to pinpoint causal associations between exposure and outcomes. Causal associations are bound to be contentious issues. When conducted with integrity, epidemiological studies have pointed out that the sources of health or ill-health lie in the socio-economic and political location of a population. But as evidence of the ill effects of anti-people policies begin to accumulate, we see epidemiology being evoked to justify the unjust polices of the state that goes to great lengths to generate counter-evidence. And those who challenge such bad science are accused of being anti-government, anti-patriotic and anti-science. The long-waged campaign against the injectable contraceptives and the more recent one against the polio eradication programme in the country illustrate this. In both the cases, a body of evidence has been built systematically, step by step, against the advisability of such programmes. But the establishment continues to create more “evidence” to counter facts with figures.
For Binayak, though trained as a medical professional, involvement in human rights issues was inescapable in a state like Chhattisgarh that is witnessing largescale government-sponsored terrorism in the name of Salwa Judum, an operation whose stated objective is to combat Maoist insurgency but which in reality is to wrest ancestral land from the tribal communities, for the use of private industrial houses. Binayak Sen’s continued incarceration is the expression of zero tolerance by the state for anyone, who will hamper the zooming up of the sensex. Questioning the path of development that the country is hurtling along, and the threat it poses to the lives of people and other living beings, will be viewed as a threat to national security and all efforts will be attempted to contain dissent.
References
Medico Friend Circle (2008): ‘Release Dr Binayak Sen! Health, Human Rights and Development Activist: Prisoner of Conscience in Chhattisgarh, 2007-08’ (monograph), MFC Pune, p 17.
The National Institute for Occupational Safety and Health (2007): ‘Pocket Guide to Chemical Hazards’, www.cdc.gov/niosh/npg/npgd0617.htmlaccessed
24.12.07. Roberts, L, Lafta R, Garfield R, Khudhairi J, Burnham G (2004): ‘Mortality Before and After the 2003 Invasion of Iraq: Cluster Sample Survey’, www. thelancet.com published online October 29, 2004. http://image.thelancet.com/extras/04art10342 web.pdf. Sathyamala, C (2007): ‘Binayak Sen: Redefining Healthcare in an Unjust Society’ (editorial), Indian Journal of Medical Ethics 4 (3): 105-106. Woodward, J (2007): ‘Doctor Fears for Life in Homeland: Prevented from Speaking at SFU, Author Continues Controversial Work despite Danger’, The Globe and Mail, April 28,. Zinn, Christopher (2005): ‘Doctor Who Spoke on
Public Health Issue is Sued’, BMJ, http://www. bmj.com/content/full/330/7489/439-a.
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