Medicine, Conflict and Survival

Abstracts of articles in Issue 19.4

Crisis in the United Nations, NATO and the European Union by Caroline Lucas

The unilateralist policies of the United States administration have raised the question of how the international system should operate. It is suggested that the administration is dismissive of institutions such as the United Nations, the International Criminal Court and the Kyoto Protocol because they do not permit the US to follow its desire to be the world’s unchallenged economic, political and military force. It is proposed that the Organization for Security and Co-operation in Europe should be responsible for European security in place of NATO. The European Union should not attempt to compete militarily with the US, but could act as a counterweight by adopting sustainable economic policies and political reforms. The United Nations must be democratized and international security enhanced by dealing with poverty and inequality. An emerging global public opinion may provide the political will for this to be achieved.

Seascape with Monkeys and Guinea-Pigs: Britain’s Biological Weapons Research Programme, 1948–54 by Elizabeth A Willis

The British biological weapons (BW) research programme based at Porton Down continued after the Second World War. Five series of BW experiments with animals at sea were undertaken to supplement laboratory work. The causative organisms for plague, brucellosis, tularemia and later Venezuelan equine encephalomyelitis and Vaccinia viruses were tested in the Caribbean near Antigua in the late 1940s, in Hebridean waters (north-west Scotland) in the early 1950s and off Nassau in the Bahamas in 1953–54. In September 1952, at the end of Operation ‘Cauldron’ off the Isle of Lewis, a trawler, the Carella, passed through the danger area when a toxic cloud had been released and was covertly watched until the incubation period had passed in case those on board had come into contact with the plague bacillus. Publicity about the trials was avoided, but a press statement was issued in March 1954. The last series provoked sustained agitation in Cuba. More recently an outline of the sequence has emerged in the UK parliamentary record and in Porton’s official history, and a fuller account of the Scottish trials has awakened some interest locally.

The Biological Weapons Convention after November 2002 by Piers D Millett

The Fifth Review Conference of the Biological Weapons Convention, in November 2002, was the first to fail to produce a Final Document. It saw heated debate on non-compliance with the spirit of the prohibitions that it enshrines and marked the collapse of almost ten years of negotiations attempting to create a Protocol to strengthen the Convention. What was to emerge was a new process, very different from the traditional tools of arms control. This article examines the events that culminated in this drastic new approach, details the nature of this new process and discusses the possible short-, medium- and long-term impact of these events on the norm against the weaponization of disease.

Bioterrorism in the United States: A Balanced Assessment of Risk and Response by Victor W Sidel

There are many definitions of terrorism and numerous examples of the use of explosives and small arms, especially against civilians and with the objective of instilling fear. Although chemical and biological agents have only rarely been used by terrorists, there has recently been much concern about the threat of bioterrorism and the role of future health personnel in counteracting it. Rational setting of priorities requires the balance of risks against benefits in prevention and preparedness. Adverse effects of preparedness include inappropriate warnings, diversion of resources from other public health measures, both in the United States and overseas and constraints on civil rights. It is argued that the US should counteract the threat of bioterrorism by dealing with its causes through effective arms control, and by international law rather than through the ‘war on terrorism’.

Which Bio-weapons might be used by Terrorists against the United Kingdom? by Frank Boulton

The properties of potential biological weapon agents for bioterrorism include a consistent effect at low dosage and short incubation period in a population of low immunity, being difficult to treat, able to be produced in bulk, stable in storage and readily disseminated. Possible agents include smallpox, haemorrhagic fever viruses, anthrax, tularaemia and plague. The example of Severe Acute Respiratory Syndrome (SARS) demonstrates the possible consequences of an act of bioterrorism, but also the necessary global response. There is scepticism about the practicability of surveillance schemes and the global elimination of biological weapons though the Biological and Toxin Weapons Convention remains urgent.

Bioterrorism: How Should Doctors Respond to the Threat of Biological Weapons? by Vivienne Nathanson

Planning for the threat of a biological weapons attack includes preparations to recognize and identify an attack and its scale. Training is the key element of any response, but it is not possible for any health service to maintain sufficient extra capacity to deal with a massive bioterrorist threat. Training must include both first- and second-line responders. Subject to issues of confidentiality, information about plans should be as widely available as possible. Planning for prevention is also important. This should include stopping the production and dispersal of weapons under international humanitarian law and establishing the ethical basis on which doctors and scientists would not become involved in the production of biological and other weapons.

Abstracts of articles in Issue 19.3

EDITORIAL – Rights, Wrongs and War by Douglas Holdstock

Electrical Devices Used by Prison Officers, Police and Security Forces by Harold Hillman

Electrical devices for crowd control, immobilizing threatening suspects and torturing prisoners are manufactured, traded and used in many countries. This article discusses their physiological, clinical and pathological effects and considers some legal implications of their use.

Countershock: Mobilizing Resistance to Electroshock Weapons by Brian Martin and Steve Wright

Electroshock, stun and restraint technologies are often used for torture and as tools of repression. There is much information available exposing the problems with such technologies, but little about how to be effective in challenging their use. The concept of political ju-jitsu – the process by which an attack on a non-violent resister can backfire on the attackers – is introduced and adapted to examine challenges to electroshock weapons. In order to make these weapons backfire, it is important to emphasize the value of potential targets, to expose secret dealings, to reveal the harm caused by the weapons and to communicate clearly to a wide audience. A longer-term goal is policy change to deny access by torturing states to such repressive tools. Countershock strategies and methodologies are introduced here as potential tools to create ever-expanding torture-technology-free zones.

The Psychosocial Effects of Landmines in Jaffna by Hentry Roche Gunaratnam, Sinothaya Gunaratnam and Daya Somasundaram

The victims of landmines in Jaffna were studied from a psychosocial perspective in order to identity major problem areas and give priorities for rehabilitation. Sixty-seven victims of landmines from April 1996 to March 1998 in the Valikamam area of Jaffna were studied. There were three times as many males as females. About 48 per cent were aged 20–39 years. About one-fifth of the victims were children. Of the females, 60 per cent were unmarried. The majority belonged to the lower socio-economic strata. Half lost their earning capacity after the injury. Post-traumatic stress disorder (72 per cent), acute stress reaction (73 per cent), anxiety disorder (80 per cent) and depression (73 per cent) were found to be very significantly higher in this group than in the general population. There were also remarkable changes in the areas of functional ability, religious practice, use of alcohol and social relationships. The ‘phantom limb’ phenomenon was a striking feature among amputees. The psychosocial impact of landmine injuries has to be considered seriously in rehabilitation work.

Japan’s Anti-Nuclear Weapons Policy Misses Its Target, Even in the War on Terrorism by Anthony DeFilippo

While actively working to promote the abolition of all nuclear weapons from the world since the end of the cold war, Japan’s disarmament policies are not without problems. Promoting the elimination of nuclear weapons as Japan remains under the United States nuclear umbrella creates a major credibility problem for Tokyo, since this decision maintains a Japanese deterrence policy at the same time that officials push for disarmament. Tokyo also advocates a gradual approach to the abolition of nuclear weapons, a decision that has had no effect on those countries that have been conducting sub-critical nuclear testing, nor stopped India and Pakistan from carrying out nuclear tests. Consistent with Article 9 of the Constitution, the Japanese war-renouncing constitutional clause, Tokyo toughened Japan’s sizeable Official Development Assistance (ODA) programme in the early 1990s. Because of the anti-military guidelines included in Japan’s ODA programme, Tokyo stopped new grant and loan aid to India and Pakistan in 1998 after these countries conducted nuclear tests. However, because of the criticism Japan faced from its failure to participate in the 1991 Gulf War, Tokyo has been seeking a new Japanese role in international security during the post-cold war period. Deepening its commitment to the security alliance with the US, Tokyo has become increasingly influenced by Washington’s global polices, including the American war on terrorism. After Washington decided that Pakistan would be a key player in the US war on terrorism, Tokyo restored grant and loan aid to both Islamabad and New Delhi, despite the unequivocal restrictions of Japan’s ODA programme.

Abstracts of articles in Issue 19.2

Globalization: A Long-Term View by Keith Suter

The process of globalization is now the most important development in world affairs. It is the end of the world order dominated by nation states (or countries) and the beginning of an era in which national governments have to share their power with other entities, most notably transnational corporations (TNCs), inter-governmental organizations (IGOs) and non-governmental organizations (NGOs). The process has to be viewed in its long-term historical evolution. Unfortunately, the process was seen as a technical international law issue by most people so there was a lack of attention to ensuring that the process worked for the benefit of all of humanity. The current (belated) controversy, such as the 1999 Battle of Seattle, could be a window of opportunity for NGOs to encourage a more informed public debate on how to create proposals for a better world.

Globalization: The Path to Neo-Liberal Nirvana or Health and Environmental Hell? by Neil Arya

This article addresses the impact of the neo-liberal agenda of globalization and in particular how international financial institutions and transnational corporations have affected and continue to affect the health of peoples, especially the poorest. It also examines impacts of these policies on the environment and peace.

