Playing the waiting game as bombs drop on Iraq
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7391.675 (Published 29 March 2003) Cite this as: BMJ 2003;326:675All rapid responses
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In this day and age of highly sophisticated warfare it seems
inconceivable that so many mistakes lead to the death of soldiers under
“friendly(?!) fire”. If we understand, however, that this tendency to
execute “own goals” or “shooting oneself in the foot” is a function of
personal contradictions it becomes much more clear that they will continue
to happen in a war so many feel so ambivalent about. To expect soldiers,
as part of the war machine, to be “machines”, that is, immune to such
contradictions is dehumanising. After the war thousands of soldiers and
civilians will attend professionals with symptoms of Post Traumatic Stress
Disorder, and we will diagnose them as if there were something wrong with
the individuals affected, rather than with the situation they found
themselves in. Not being sure that this war is legal, just, or even
necessary will add to the “normal” psychological distress caused by the
unavoidable horrific experiences present in every war.
Being led into it by GWBush, the oxymoron of a leader, and having to pay
taxes that fund the bombs that kill the children all spell contradictions
for the general population and for the soldiers alike.
The appropriation of oil reserves as well as Iraq’s decision to deal in
Euros rather than dollars in the oil market (which threatens to spread to
the whole OPEC) are the real reasons for the weapons inspectors not being
given more time to do their job. This demolishes any pretence of “ethical”
basis for invading a sovereign estate.
This war will cause more psychosocial distress, more grievances, more
future terrorists, more soldiers with “Gulf War Syndrome II” and more wars
ahead. Hurrah!! Say the arms trade markets.
The only vaccine against these contradictions is to stop this war and to
work hard, with others nationally and internationally, to prevent future
ones. That means to work for social justice for all inhabitants of the
planet. Our Mental Health demands it.
Coincidentally, the first unit for DSPD (Dangerous Severe Personality
Disorders), a politically defined diagnosis, is opening now. Under this
new paradigm it will be possible to detain people who are not clearly
mentally ill before they commit an offence (See the film “Minority Report”
for a Hollywoodised treatment of the theme). It is assumed we will be able
to predict risk of future violence in spite of the general failures of
known instruments to predict with accuracy on individuals. Obviously the
first person diagnosed has been Saddam Houssein, but other pre-emptive
strikes will follow, called “preventive detention”. Are we creating a
climate where paranoia justifies aggression? Is this not the drunken pub
brawl scenario of “I hit him because he gave me the eye?”
Dr Silvia Bercu
Competing interests:
None
Competing interests: No competing interests
Utilization of a genuine blood substitute: a suggestion to the medical fraternity in Iraqi hospitals
Sally Hargreaves' news article is of great contemporary interest(BMJ
2003;326:675, 29 Mar). Like all other rational people, we are extremely
distressed by the loss of innocent human lives in war. A large number of
war casualties die because of haemorrhagic shock. Bellany (1)has projected
that the percentage of wounded soldiers who die in battle fields will
increase from 20 to 26% unless they are evacuated within two hours, and
32% if not evacuated within 24 hours. The majority of soldiers and
civilians killed in action, crossfire or bombings die due to blood loss
from compressible wounds and these deaths thus have the potential to be
preventable if there can be timely blood, or a blood substitute,
transfusion.
The current generation of blood substitutes can provide respiratory
function of haemoglobin, agents to replace platelets, plasma coagulation
factors and its various combinations. However, all attempts to provide a
haemoglobin based oxygen carrier, be it from a human or a bovine source of
haemoglobin, have not passed through the Phase III clinical trials in the
US. Apart from this, there are other issues of forbidding costs and
complications.
