Sunday, January 25, 2015

Uncertain Health in an Insecure World – 20

“crISIS in the Caliphate”

What is the health status of the ISIS- or ISIL-controlled territories… the pan-Islamic Caliphate?

Islam is practiced in nearly all the countries of the world. The Pew Research Center reports that 23% of the world’s population is Muslim – 1.8 billion people, up from 1.6 billion in 2010. Islamic rituals such as ablution, praying five times daily towards Mecca, Halal dietary restrictions, fasting, modesty in the presence of the opposite sex, male circumcision and other practices may complicate health care, and could potentially affect Muslim patient outcomes in Western delivery systems.

There is no fundamental schism between Islam and Judaism – both are peaceful religions. The degree to which individuals and communities follow the rules & regulations of these religions – observance – creates different expectations for health care. Despite long-standing geopolitical differences & related military conflicts that exceed the scope of this medium, with some nuances, much of what Islam requires of observant Muslims also applies to observant Jews seeking health care.

Health care professionals are universally committed to culturally sensitive & compassionate care of all people, whatever their religious beliefs or observances. The act of caring for others is revered in Islam, as a manifestation of love for Allah and Muhammad. Muslim doctors may or may not choose to follow the Hippocratic Oath. Unlike modern Western medicine, Islamic health care stresses holistic approaches and well-being (Tawheed, or Oneness of Allah) through meditation and prayer.

But what does health care look like in ISIL-controlled territories of the emerging “Islamic State”?

Of course, there’s the trauma and death of combatants and collateral civilians. While statistically shocking, this mortality and morbidity – combatants killed-in-action (KIA) and civilian casualties – is almost taken for granted in 24/7 news cycle and official governmental reporting. In the fog of war and the related diaspora of refugees, KIA and casualty counts are hard for agencies on the ground or abroad to verify. The U.S. military claimed to have killed 4,000 ISIL combatants, only to have the Viet Nam War veteran and U.S. Secretary of Defense Chuck Hagel promptly refute the accuracy of such 30,000 foot fly-over body counts.

A lack of precise, real-time human health impact information is not unique to this global hot spot.

In countries surrounding the “Islamic State”, health workers are routinely caring for ISIL militants. A Mersin, Turkey hospital nurse was recently quoted as saying, “We treat them, and they go on to decapitate people”. She noted that Syrian refugees often identify themselves to hospital workers as Bashar al-Assad regime “opposition members”, only to be later revealed as ISIL fighters and commanders. Ironic to most, ISIL is currently holding hostage at least 46 Turkish citizens.

Should wounded terrorists receive health care consistent with the Geneva Convention? Should public taxes in neighboring countries pay for militants to recover from their war wounds, returning them to the battlefield? Did sleeper cell terrorists in Western Europe receive publicly funded health care?

Provocative questions! My answers are ‘Yes’… ‘No’… and ‘Probably’.

One of the first foreign hostages beheaded by ISIL in September 2014 was British medic David Haynes. The recently expired ISIL deadline for the Japanese government to pay $200M to prevent the brutal decapitation of two of its nationals (at least one of whom is now dead) creates a moral and policy dilemma – this unprecedented ransom could save two innocent lives, or be used for humanitarian aid and health care needs of hundreds of thousands at home or abroad.

Last week, U.S. Secretary of State John Kerry, another Viet Nam War veteran who protested American military atrocities in the 1970’s, chastised a left-wing women’s anti-war protest group (CODEPINK), telling them that ISIL is, “killing and raping and mutilating women”. It’s hard to definitively prove this Kerry rhetoric. But in response to CODEPINK hecklers, Kerry went on to correctly state about ISIL that, “They’re not offering health care of any kind.

Unlike some militant (a.k.a. terrorist?) groups like the political wing of Hamas in the Gaza Strip & West Bank, ISIL’s ballooning budget from stolen oil sales and ransoms does not support basic health care in the territories under its military control. ISIL operates no field hospitals.  ISIL lays siege to refugee field hospitals such as the one in Kobani, Syria. ISIL car-bombs field hospitals such as one in Atmeh, Syria. In fact, the ebb & flow of wounded fighters at field hospitals in Syria, Iraq and northern Yemen has made them favored targets for suicide bombings and reprisal attacks. 

The dramatic images of lifesaving aerial drops to desperate Yazidi refugees on Mount Sinjar in northwest Iraq have faded. But these and other displaced people still require mobile and refugee camp-based primary care & mental health services. Ironically, countries like Canada and France provided millions of dollars in humanitarian and health care aid to the ISIL-controlled regions in the months preceding the deadly ISIL-inspired lone wolf and sleeper cell attacks in Ottawa and Paris.

Despite foreign aid, the people of the Syrian Arab Republic are more than four years into a WHO-declared public health crisis. Children of Syria and Iraq are the most vulnerable. Disruptions in basic public health services like vaccination have prompted reemergence of measles & polio, and a severe depletion of medicines to treat childhood cancer. UNICEF’s Executive Director, Anthony Lake, recently stated that “Millions of children inside Syria and across the region are witnessing their past and their futures disappear amidst the rubble and destruction of this prolonged conflict.” Theirs is becoming a “lost generation”.

ISIL is clearly a threat to global security, and is destabilizing the health of millions.

Until we in the Square view this unhealthy Caliphate as our concern, this crISIS will continue to rake the region, and impact health for all of the 7.1 billion people around the globe.

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