Child Soldiers and Children Associated with the Fighting Forces by Sarah Uppard

Experience has shown that the breakdown of protective structures such as families and communities, particularly in times of conflict, leaves children vulnerable to recruitment into armed groups. These children are subject to gross violations of their human rights, such as the right to protection from harm, violence and abuse. At least 300,000 children are currently being used to fight in armed conflicts in over 30 countries across the world. Girls and boys are abducted, coerced or persuaded to join armed forces, often in brutal circumstances. These children are usually involved in internal conflicts, where poverty and exclusion leave very few other viable options – becoming soldiers may appear to be their only means of survival. Many, however, sustain physical injuries and permanent disabilities as a result of combat and it is impossible to know how many are killed. A large number encounter health problems such as sexually transmitted diseases, including HIV/AIDS. Lack of data on the health of child soldiers means that appropriate medical care and treatment may be inadequate or inaccessible, even during a planned demobilization. There is an urgent need for systematic research and data collection in order to better understand and provide for the healthcare of all children leaving armed groups.

Post-Conflict Reconstruction of the Health System of Afghanistan: Assisting in the Rehabilitation of a Provincial Hospital – Context and Experience by Judith Cook

Over more than two decades of conflict, Afghanistan’s health system came to depend heavily on assistance from donors and non-governmental organizations (NGOs). When the Taliban fell in November 2001 the health system was in a state of collapse; Afghanistan’s health indicators were amongst the worst in the world. National Health Policy is to deliver an essential package of health services to the entire population. It is acknowledged that reconstruction of the health system will depend on donor financial support and NGO involvement in health programmes. An example is Médecins du Monde’s involvement in health system rehabilitation in the Ghor province. Investing in health can contribute to peace, stability and political transition. Security, needed for reconstruction and for NGOs to continue their crucial work in health, has recently deteriorated in parts of Afghanistan. Joint Regional Teams to provide security to outlying areas have been announced by the US. There is concern that their proposed humanitarian and development role could compromise perception of the neutrality and impartiality of NGOs.

HIV/AIDS and Debt Crises: Threat to Human Survival in Sub-Saharan Africa by Walter Odhiambo

Whether originating from the African primates in the Central African forest, or from polio vaccine trials by some western scientists, there is no doubt that HIV/AIDS poses the greatest single challenge to the marginalized poor of Africa, where it has found a malnourished, vulnerable, defenceless host. Collective response is necessary by physicians and health professionals who must be at the forefront of restoring hope and a dignified quality of life. In sub-Saharan Africa, HIV/AIDS is not a security threat but a painful slow death which forces victims into exhausting their lifetime savings on expensive medicines and massive hospital bills. It leaves helpless orphans to struggle for survival in countries where government subsidy on education and healthcare has been long withdrawn so as to channel the meagre state resources into debt servicing. A combination of the HIV/AIDS pandemic and Third World debt is subjecting millions of children to the worst form of violence. This article reviews the situation in sub-Saharan Africa, with special reference to Kenya and South Africa as examples of countries devastated by the HIV/AIDS pandemic. Changes elsewhere are noted and the global response is critically examined.

Setting the Truth in Stone: Guatemala’s Monuments to the Dead by Ruth Gidley and Hannah Roberts

Six years after the end of a protracted internal conflict in Guatemala, many individuals and communities are still working to overcome the legacy of Guatemala’s violence and silence about the past. This article considers the role of monuments and examines the context and situation in Guatemala. It discusses the impact of the violence on a local level and how many Mayan spiritual practices were paralyzed. Some communities have exhumed mass gravesites and built monuments that honour the dead and challenge the army’s official version of history. Acknowledging the past has enabled some communities to move towards genuine reconciliation. Finally, the article reflects on the role for international support and accompaniment of this process.

PERSONAL PAPER – A Second Renaissance by Dennis J Kucinich

This piece was written to mark the first anniversary of 11 September 2001. At that time the author outlined his views on the need for America to focus on an era of peace rather than war, repairing its position in the world community through cooperation not confrontation. By banning weapons in space, placing peace at the centre of its foreign policy, restoring the ABM treaty and abolishing biological weapons, the author envisaged a new era in which America could place itself at the heart of the international community.

CONFERENCE REPORT – Investing in Health for Economic Growth and Poverty Reduction: New Perspectives and Opportunities by Carol Medlin and Malayah Harper

A three-day conference was held in Wilton Park in May 2002, organized in association with and support from the Department for International Development (DfID), the Norwegian Agency for Development Co-operation (NORAD) and the Institute for Global Health (University of California, USA). This report summarizes the major themes of the conference and highlights areas in which participants felt further work would be needed to address unresolved questions and concerns. Discussions took place under ‘Chatham House Rules’ of confidentiality; this report therefore refers generally and without specific reference to individual commentators.

Abstracts of articles in Issue 19.1

The Nuclear Issue: Where Do We Go From Here? by Joseph Rotblat

The drive for the elimination of nuclear weapons is going badly and there is currently little support from the general public. The United States Nuclear Posture Review incorporates nuclear capability into conventional war planning. The Stockpile Stewardship Program is designed to maintain nuclear weapon capability. The US is planning an essentially new earth-penetrating nuclear weapon and is prepared to test this in the national interest if thought necessary. These policies could stimulate nuclear proliferation by others, do nothing to deter terrorism, promote persisting polarization of the world, are a clear breach of the Non-Proliferation Treaty and rest world security on a continued balance of terror. A renewed mass campaign to counteract all this, on legal and moral grounds in particular, is urgently needed. IPPNW and kindred organizations must restore sanity in our policies and humanity to our actions.

Human Security: Expanding the Scope of Public Health by Paula Gutlove and Gordon Thompson

Human security is an evolving principle for organizing humanitarian endeavours in the tradition of public health. It places the welfare of people at the core of programmes and policies and is community oriented and preventive. It recognizes the mutual vulnerability of all people and the growing global interdependence that marks the current era. Health is a crucial domain of human security, providing a context within which to build partnerships across disciplines, sectors and agencies. These principles have been demonstrated in field programmes in which healthcare delivery featuring multi-sectoral co-operation across conflict lines has been used to enhance human security. Such programmes can be a model for collaborative action and can create the sustainable community infrastructure that is essential for human security.

The Responsibility to Protect by Mary-Wynne Ashford

The recent policies of the United States Administration threaten the entire structure of international law. Widespread concern in the US and elsewhere has been expressed in a different cluster of principles, in particular in the report of the Canadian-based Commission on Intervention and State Sovereignty. Its report states that the primary responsibility of a state is to protect its citizens; such protection includes prevention, reaction and rebuilding. The implications of this for military intervention are discussed; this must be a last resort after all non-military options have failed in response to the actual or probable large-scale loss of life and the objective to prevent further suffering. The action must be authorized by the United Nations Security Council or, if this fails to respond, the General Assembly. A further commission should examine how the international community should respond to states that refuse to comply with international law regarding weapons of mass destruction.

‘War on Terrorism’ and Deep Culture by Joanna Santa Barbara

This article examines the reasons underlying the massive reaction to the terrorist attacks of 11 September 2001 compared with the lack of response to the many thousands of preventable deaths elsewhere daily. It is suggested that the explanation is the ‘deep culture’ of the United States based on the myth of the frontiersman. The world is divided into winners and losers, good and bad; non-US citizens are of less value as human beings. The only response allowed by this deep culture is striking back at ‘the enemy’. The difficulties with this response are discussed and non-violent alternatives considered.

Challenges of War Surgery in Mallavi, Sri Lanka by Mhairi Collie

Northern Sri Lanka has been separated by an active front line from the remainder of the country and has lacked basic facilities, including hospital care, because of the war between the government and the Tamil Tigers. This article reports on the resulting situation in one district hospital in the region and on the work of Médecins sans Frontières in providing specialist hospital care under such difficulties.

OPINION – Israel and Palestine – The Middle East and IPPNW: Resolutions and Declarations by Ernesto Kahan

The Israeli-Palestinian conflict is characterized by a cycle of violence from both parties. Their policies will continue to fail until realistic and sincere negotiations begin. This essay describes the activities of affiliates of IPPNW and reports a programme to achieve this.

OPINION – Israel and Palestine – The Day We Need to Remember by Hikmat Ajjuri

The crime of 11 September 2001 is another aspect of the military culture of the last 5,000 years, which is also reflected in the continued conflict in Israel and Palestine. No real attempt has been made to convert the Oslo agreement into a permanent peace settlement, which must include a viable Palestinian state. Nevertheless, all acts of terror must be condemned whatever their motivation. The support of the United States is essential for a Palestinian state to come into being.