In Calcutta, our group of doctors and scientists have been working on
the utilization of placental unbilical cord whole blood as an emergency
alternative of adult whole blood transfusion since 1999 in a project
funded by the Dept. of Science and Technology and supported by the Dept.
of Health and Family Welfare, Govt. of West Bengal, India. We appeal to
the medical fraternity working in distressed conditions in hospitals in
Baghdad and Basra, not to discard the placenta after the birth of healthy
babies in their hospitals, by LUCS or otherwise. Instead we advice you (
as per our experience)(2) to aseptically collect blood from the umbilical
vein in a standard paediatric blood bag containing 14ml of citrate
phosphate adenine solution and store it in a refrigerator at 1-6 degree
centigrade for eventual use in times of emergency. Since 1999 till date,
we have used 556 units of umbilical cord whole blood and we have
transfused this blood to consenting volunteers (ages 18 months to 88
years), without encountering a single case of immunological or non-
immunological reaction. The recipients of this blood have included
patients of traumatic or operative shock or other emergency conditions
necessitating blood transfusion. Apart from these cases, this blood has
been used in a whole gamut of medical conditions like malignancy to
autoimmune diseases. Cord blood is rich in fetal haemoglobin (HbF 50-85%),
which has a much greater affinity than adult haemoglobin and the
haemoglobin concentration of cord blood is 16-18gm%. It also has a high
platelet count (750,000/cmm) and a rich plasma content containing growth
factors, cytokines and further has the advantage of the hypoantigenicity
of the fetus.
Reference:
(1) Bellamy RF, "The Causes of Death in Conventional Land Warfare-
Implications for Combat Casualty Care Research", MilMed, 1984;149:55-62.
(2) Bhattacharya N, Mukherjee K, Chettri MK et al," A Study Report of
174 Units of Placental Umbilical Cord Whole Blood Transfusion in 62
Paients as a Rich Source of Fetal Haemoglobin Supply in Different
Indications of Blood Transfusion,Clin Exp Obst & Gyn
XXVIII,n.1,2001,47-52
Competing interests:
None declared
Competing interests: No competing interests
Like Mr Hashimi I would have liked the BMJ to have
given more coverage to the War this week. However
the one page article was full of facts, dreadful facts,
many of which are not fully appreciated, if at all, by
those who support this war. In my view this is the kind
of information which needs to be disseminated as
widely as possible in order to change hearts and
minds in this country and the US. Information in this
article can be a powerful weapon in the argument
against this war and its power should not be
underestimated.
Competing interests:
member of MCANW
Competing interests: No competing interests
This resonse is right on. This morning I, an American, watched the
elaborate flag draped coffins, the military band, the slowly pacing
uniformed pallbears receive the British soldier's remains, while a cut-in
of CNN had an American military spokesman resonding to questions about the
war. BMJ and other medical journals should get involved to counter the
propaganda of such business publications as the Economist, which had been
pushing this war for the past six months at least. It is obscene how the
suffering of little children is juxtaposed in newprint to stock market
implications.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir/Madam
We are surprised and indeed disgusted to see the BMJ turning a blind
eye to the manslaughter that occurs now in Iraq.
Since the world’s only superpower along with Britain, decided to go
it alone against the will of the international community, sorry pictures
of genocide and destruction have never left our television screens.
This superpower has decided to enslave every technological advance
man has achieved in order to eradicate humanity en mass. While the whole
world is watching the carnage inflicted in every minute through the mind
boggling pictures from Iraq, the BMJ chose not to come up with anything
other than a one page article. This article was entitled “Playing the
waiting game as bombs drop on Iraq”, where a neutral, mundane cocktail of
officials admit to the impotence of their organisations at the time of
peak human desperation.
We ask: Where is the enthusiasm of the BMJ that was bellowing when
the “New Contract” was being discussed nine months ago? There was not a
glimmer of that. Instead of pointing the light on what could prove to be
the most grotesque display of human aggression in this century, the BMJ is
now reduced to publishing merely about MMR, anxiety and vertigo.
While the above should not be taken as a criticism to belittle any of
the topics or articles mentioned above, there is strong evidence that the
British Medical Association and with it the BMJ is gradually becoming
detached from reality on two fronts. The first is the political front.
This was glaringly exemplified by the BMA’s grossly misjudging the
profession’s acceptance of the “New Consultant Contract”, which led to it
suddenly becoming “Old” overnight. The second failure is in its lack of
topicality, turning a blind eye to the human suffering and mass murder in
Iraq, courtesy of the American and British leaders of the West. The mass
killing and maiming of innocents these two have carried out over the years
remains unparalleled throughout the history of mankind. Whole races were
almost exterminated. Recall the tragedies of the Aborigines and Red
Indians, just to mention two.