Abstracts of articles in Issue 18.4

The United Nations: The Embarrassment of International Law by Denis J Halliday

The United Nations should be working towards an international community living in peace under the aegis of international law. Although progress was made in its early years, notably in decolonization, with its membership increased from 50 to 189, major inequalities remain between its nations and their peoples. The Security Council, and in particular its five permanent members (P5), has been guilty of double standards in enforcing international law. Investment should create prosperity and not increase demand for arms. Independent oversight of the UN, and particularly the Security Council, by civil society is needed. If the legitimacy of the UN is to be restored, the Security Council should become more representative, the power of the General Assembly should be restored and the role of the International Court of Justice should be increased. All members of the UN, especially the P5, must respect international law as enshrined in the UN Charter and Conventions.

Aiming for Prevention: International Medical Conference on Small Arms, Gun Violence and Injury by Brian Rawson

IPPNW and Physicians for Social Responsibility, Finland organized an international conference on small arms and firearms injury in Helsinki from 28–30 September 2001, emphasizing the preventive medicine aspects of the issues discussed. This article describes the background to this conference and reports the work of IPPNW in following it up.

Small Arms, Physicians and Politics by Neil Arya

Figures for deaths from private use of small arms, particularly in children and young people, are summarized and responses to the discussion of these figures in a recent editorial in the British Medical Journal are considered. It is contended that the figures highlight a major public health problem, particularly in the United States. Further, this article emphasizes that the politicization of the debate by the US gun lobby should not be allowed to obscure the conflict-related consequences of small arms in the developing world.

More Guns, More Deaths by Wendy Cukier

It is contended that easier access to small arms increases the likelihood of misuse, on the basis of evidence comparing rates of firearm mortality and availability both between comparably developed countries, contrasting particularly the United States and others, and in different regions of individual countries. For example, firearm mortality is often greater in rural areas than urban. Possible inaccuracies in data collection are considered, but felt not sufficient to account for the finding. Measures to restrict availability such as stricter licensing, regulations governing storage and legally-imposed ‘gun-free zones’ may all reduce the death toll. In conflict zones, measures to remove arms post-conflict reduce subsequent mortality. Breaking the supply chain is also important and the link between supply, demand and the values of a society must be kept in mind.

The Value of Credible Data from Under-Resourced Areas by David R Meddings

Data collection requires a substantial investment in human resources and infrastructure, but it is essential that it is accurate to ensure the credibility of its use. These issues are explored in the light of data from injuries in ‘disorganized’ settings based on the experiences of field hospitals staffed by the International Committee of the Red Cross. Such data was influential in the campaign to ban landmines and can be used in the legitimate questioning of states’ foreign policies. It is important to distinguish between combatant and non-combatant weapons injuries. A significant proportion of civilian weapons injuries in combat zones, particularly post-conflict, occur in a domestic context; some widely quoted figures for civilian war-related injuries are too high, though the correct figures are still far too high. While reducing the supply of arms, the importance of other social factors such as education, poverty and the provision of health care is stressed – provision of health care is affected in combat zones.

The Physician’s Role in Preventing Small Arms Injury by Stephen Hargarten

The first step in defining a public health problem is to describe its scope and nature. For most diseases, this involves details on the victims, morbidity and mortality, and the agent of the disease. In the case of the small-arms ‘disease’, apart from data on the injuries caused, most other information resides with criminal justice agencies that are primarily concerned with criminal activity. In the United States, beginning in the state of Wisconsin, an approach based on the nation-wide data system of car crash deaths has been developed, linking medical examiners, coroners, police data and other information to provide a comprehensive picture of firearm-related deaths. The next step should be to develop standardized firearm-markings that would aid in controlling the illicit trade in small arms and more detailed information on the relationship between type of firearm and injury. Physicians can do much to aid prevention of small arms injury by advocating this public health approach.

The Effects of War on the Colombian Population by Nelson Arboleda

In the last decade, more than 1.5 million children have died as victims of war and 2000 over 300,000 children were being used as combatants. Colombia, the fourth largest country in Latin America in terms of population and second in area, has been the site of conflict between the government and guerrilla groups, which has created over 200,000 victims and has worsened in the last five years. There is severe poverty and illegal trading in arms and narcotics is closely linked to the conflict. Kidnapping, both individual and mass and often of children, has been a particular feature. Colombia urgently needs programmes to eradicate poverty and violence and must be fully supported by international organizations. Research to suggest effective interventions is an essential part of such programmes.

The Relationship between Human Security, Demand for Arms and Disarmament in the Horn of Africa by Kiflemariam Gebrewold

The drive to find security through possession of weapons is linked to the history and culture of a social group. Amongst pastoralists in the Horn of Africa there is a failure of security through state systems such as police and the recent replacement of less-lethal traditional weapons by small arms and other light weapons. A warrior or vendetta culture with these arms leads to violent inter-clan clashes with many casualties, although traditional methods of weapons control still seem operational within clans. Understanding the drive to seek weapons is essential in finding ways to control their use. Improving the capacities of the police must come hand in hand with human rights training and an end to corruption. Further work is required on how traditional methods of arms control can be co-operatively linked with state controls.

Guns, Health and the Exploitation of Natural Resources by Owens Wiwa

There are about 1 million small arms in Nigeria, which contribute to a large number of politically motivated killings. These are mainly sectarian (Christian and Muslim) and ethnic, over land and water rights and the relationship between the activities of companies and the environment. In the Ogoni region of the Niger Delta, with a population of half a million in an area of just over 400 square miles, there are 100 oil wells; the local community is attempting non-violently to clean up their environment. From July 1993 to April 1994 there were about 3,000 cases of gun violence, compared with only two in the previous five years. There were 250 deaths and about 100 amputations. Other forms of violence, including rape, also increased. Routine procedures in the hospitals that remained open were disrupted, there were serious effects on the mental health of the community and many became refugees. It appears that the guns used in this episode were imported by a multinational company for use by the Nigerian police.

Abstracts of articles in Issue 18.3

The Impact of the Intifada on the Health of a Nation by Samia O Halileh, Amal R Daoud, Rana A Khatib and Nahed S Mikki-Samarah This article describes the nature and extent of non-fatal injuries sustained by Palestinians during the first three months of the second intifada in late 2000 by looking at two sets of data. 10,279 cases were obtained from the records of the Red Crescent Organization, which provides first level emergency care via ambulance crews in the West Bank and Gaza Strip. For 6,071 cases in the West Bank, additional information was available from the Ministry of Health, which keeps records of first and second emergency level care provided at hospitals and health points. The Ministry of Health cases were classified by type of weapon, site of injury and level of treatment provided. Fifty-eight per cent of injuries occurred in young men 18–34 years, but 25 per cent occurred in school children, ten per cent in people over 50 years and five per cent in females. Fifty-nine per cent of the injuries were caused by bullets and 76 per cent of these affected the upper part of the body; 13.4 per cent of the injuries were severe, with major implication for disability and the need for long-term care and support.

Healthcare under Sanctions in Iraq: An Elective Experience by Muhammed Akunjee and Asif Ali

As a consequence of the 1991 Gulf War and the ensuing UN sanctions, not only was the Iraqi government destroyed, but also the general infrastructure of the country was disrupted, with the civilian population and public services bearing much of the aftermath. Ten years after the war, the health system in Iraq is still in a perilous situation. The effects of sanctions have affected almost every aspect of medical care. There has been a mass exodus of health care professionals, many of whom were foreign nationals. Doctors’ salaries fell rapidly to only $30 a month, barely enough to buy the necessities of daily living. Iraqi hospitals have no access to foreign journals, textbooks or the internet; leading to a generation of out-dated and under-skilled health professionals. Most worrying is the ever-present embargo on many essential medicines. Only one-third of the medicines are available for chemotherapy for the treatment of acute lymphoblastic leukaemia in children (UKALL 97 modified 99 protocol). At the Al-Mansour paediatric teaching hospital this shortfall has led to a substantial increase in childhood mortality, with disease-free survival rates falling to 25 per cent compared to 60 per cent in 1988.

Obstetrics during Civil War: Six Months on a Maternity Ward in Mallavi, Northern Sri Lanka by Ondrej Simetka, Brigg Reilley, Mathilda Joseph, Mhairi Collie and Johannes Leidinger

A long-term, large-scale ethnic armed conflict continues in Sri Lanka, where militant separatists control a northern section of the island. The conflict has resulted in a large population of internally displaced persons and a shortage of medical staff. Drug and equipment shortages compound the difficulty in access to medical care. This article reports the experiences from 1 November 2000 to 30 April 2001 recorded by review of medical records and by interviews, in the peripheral unit, in a separatist controlled area of the Mallavi maternity ward. There were 704 births. Most of the mothers had been displaced by the war (69.5 per cent) and had experienced food shortage (67.5 per cent). Referred patients (18.1 per cent) had a high rate of caesarean section (44.3 per cent) and had travelled a mean of 57.6km to reach Mallavi. There had been substantial antenatal care (94.0 per cent), tetanus toxoid vaccination (95.1 per cent) and malaria prophylaxis (86.4 per cent). Risk factors for low birth weight included a maternal body mass index less than 19 (RR 1.55, CI 1.11-2.16, P=.011), primiparity (RR 1.44, CI 1.05-1.97, P=.024) and self-reported malarial infection during pregnancy (RR 1.42, CI 1.03-1.97, P=.036). Rates of low birth weight, stillbirths, neonatal deaths and maternal mortality in the Mallavi units were higher than the Sri Lankan national averages. Improvements in quality of care and access to health care are unlikely while the war continues.

A Short History of Biological Warfare by Neil Metcalfe

Biological weapons have been used in war from the start of recorded history. This article reviews the history of the subject, including the outbreak of the Black Death and the use of smallpox against American Indians. The new science of microbiology was misused from soon after its start and, despite the 1925 Geneva Protocol, the Japanese experimented extensively on prisoners in China. The Allies carried out extensive research during the Second World War, notably the United Kingdom into anthrax on Gruinard Island and the United States into a variety of agents. Despite the 1972 Biological Weapons Convention (BWC), a major programme continued in the former Soviet Union (leading to an accidental outbreak of anthrax). Most recently Iraq was revealed as having an extensive programme, with weaponization of large amounts of various agents, and several terrorists groups have attempted to use biological agents as weapons. Modern developments in biotechnology could lead to even more serious developments, and effective preventive measures, including strengthening of the BWC, are imperative.

Progress in the International Protection of Human Rights by Keith Suter

Great progress has been made in the international protection of human rights since 10 December 1948 (when the United Nations General Assembly adopted the Universal Declaration of Human Rights). Amidst the doom and gloom of the media’s reporting of current affairs, it is easy to overlook this progress. This article provides a definition of ‘human rights’ and examines early human rights campaigns. It then considers the areas of progress: human rights are now part of the international political vocabulary, there is a recognition that respect for human rights can assist a country’s economic and social development, there has been a growth of human rights treaties and techniques and non-governmental organizations (NGOs) see protecting human rights as a major activity. State sovereignty has been eroded as national governments are being held accountable to the international community for their human rights policies. A new challenge is to ensure respect for human rights by non-state entities, such as transnational corporations. The growing culture of international protection of human rights is here to stay. This is not a reason for complacency, but it is a sign of hope.

Project Sunshine and the Slippery Slope: The Ethics of Tissue Sampling for Strontium-90 by Sue Rabbitt Roff

When citizens of Atlantic alliance countries are being asked by their elected leaders to suspend many of the fundamental rights of democracy in order to defend them, it is timely to consider the perils of the slippery slope that was opened up by the harvesting of human bones and tissue for studies of strontium-90 fallout during the height of the cold war. In particular, the need to collect samples from recently deceased infants and children seems to have overridden the rights of parents to determine what became of their loved ones after death. Forty years later, parents and others question whether the fact that this research contributed significantly to the partial moratorium on atmospheric tests justified the overriding of their rights. It also reminds us that the testing of nuclear devices, even in the defence of democracy, presents global health hazards.

Blood Money: The Duty of Care to Veterans of UK Nuclear Weapons Tests by Sue Rabbitt Roff

Fifty years after the first UK nuclear weapon test at Monte Bello off the north-west coast of Australia in October 1952, this article documents the deliberate and repeated decisions not to provide adequate radiation protection to most of the 40,000 men who participated in the British programme in the 1950s in Australia and Christmas Island, precisely to avoid future liability claims. The evidence lies in the minutes and memoranda of the scientists, doctors and military leaders overseeing these tests. Archival material in the United Kingdom Public Records Office and the National Archives of Australia is, according to senior barristers, sufficient to sustain an allegation of negligence, even by the standards of 50 years ago, against the government of the day and an allegation of cover-up by the current government, faced with potentially huge compensation bills and pension pay-outs for long-term radiation injury to former servicemen. Recent governments have tried to reassure the veterans with epidemiological studies, which are almost inevitably inconclusive. However, pilot studies have now begun on radiobiological tests that may be able to determine whether a particular individual was irradiated significantly 40 or 50 years ago and whether he has subsequently suffered cancers or other ill health because of this radiation burden. The first results from these studies should be available around the time of the fiftieth anniversary of the first UK test.

Abstracts of articles in Issue 18.2

The United Nations and the Promotion of Peace by Paul Rogers

Despite the end of the cold war, many other conflicts persisted in the 1990s. The hope that a peace dividend would help to alleviate poverty was replaced by doubts regarding the effects of free market globalization and environmental constraints. Future concerns include the continuing aftermath of the cold war, the increased destructiveness of modern warfare, despite the increased sophistication of modern weaponry, the widening poverty gap between a wealthy elite and the majority of the world’s population and developing global economic and environmental threats. The response to all this should be economic co-operation for sustainable development, including trade reform, and radical change in the environmental impact of the industrialized countries. Yet it appears that the response of the US, and to a lesser extent Europe, is to maintain the status quo in its own interests by military means, an attitude that seems to have been reinforced by the events of 11 September 2001. Nevertheless, these developments are opposed by citizen groups in the developed world and by analysts in the South. The United Nations and its agencies have been at the forefront of analysis and proposals for action in many of these fields. Its role is likely to increase in the next 30 years and it must be made as effective a global body as possible.

Biological Warfare: The Threat in Historical Perspective by Brian Balmer

The story of work on biological warfare in the twentieth century is briefly reviewed and the history of the British programme analyzed, largely from documents now available in the Public Records Office. The position of the United Kingdom in relation to other military and political issues has varied, as has its overall attitude from time to time. In the 1930s a defensive stance was linked to the health effects of conventional war. During and after the Second World War the objective was to obtain a biological bomb before actual or potential enemies, but later the emphasis returned to a more defensive stance, with attempts to assess the hazard over wide areas. Any evaluation of the effects of new developments in genetics should take the changing nature of these past assessments into account.

The Potential for Abuse of Genetics in Militarily Significant Biological Weapons by Simon Whitby, Piers Millett and Malcolm Dando

Concern has been expressed at successive Review Conferences of the Biological and Toxin Weapons Convention (BTWC) regarding the possible misuse of new biological knowledge; this article reviews some of these developments. Genetic manipulation, and genomics in particular, would modify existing pathogens and render previously harmless organisms pathogenic. Viruses could be modified as vectors to alter their pathogenicity in animals and man or act as carriers for genes or toxins. Plant pathogens, particularly fungi, could be modified as biological warfare agents against crops. An effective verification protocol for the BTWC is an essential part of the web of deterrence against these developments.

Response to Whitby, Millett and Dando by Peter M Biggs

Hope and Ambition turn to Dismay and Neglect: The Biological and Toxin Weapons Convention in 2001 by Daniel Feakes and Jez Littlewood

The background to the failure of the December 2001 Fifth Review Conference of the Biological and Toxin Weapons Convention (BTWC) to agree a politically binding final declaration is discussed. Negotiations in the Ad Hoc Group (AHG) of the BTWC, which was set up after the 1994 Special Conference, are described. Accusations of non-compliance with the BTWC are not new and it is concluded that the ultimate failure of the 2001 Review Conference was principally, but not entirely, due to rejection by the United States that the AHG should remain in being. Strengthening the BTWC remains as important as ever, but it remains to be seen if there is the political will to achieve this.

Verification of the Biological Weapons Convention: What is Needed? by Oliver Meier

The lack of transparency and verification of the Biological Weapons Convention (BWC) is one factor behind the current weakening of the ban on biological weapons. Despite recent setbacks, governments need to fill the verification gap so that violations of the BWC can be detected and deterred. Continued talks on a strong verification mechanism for the BWC should aim for an open verification regime and one that is flexible enough to adapt to new technical and political circumstances. Effective monitoring of compliance with the BWC will require concerted effort by governments and civil society.

Closing Loopholes in the Biological Weapons Convention by Jan van Aken and Edward Hammond

The Biological and Toxin Weapons Convention (BTWC) received two major blows in the past months. Negotiations for a protocol to strengthen the BTWC came to a halt and the Fifth Review Conference was unable to reach agreement on a final declaration. In addition, ongoing research projects, predominantly in the United States, are threatening to undermine the comprehensive ban on the development, production and use of biological weapons. This article provides two examples of research that exploit perceived loopholes in the BTWC or impinge on the scope of the Convention, namely the planned use of biological agents for forced drug eradication and the development of anti-material agents.

Landscape with Dead Sheep: What They Did to Gruinard Island by Elizabeth A Willis

In the context of intensified international concern about biological weapons (BW), this article looks at the pioneering British research in this field during the Second World War, which caused the long-term contamination of Gruinard Island in north-west Scotland. Public Record Office documents have been examined to show how scientists reported on the experiments at the time and what they thought about their (top secret) work, as well as how politicians directed their efforts and used their results, leading to continued BW research post-war. In the 1960s the contamination became known and discussed in the media and was eventually the subject of a public announcement. Decontamination was not regarded as a practical proposition until the 1980s and was undertaken in 1986 in two areas of the island, which was declared safe in 1990. Some doubts remain locally about the extent and effectiveness of the clean-up process, along with a legacy of bitterness.