The BMJ is risking being so insensitive as to be insulting to its
readers. As a result the advertising “Career” section of the BMJ continues
to grow exponentially at the expense of the main scientific part which in
its last issue was limited to some 50 pages, adverts excluded.
How can we hope to influence and point our politicians, locally and
internationally, in the right direction if all that keeps us busy now is
“Doctors’ Wellbeing”. It appears that before we could change the logic and
infuse insight within our Governments, we need a radical change of
thinking within the BMA and its BMJ editorial team.
References:
1. Hargreaves S. Playing the waiting game as bombs drop on Iraq. BMJ
2003;326:675.
Competing interests:
None declared
Competing interests: No competing interests
'Concerned Medical Students on Iraq': Open Letter
Although the war in Iraq now appears over, it is important that we,
as medical students and future health care professionals, continue to
raise awareness and become informed about the humanitarian situation in
Iraq and contribute to an informed dialogue with the public, the
government, and the medical profession.
Aside from the stand taken by the Physicians for Global Survival
(www.pgs.ca), the medical community has mostly been silent on this issue,
as stated by Brad Mackay on eCMAJ (MDs mostly mum on Iraq, eCMAJ, April
11, 2003,
http://www.cma.ca/cmaj/cmaj_today/2003/04_11.htm) and letters to the BMJ
(http://bmj.com/cgi/eletters/326/7391/675#30807). Thus we, the undersigned
600+ medical students across Canada, released an open letter on April 8,
2003, stating our opposition to the military intervention in Iraq on the
grounds that it constituted an attack on the health of Iraqi civilians and
will likely cause a humanitarian crisis.
As stated in our letter, we 'feel the Iraqi people deserve neither
the dictatorship of Saddam Hussein nor the present pre-emptive assault
against their country that has already claimed hundreds of lives'.
However, it is clear that much remains to be done to ensure that an
outbreak of humanitarian disaster does not erupt in this now destabilized
nation. In our letter, we called for all concerned parties to:
1) Recommit themselves to and abide by the Geneva Convention and other
international agreements.
2) To help the Iraqi people develop a state that will respect the self-
determination and sovereignty of all Iraqi people.
3) To promote the institution of an economic order in Iraq where the
people of Iraq will be the primary beneficiaries of their oil reserves.
4) To advocate and ensure the prevention of future wars by recommiting to
the collective frameworks of peace, justice, and security as enshrined in
the UN Charter and other international agreements.
5) To advocate and ensure that the current conflict does not completely
divert scarce aid and attention from other humanitarian needs around the
world.
Recent reports from Iraq indicate that the Geneva Convention has not
been followed, including the responsibility of the occupying power to
protect its
civilians, their property and institutions. The development of a
sovereign state that would fairly represent the various ethnic groups of
Iraq will also
be difficult, especially with the implementation of a U.S.-appointed
leader. The allocation of generous deals to U.S. oil companies with
Republican party ties is also questionable, and finally, recent talks on
the 'danger' of
Syria is already raising fears in the rest of the world. These are just a
few of the many disturbing developments recently exposed.
The humanitarian situation in Iraq is also deteriorating quickly,
with millions of inhabitants living without water, electricity, food, or
medical supplies. UNICEF spokeswoman has stated "It is clear that Iraq
is on the brink of an unprecedented humanitarian crisis. . .". WHO has
stated that the most urgent priorities will be 'providing treatment and
supplies for trauma and injury,
prevent the outbreak of communicable diseases, providing fresh drinking
water and sanitation, and trying to minimize discontinuation of treatment
for chronic disease' (Relief crisis unfolds as Iraq war progresses, Clare
Kapp, March 29, 2003, Lancet 2003 Mar 29;361(9363):1103-4).
Thus, we again reiterate our demand, as stated in our letter, for
independent humanitarian organizations to immediately gain free and
independent access to
the victims of war free of politial or military influence. Finally, we
call upon all concerned parties to immediately recommit themselves to the
collective frameworks for peace, justice, and security as enshrined in the
United Nations Charter and other international agreements.
Please find our open letter at http://www.uwomeds.com/iraq. We hope
this letter will contribute to informed discussion amongst members of the
government, the public, and the medical profession.
Sincerely,
Patricia Lee
University of Western Ontario
Meds 2005
Competing interests:
None declared
Competing interests: No competing interests