Abstracts of articles in Issue 18.1

Editorial: 11 September 2001 – and After by Douglas Holdstock

Setting the Scene: The New Conflict Environment and Contemporary Challenges for Interventionists by Ann M Fitz-Gerald

This article examines the characteristics of contemporary conflict and humanitiarian environments and looks at the reasons that underpin their evolution. It studies the role of globalization, international economies, weapons proliferation, warlords, individual security guarantees and urbanization.The role of the international community is discussed and the main responsibilities and actors are defined. Future challenges for multinational military forces are examined and an overview given of the role of non-governmental organizations (NGOs), United Nations (UN) agencies, bilateral and multilateral donors, commercial companies and host governments. Lastly, recommendations are given on how the international community can close existing gaps that impede operational effectiveness, whilst still providing integrated responses to global needs.

Three Wars that Never Happened by W M S Russell

This article discusses three serious wars that were averted and the three men who averted them. In 1478-79, Pope Sixtus IV's hatred of the Medici culminated in aggressive war against Florence, supported by his powerful ally King Ferrante of Naples. The initial stages of this war were indecisive, but it was about to become much more serious, probably involving all the Italian states and possibly meaning the total destruction of Florence. Lorenzo il Magnifico sailed to Naples, convinced Ferrante this more serious war was against his interests and obtained a generous peace. In 1861, the British Government responded to the boarding of a British ship by a vessel of the American North with a peremptory letter. Albert, Prince Consort, though dying of typhoid fever, amended the letter to save Lincoln's face and thus averted war with the North. From 1871 to 1890, Otto von Bismark worked for a stable peace between the European powers to attained by arranging meetings of most or all of them to accustom them to solving disputes by negotiation. Two such meetings in Berlin secured 36 years of peace between the powers, despite many disputes, and in particular averted war for possessions in Africa, which could have involved them all.

Globalization, Migration and Health by Angela Burnett

The term 'globalization' describes the integration of economic systems through improved communication, but it also represents increased insecurity for those with few resources – particularly refugees. This article examines why people migrate, their numbers, constraints on their movement and their particular health care needs. Immigrants have much to contribute to their recipient countries, but at some loss to their homelands. Both economically and morally, more liberal immigration policies would be beneficial. Policies towards asylum seekers should not be more restrictive in the aftermath of 11 September 2002 and detention should be the exception rather than the rule. Globalization should be managed so as to improve people's lives throughout the world.

Psychological Response to Disaster: The Attacks on the Stark and the Cole

The terrorist attack on the USS Cole on 12 October 2000 was remarkably similar to the 1987 attack on the USS Stark. This article discusses the psychosocial consequences of the attacks on the families and crews of the ships and the community response of the Navy to the attacks, particularly that of the Navy Family Service Centers. The impact of the attacks is compared to the impact of natural and man-made disasters on communities while the impact on the crew is examined in light of combat psychiatry and post-traumatic stress disorder (PTSD). Events such as these are likely to produce PTSD despite early intervention efforts. Following the attack on the Stark greater attention was given to the grief of family members than to the trauma of the crew, while the crew of the Cole has received longer-term psychiatric assistance than in previous similar episodes.

The Case of Serbia/Yugoslavia: An Analysis through Spiral Dynamics by Vuk Stambolovic

Yugoslavia and later Serbia have puzzled the world since the early 1990s. This article presents a study based on the principles of spiral dynamics that were used to analyze the transformation of South Africa. According to spiral dynamics, Yugoslavia under the joint influence of nationalists and retro-socialists regressed to the egocentric and exploitative level of psychosocial existence and, in spite of recent political changes, has maintained the same centre of gravity. Although its political structure has changed, nationalist and retro-socialist values remain dominant in the cultural domain and in the domain of self. Yugoslavia/Serbia desperately needs the new dynamic process of development. Priorities are the establishment of a hierarchy of authority, self-confrontation and development of widely based enthusiasm. These could lead Serbia to become responsible and mature.

Commentary: Pipelines and Poppies by Bill Hayton

Personal Paper: Prevention of War is a Precondition of Nuclear War by Ulrich Gottstein

Statement: International Phyisicians for the Prevention of Nuclear (IPPNW) International Medical Conference on Small Arms, Gun Violence and Injury

Conference Report: Humour as a Strategy in War by Liz Willis

Book Reviews

Abstracts of articles in Issue 17.4

Preventing War through Non-violent Direct Involvement in Conflict – I: Principles and Background by the IPPNW Development Team

International Physicians for Prevention of Nuclear War now considers prevention of all violent armed conflict as one of its core objectives, as such conflict is incompatible with health. Health professionals have long been involved in this area with an inclination towards non-violent means. The growth of interest in the area of non-military peacemaking, the growth of knowledge and research in the last few years and the post-cold war nature of most contemporary wars mean that IPPNW needs to approach war prevention in a systematic way, benefiting and co-operating with other creative forces in the field. In this first of two articles we present some important work by contemporary non-violent researchers. We seek to develop an imagination and a mode of thinking to enable health professionals to prepare to engage in Non-violent Direct Involvement in Conflict (NVDIC).

Preventing War through Non-violent Direct Involvement in Conflict – II: Proposal for the Role of IPPNW by the IPPNW Development Team

IPPNW now considers prevention of all violent armed conflict as one of its core objectives as such conflict is incompatible with health. Secondary prevention of war must involve early detection of volatile conflicts and their effective treatment by non-violent but direct intervention. Such non-violent direct interventions in conflict (NVDIC) are most desirable but currently underdeveloped. Most importantly they do not enjoy the prominence that would facilitate their wide understanding, acceptance and support. This article discusses ways in which IPPNW can best use its experience and resources to engage more appropriately and systematically in NVDIC. It is suggested that participation in observation and mediation missions, direct health related work, public promotion of health and environmental concerns, prominent involvement of women, use of health professionals’ status, support of peace-promoting local health professionals, use of local knowledge and experience of IPPNW affiliates, psychological analysis and, most of all, co-operation with groups currently developing NVDIC are domains in which IPPNW can do great work. There are, however, many unresolved ethical and practical questions. It is therefore of the greatest importance that organizations such as IPPNW should be involved in ongoing research on NVDIC. NVDIC must be developed in a framework of evolving appropriate research methodology addressing both its effectiveness and mechanisms of action.

Wars of the Nineties by Henri Firket

The 40 wars of the past decade, all ‘minor’, have resulted in a total of more than two million deaths and 20 million refugees or displaced persons. Few have been the international wars typical of previous periods. Nine out of ten began as internal or civil wars, foreign intervention – when it occurred – being always secondary. The weapons used, the effects on the civilian populations, the type and extension of damages are different but equally destructive. The main causes of these conflicts are cultural or religious, rather than economic. The best attitudes to attempt to prevent or stop them are surveyed.

Sitting it out in the Sealed Room: the Israeli Response in the 1991 Gulf War by Sue Rabbit Roff

The response of the Israeli civilian population to the Scud missile attacks and the possibility of chemical and biological warfare during the 1991 Gulf War have been monitored in various contexts. The present article reviews the findings and their implications for civilian defence planning in the event of a reprise. In 1991 the most controversial policy was the insistence that Israeli families prepare a sealed room in which to sit out the Iraqi attacks. The evidence suggests that in some instances this may have been counterproductive, even during relatively short periods of immurement.

REVIEW ESSAY

‘The United States and Biological Warfare: Secrets from the Early Cold War and Korea’ by André Bruwer

The United States and Biological Warfare is about accusations that the United States resorted to bacteriological warfare at a time of great military stress during the Korean War. In December 1951, the then US Secretary of Defense ordered early readiness for offensive use of biological weapons. Soon afterwards, the North Korean and Chinese armies accused the United States of starting a large-scale biological warfare experiment in Korea. The US State Department denied the accusation. Both parties to the dispute maintain their positions today. The authors spent 20 years researching the accusations in North America, Europe and Japan. They were first foreigners to be given access to Chinese classified documents. The reader is also introduced to the concept of ‘plausible denial’, an official US policy which allowed responsible governmental representatives to deny knowledge of certain events. The authors hope that their work will contribute to the understanding of a time when modern war expanded into a new type of violence.

Abstracts of articles in Issue 17.3

The Future of Non-lethal Weapons by Nick Lewer, Malcolm Dando and Tobias Feakin

An Overview of the Future of Non-lethal Weapons by John B Alexander

During the past decade, vast changes have occurred in the geopolitical landscape and the nature of the types of conflicts in which technologically developed countries have been involved. While the threat of conventional war remains, forces have been more frequently deployed in situations that require great restraint. Adversaries are often likely to be elusive and commingled with noncombatants. There has been some shift in public opinion away from tolerance of collateral casualties. Therefore there is a need to be able to apply force while limiting casualties. Non-lethal weapons provide part of the solution. Among the changes that will influence the future have been studies by the US and NATO concerning the use of non-lethal weapons, coincidental with increased funding for their development and testing. New concepts and policies have recently been formalized. Surprisingly, the most strident objections to the implementation of non-lethal weapons have come from organizations that are ostensibly designed to protect non-combatants. These arguments are specious and, while technically and academically challenging, actually serve to foster an environment that will result in the deaths of many more innocent civilians. They misconstrue technology with human intent. The reasons for use of force will not abate. Alternatives to bombs, missiles, tanks and artillery must therefore be found. Non-lethal weapons are not a panacea but do offer the best hope of minimizing casualties while allowing nations or alliances the means to use force in protection of national or regional interests.

‘Non-lethal’ Weapons and International Law: Three Perspectives on the Future by David P Fidler

Literature on ‘non-lethal’ weapons (NLWs) frequently contains assertions that more robust NLW development and use are needed because of the changing nature of military operations. These assertions are in opposition to international legal analysis of NLWs, which show international law restricting NLW development and use. This article examines this tension by briefly analyzing the restrictive impact that international law has on NLWs and by elaborating three perspectives on what the relationship between NLWs and international law should be. The article outlines the moral foundations for existing international law on the use of force and armed conflict and then sketches international law’s current impact on NLW development and use. Next, the article explores the compliance, selective and radical change perspectives that emerge from discourse about international law and NLWs. The compliance perspective insists that NLWs comply with existing rules of international law. The selective change perspective seeks limited changes in international law to allow more robust use of NLWs. The radical change perspective sees in NLWs the potential to reform radically international law on the use of force and armed conflict. Identifying the three perspectives helps clarify future choices NLWs may present in international law and suggests that the future relationship between NLWs and international law will be more complex, controversial and dangerous than people may realize.

The Revolution in Military Affairs Debate and Non-lethal Weapons by Gerrard Quille

This article introduces a discussion on developments in political and strategic thinking on the use of existing and emerging weapons (including Non-lethal Weapons) and their doctrinal operational implications in the context of present trends in international relations. It asserts the need to address both the strategic assumptions and the political implications of choosing military-led solutions to trends in international social conflict. The so-called Revolution in Military Affairs (RMA) must be considered in the light of the current debate on the military application of non-lethal weapons (NLWs) to present or future conflict. The issue is introduced from a politico-strategic perspective, with a critique of the RMA debate as a starting point for discussion of the role of NLWs in conflict. Questions are set out for the politicians and strategists who are asked to formulate policy based on technology to be used in new political/social conflicts. The danger of neglecting other important dimensions of politics and strategy vis-à-vis present conflict is noted.

The Role of Sub-lethal Weapons in Human Rights Abuse by Steve Wright

This article is based on two recent reports contracted by the European Parliament (EP), which assessed sub-lethal weapons as flexible tools of political control. It analyses the role and function of existing weapons systems in human rights abuses using examples from Indonesia, Israel, Kenya, Northern Ireland and Turkey. These weapons are designed to ‘appear’ rather than ‘be’ safe and, since they augment rather than replace lethal technologies, their use can distort conflicts and actually bridge the firewall between use of less-lethal and lethal technologies.

Non-lethal Weapons Technologies – the Case for Independent Scientific Analysis by Jürgen Altmann

Various technologies have been proposed for non-lethal weapons (NLW), some of them credible, or at least plausible, but others were made without evidence or references. Five such technologies are examined. For the chemical and biological examples, detailed information is lacking but the diminishing number of such claims over time and general scientific knowledge suggest that fulfilment of the promises is improbable. For acoustic weapons, a detailed study found that many of the allegations are plainly untrue. In this case, even wrong values for physiological thresholds were presented. Civil and military NLW programmes in the USA put their main emphasis on simple, rather than exotic, short-term technologies. In order to avoid dangers arising from unrealistic promises, the concept of preventive arms control should be applied to NLW. Its first step is a scientific analysis, investigating the new weapons, the propagation of their effects and the effect on the targets. Such detailed studies are needed for each proposed NLW technology.

Future Police Operations and Non-lethal Weapons by Jorma Jussila

Society has entrusted the police with power and obligation to enforce law, maintain order and protect its members and the legal order of society. To be able to fulfil these obligations the police need credible means of countering threats against these values. Selecting the weapons, or rather use of force instruments, presents a multi-faceted problem of balancing human considerations, judicial and societal requirements with tactical needs and technological possibilities. No matter what the incident is, a police officer is expected to protect the innocent, him/herself, colleagues and the object persons and to cause no more harm than is justifiable and unavoidable. Unfortunately there is no safe use of force and in real life the only option available for resolving certain conflicts is some degree of force. Any weapon can be misused but most weapons have a legitimate use. Denying legitimate use, as well as allowing uncontrolled use, may lead to unnecessary suffering and loss of life. Technology is offering interesting alternative possibilities to the police and these must be considered with open eyes, bearing in mind that misuse, like torture, is not a property inherent to technology but an intentional behaviour of some people. Thorough research and fair and credible controls on police weaponry are needed to avert the possibility of misuse and to maintain trust.

Operationalizing Non-lethality: a Northern Ireland Perspective by Colin Burrows

‘The troubles’ over the last 33 years in Northern Ireland have claimed the lives of 3,636 people, including 302 police officers and 644 soldiers. Of these deaths, 315 were attributed to the military and 52 to the police. Formative experience of public disorder within the early parts of the conflict is reviewed. This article places the evolution, development and use of baton rounds (rubber and plastic bullets) in context and describes the training of police in their use. The development of a conflict management strategy which provides synergy with community based policing is discussed and the importance of understanding the underlying causes of a conflict for law enforcement personnel is emphasized.

Perspectives and Implications for the Proliferation of Non-lethal Weapons in the Context of Contemporary Conflict, Security Interests and Arms Control by Nick Lewer and Tobias Feakin

This article briefly looks at the characteristics of contemporary conflict and the global political arena, particularly from 1989 and the end of the cold war. The development of and potential roles for second generation non-lethal weapons (NLWs) in war-fighting, peace support operations, and civil policing are discussed. There are arguments both for and against further and rapid development of NLWs. The question of proliferation and arms control is examined within the context of concepts such as the revolution in military affairs (RMA) and factors such as the increasing role of non-state actors, current security requirements and the problems concerning the implementation and enforcement of current and envisaged arms control regimes. Proliferation, which may be vertical or horizontal, may not always be seen as a malign process but rather one which requires specific ethical and operational perspectives. Proliferation is about both technology push and operational requirements. The effectiveness of legislative approaches to controlling proliferation, especially to countries which are considered to have poor human rights records, is discussed and issues about who wants to control NLWs, and why, are raised. Some technologies may be seen as less threatening to existing arms control and management treaties and the ethical debates which surround them. A concern regarding increasing use of non-lethal technologies for political oppression is part of this debate. The issues are illustrated using India as case study.

Abstracts of articles in Issue 17.2

The Hidden Casualties of Conflict by Douglas Holdstock

Survival with Pain: An Eight-Year Follow-up of War-Wounded Refugees by Ann-Charlotte Hermansson, Mikael Thyberg, Toomas Timpka and Björn Gerdle

The aim of this study was to investigate the nature of chronic pain in male war-wounded refugees and to examine the relationship between chronic pain and psychiatric symptoms. A culturally heterogeneous group of 44 war-wounded refugees were investigated during hospitalization, shortly after arrival, and followed up after two years. This study is an additional follow-up after eight years. The data collection methods used were structured interviews and physical examination. The measures of outcome were: Visual Analogue Scale (VAS) grading of pain; clinical categorization of pain into nociceptive or neurogenic; Hopkins Symptom Check List (HSCL-25); Post Traumatic Symptom Scale (PTSS-10). Chronic pain was found in 32 (73%) out of 44 subjects. The pain was purely nociceptive and neurogenic in 53% and 25%, respectively. The frequency of psychiatric symptoms was significantly related to the mean intensity of pain. War-wounded refugees display psychiatric symptoms and chronic pain in a complex pattern. Further research is needed as a basis for pain rehabilitation programmes suitable for this group. Ideological Commitment, Experience of Conflict and Adjustment in Northern Irish Adolescents by Orla T. Muldoon and Keith Wilson This study aims to assess young people’s overall experience of political conflict, as well as the extent of these experiences in relation to gender, religious affiliation and residential location (high or low conflict). Second, this study assesses the impact that young people’s ideological commitment and experiences of the conflict have on their self-esteem and mental health. A sample of 96 Protestant and Catholic young people (mean age 15.2), drawn from four schools in two areas of Northern Ireland, completed self-report measures of self-esteem, mental health, ideological commitment and experience of conflict. The areas differed substantially in the amount of violence they had experienced. The results indicated that young people’s experience of violence varied in relation to the town in which they lived. Boys’ experience of violence appeared to be related to their religious affiliation. Experience of conflict and ideological commitment, two attributes that were positively related, interacted to predict both mental health and self-esteem. The importance of ideological commitment to our understanding of the impact of political conflict on young people is discussed.

Providing Health Care for Refugee Children and Unaccompanied Minors by Margaret A. Lynch

The health of refugee children must be considered beyond ensuring access to health care to include issues such as housing and education. Refugees require support in using services, and their culture and religious background must be taken into account. Refugee children have the same rights to health as any other children, yet their non-eligibility for welfare foods may have implications for their nutrition. Providing for 15–18 year olds presents particular problems. It is therefore important for access to appropriate care for unfamiliar diseases and that emotional health problems are recognized, particularly when they are related to past experiences of violence.

How Primary Care Services can Incorporate Refugee Health Care by Peter Le Feuvre

Two principles should underpin the provision of primary health care to refugees: (a) that refugees should have the same access to and quality of primary care services as the local population, and (b) any specialist service should have the goal of full integration of the refugee into normal general practice. The various ways in which medical care can be provided to refugees and the knowledge, skills and attitudes important to such provision are described. One way in which such a service was provided in east Kent is reported. The term ‘refugee’ encompasses newly arrived refugees who are awaiting a decision from the Home Office, as well as those who have been given permission to stay, either as recognized Refugees under the provisions of the 1951 United Nations Convention, or with Exceptional or Indefinite Leave to Remain.

Children of Traumatised and Exiled Refugee Families: Resilience and Vulnerability. A Case Study Report by Amer A. Hosin

This article focuses on the main problems and outcomes of two children of a traumatized refugee family who have been in Britain since 1993. Their parents witnessed near death experiences and physical assaults, and suffered losses and a wide range of physical problems; the father manifests post traumatic stress disorder (PTSD) symptoms. The children have been exposed regularly to episodic rage and violent behaviour by their father, and have developed separation problems and psychosomatic complaints. Their mother has coped better and is very resilient in her care and approach to problems. This report acknowledges the negative experience of trauma, but also the sources of resilience of parents, children’s adjustment and cultural differences in coping styles. Refugee experiences devastate individual well-being and coping mechanisms if there is no hope, support and faith in one’s own potential. Protective and risk factors that may affect the manifestation of trauma symptoms are highlighted. A variety of treatment approaches are required for both adult and child victims of multiple trauma. A wide range of techniques, such as group therapy, behaviour and cognitive therapy, and desensitization and relaxation training, can help sufferers to enhance their coping skills and deal effectively with devastating life events.

Reconciliation and Healing of a Nation by Alexandra Murrell

This article explores the effect of mass trauma and how it is dealt with both individually and socially. The question why the systematic massacres happened in Cambodia is addressed. Also covered is a brief history of the continual divisions in Cambodian society. The Cambodians have not come to terms with their tragedy or moved closer to the rest of the world. Some means of reconciliation are suggested.

Colloquium on ‘A Culture of Peace’ by David Head

Non-governmental UN Millennial Events by Jeffrey Segall

Abstracts of articles in Issue 17.1

Health for All in the New Millennium by Robin Stott

Civilians and War: A Review and Historical Overview of the Involvement of Non-combatants in Conflict Situations by David R Meddings

The effects of light weapons are now regularly seen on television and are becoming an international issue, particularly regarding their impact on civilians. It is claimed that 80% or more of deaths and injuries in today’s wars are civilian; there is no objective evidence for this as little accurate information is available. Recent surveys suggest, however, a proportion of between 35 and 65% – still far too high considering the protection to which civilians are entitled under international humanitarian law. It is proposed the problem arises from twentieth-century killing power in the hands of individuals with fifteenth-century discipline and organization. Recent systematic surveys distinguish between civilian deaths from light weapons in combat and non-combat situations. A high proportion of combat deaths is due to fragmenting weapons such as mortars targeted on populated areas. Many weapon-related deaths in non-combat situations are accidental (cleaning weapons, handling by children during play) and others are related to domestic disputes. The availability and use of weapons also affects civilians indirectly in many ways, such as ill-health in refugees, psychosocial effects on women and children, and economic and environmental consequences. A variety of schemes exist to reduce the availability of light weapons and reintegrate their users into society. The international community must extend and make better use of these measures.

The UN in Crisis? by Margaret Anstee

The United Nations (UN), the principal role of which is dealing with crises, has been in almost perpetual crisis since its foundation. The situation has become worse in the 1990s, a time when the need for an effective UN has been greater than ever, to cope with issues such as climate-change, pollution and the consequences of globalization. The current crisis has various aspects. Politically there have been widely publicized failures in peacekeeping, largely due to the Security Council being a body of compromise, while successes in peacekeeping have been largely ignored. In the economic and social field, influence has passed to the International Monetary Fund (IMF) and the World Bank. Development aid has plummeted, despite its key role in peace and security, and so an integrated approach to development and security is urgently needed. The UN has been constantly under-funded, with the failure of the United States (US) to pay its dues a key factor. Reform of the UN is vital, but the vested interests of member states make root-and-branch reform virtually impossible. Public pressure for reform can come from non-governmental organizations, perhaps coordinated through the Internet.

Stories of Pre-war, War and Exile: Bosnian Refugee Children in Sweden by Stephen Goldin, Lilian Levin, Lars Ake Persson and Bruno Hagghof

While standardized questionnaires produce counts of isolated events, a semi-structured interview derives a story, a complex narrative in time and place. Ninety Bosnian refugee children and adolescents (ages 1–20), resettled in Sweden, were assessed in a semi-structured clinical interview designed to identify and offer support to children at risk. A family-child account of traumatic exposure was analysed quantitatively and qualitatively. Type-stories or clusters of experience were identified for three distinct periods: prior to war, during war, and after war in exile. The extent of trauma-stress exposure during each of these periods proved unrelated. Pre-war experience presented as preponderantly good and safe. Differences in child exposure during war and exile could be understood in relation to identifiable socio-demographic factors; particularly ethnic background, social class, child age and family size. Further, the stories derived cast light on the equity of Swedish refugee reception, exposing both egalitarian and discriminatory tendencies.

The Incidence of Childhood Leukaemia in West Berkshire by Carol Barton

This paper gives an overview of local work on the incidence of childhood leukaemia in West Berkshire since 1971. The most recently published figures show that between 1972–96, a total of 106 children contracted leukaemia when 81 cases would have been expected in the under 14s. Within ten kilometres of the nuclear establishments at Aldermaston and Burghfield, the risk of a child getting leukaemia, which is very small (400 children a year in the UK) is none the less doubled in under-fives meaning that one more child a year is affected. There is also an increased incidence of all cancers in this age group and geographical area. Theories as to why this should be abound, but until the cause of cancer is fully understood, and what the part of radiation in the process could be, no firm measures can be taken to redress the balance.

Sustainable Energy, Economic Growth and Public Health by Andy Haines

Dramatic economic growth over the last 50 years has been accompanied by widening inequalities world-wide in wealth and energy consumption, diminished life expectancy in some countries, and deteriorating indices of environmental sustainability including loss of bio-diversity. Raised output of carbon dioxide (CO2) and other greenhouse gases due to increased economic and industrial activity is causing progressive climate change, leading in turn to direct and indirect adverse effects on health. Emissions of greenhouse gases can be lowered by increased use of renewable energy sources, for example, wind power in the United Kingdom (UK), greater energy efficiency and other measures to promote sustainability. The experience of some developing countries shows that favourable indicators of health and development can accompany a low output of greenhouse gases. It is unclear whether contemporary political and social systems can deliver improved human development without increased use of fossil fuels and other resources.

Globalization and Health by Gill Walt

Globalization means different things to different people; a general definition is the increasing movement of information, material and people across borders. It can be considered in terms of five conflicting but inter-relating themes, with both good and bad implications: economic transformation; new patterns of trade; an increasing poverty gap associated with widening health inequalities; the revolution in electronic communication; and the growing role of non-state actors, such as non-governmental organizations and transnational corporations, in global governance. Globalization is both an opportunity and a threat, but it is not inexorable. Successful action against its undesirable aspects is possible.

Personal Paper

Child Soldiers – and Others by Eirwen Harbottle

Conference Report

Cultures of Killing: War and Peace by Liz Willis

Books and Journals

Abstracts of articles in Issue 16.4

Editorial: IPPNW: After New York and Paris by Douglas Holdstock

Working Together for Human Rights by Victor W Sidel

The right to a standard of living adequate for health and well-being is being denied to vast numbers of people all over the world through increasing disparities in income and in wealth. In the name of economic development, a number of international and national policies have increased the grossly uneven distribution of income, with ever-growing numbers of people living in poverty as well as in increasing depths of poverty. Globalization, crippling levels of external debt, and the ‘structural adjustment’ policies of international agencies have expanded the numbers and the suffering of people living in poverty and have resulted in the neglect of government-funded social programs, of regulations protecting the environment, and of human development. Access to medical care, an essential element in the protection of health, is difficult for many, including the 44 million people in the United States who lack insurance coverage for the cost of medical care services. Working together for health and human rights also requires promotion of the right to peace. The right to life and health is threatened not only by the existence and active deployment of weapons of mass destruction, including nuclear, chemical and biological weapons and anti-personnel landmines, but also other weapons. The 20th century has been the bloodiest in human history, with an estimated 250 wars, more than 110 million people killed, countless people wounded and at the least 50 million refugees. Health workers must work together with people in our communities for the promotion of health and human rights, which, in Sandwell and elsewhere, are inextricably intertwined.

Healing the Social Wounds of War by Murray Last

The healing of those hurt by war can take different forms, ranging from violence and vengeance to psychotherapy and humanitarian aid imposed from outside. This healing has been widely and critically discussed in the literature. Instead, the focus here is more on the way communities try to heal themselves long after the outside world has lost interest. In this context, resisting the oppressor becomes less important than recovery, and the past can matter less than the future.

Population Crises and Population Cycles by Claire Russell and W M S Russell

To prevent a population irretrievably depleting its resources, mammals have evolved a behavioural and physiological response to population crisis. When a mammalian population becomes dangerously dense, there is a reversal of behaviour. Co-operation and parental behaviour are replaced by competition, dominance and aggressive violence, leading to high mortality, especially of females and young, and a reduced population. The stress of overpopulation and the resulting violence impairs both the immune and the reproductive systems. Hence epidemics complete the crash of the population, and reproduction is slowed for three or four generations, giving the resources ample time to recover. In some mammal species, crisis and crisis response recur regularly, leading to cycles of population growth and relapse, oscillating about a fixed mean. Population crisis response and population cycles have been equally prominent in the history of human societies. But in man successive advances in food production have made possible growing populations, though with every such advance population soon outgrew resources again. Hence human cycles have been superimposed on a rising curve, producing a saw-tooth graph. Because advances in food production amounted to sudden disturbances in the relations between human populations and their environments, the crisis response in man has failed to avert famine and resource damage. In the large human societies evolved since the coming of settled agriculture and cities, the basic effects of violence, epidemics, famine and resource damage have been mediated by such specifically human disasters as inflation, unemployment, and political tyranny. An account of past crises, periods of relative relief from population pressure, and resulting cycles, is given for a number of regions: China, North Africa and Western Asia, the northern Mediterranean, and north-western Europe. The paper ends with an account of the present world-wide population crisis, and the solution made possible by Malthus’s discovery that, unlike animals, we can choose to check population growth by reducing the birth-rate, instead of raising the death-rate, as in other mammals, by the population crisis response.

Issues in the Control of Low-level Radiation Exposure by Roger H Clarke

The carcinogenic risks of exposure to low level ionizing radiation used by the International Commission on Radiation Protection have been challenged as being, at the same time, both too high and too low. This paper explains that the epidemiological evidence will always be limited at low doses, so that understanding the cellular mechanisms of carcinogenesis is increasingly important to assess the biological risks. An analysis is then given of the reasons why the challenges to ICRP, especially about the linear non-threshold response model, have arisen. As a result of considering the issues, the Main Commission of ICRP is now consulting on a revised, simpler, approach based on an individual oriented philosophy. This represents a potential shift by the Commission from the past emphasis on societal-oriented criteria. These proposals have been promulgated through the International Radiation Protection Association (IRPA) and an open literature publication was published in the Journal of Radiological Protection in June 1999. On the basis of comments received and the observations presented at the IRPA 10 Conference, the Commission will begin to develop the outline of the next Recommendations. It is now more than ten years since ICRP distributed, for comment, a draft of what was to become the publication of the 1990 Recommendations. The Commission plans to develop its new Recommendations on a time scale of the next four or five years. In this paper, many of the issues that will need to be addressed in the development of the recommendations will be identified. These issues will cover biological effects, dosimetric quantities and the establishment of those levels of dose at which different protection requirements will be put into place. Concepts of exclusion and exemption will need to be clarified as well as the meaning of how to achieve what the proposal identifies as ‘As Low as Reasonably Practicable’ (ALARP). Finally, the Commission has decided to develop an environmental radiation protection philosophy that will need to be developed as part of the new Recommendations.

Personal Papers:

The Twilight of National Sovereignty by Peter Archer

Shadows and Light: Encounters in the Holy Land by Paula Green

For a Future to be Possible: Bosnian Dialogue in the Aftermath of War by Paula Green

International Physicians for Prevention of Nuclear War: Declaration of Paris: Health through Peace

Book Reviews

Books Received

Indexes to Volume 16 (2000)

Abstracts of articles in Issue 16.3

Intervention and Human Rights by Douglas Holdstock

The Impact on Civilians of the Bombing of Kosovo and Serbia by Mary-Wynne Ashford and Ulrich Gottstein

Before the 1999 bombing, Kosovo was among the poorest regions in Europe, with low scores on indices of health care. After the war, housing for much of the population is below even basically acceptable standards and health care is disrupted, with serious risk of epidemic diseases. Societal disintegration has led to high levels of stress. In Serbia, also a poor country, which already suffered from high levels of pollution before the war, large amounts of several highly toxic chemicals were liberated into the environment by the bombing. Targeting of electrical generating plant, water treatment facilities, Danube bridges, railways and roads has adverse effects on civilian life, endangers health and seriously affects health care. The military strategy of attack on civilian infrastructures is a war on public health.

Traumatic Experiences and Psychological Reactions among Women in Bosnia during the War by Ragnhild Dybdahl and Irfana Pasagic

Internally displaced women (N = 77) in Bosnia were interviewed before and after participating in group psychotherapy during the war in 1994 and 1995 to gain background information and assess stress exposure and stress reactions. Nearly all the women had experienced loss of family members, many acts of violence and mental health impairment. The participants had high scores on a symptom scale, in terms of intrusive, avoidance and arousal symptoms and somewhat lower on depression/powerlessness items. After participating in short-term group therapy they reported significant reduction in symptoms. The women who had experienced most traumatic events and had most symptoms, reported greatest reduction in symptomatology. Some of the implications of the findings are discussed and it is concluded that group therapy may be helpful in war conditions, even though traditional preconditions for psychotherapy are not present.

Human Radiation Experiments: What Price Informed Consent? by Sue Rabbitt Roff

In 1992 a system of public access was established to more than three million pages of files in government depositories related to radiation experiments on US citizens, including children, pregnant women, and convicts, studying the effects of radioactive isotopes and testicular irradiation. The background to some of these studies is described; many were considered by Ethics Committees and the results published in the open literature after peer review.

Disease and Security: the Effect of Emerging and Re-emerging Diseases by Johan C Schoeman

This article examines the role of emerging new and re-emerging diseases in the failure of the ‘Health for All by 2000’ concept. The gap between infection and control has widened instead of closing, which has definite military and security implications. It is argued that there is a direct link between disease and the social order, and that the traditional view of development first, followed by an increase in health status, must change. However, the political will and the necessary resources to combat emerging and re-emerging diseases are still lacking in many countries. Through the improper use of treatments and dosages, most notably antibiotics, new strains of previously eradicated diseases are appearing. Added to this are new patterns of relationships between man, his environment and the occurrence of disease leading to new diseases making its appearance. There is a direct relationship between war and disease, making disease something with political, military and security relevance. The aspect of intelligence, which has the task of predicting the future, now has to take note of the occurrence of disease and its effects.

Personal View: The New Millennium: Do We Have the Courage of Optimism? by Johan Galtung

Seminar: Learning from Kosovo: the Future of Humanitarian Intervention by Marko Kerac and Gillian Reeve

Conference: 2nd World Water Forum by Wendy Barnaby

Books and Journals

Book Reviews

Books Received

Recent Papers and News Items

Forthcoming Events

Abstracts of articles in Issue 16.2

Joining Together to Combat Poverty: Everybody Welcome and Needed by Andy Haines, Iona Heath and Richard Smith

Nuclear Weapons for Ever? The NPT Review Conference-and After by Douglas Holdstock

Globalization and Health by Michael Rowson

Globalization is happening. But it appears that it has been associated with a rise in inequalities both between and within nations. Financial and trade liberalization, the main motors of the current phase of globalization, have been introduced with reckless abandon with little thought to the consequences. Future policy advice must bolster the role of the state in defending populations from the excesses of market forces, and there should be rigorous analysis of the health and other social impacts of economic policies.

The World Trade Organization: Implications for Health Policy by Meri Koivusalo and Michael Rowson

Agreements negotiated at the World Trade Organization already have important implications for health and health policy. They impact on the ability of governments to regulate trade in the interests of health; on national and international governance and public health standards; and on the future of the precautionary principle. Agreements on trade-related aspects of intellectual property rights and trade in health services could benefit the multi-national health care and pharmaceutical industries, and impact negatively on cost and equity.

Food and its Safety by Rosa K Pawsey

The manner in which food is produced, distributed, sold and controlled has changed radically over the last fifty years. This has lead to dissociation and de-skilling of consumers while control of quality and safety have remained in the hands of legislators and producers. With the globalization of trade consumers perceive in foods unacceptable levels of food safety risk. In the new century the conflict between perceived safety and manageable risk may be achieved by open debate and the establishment of mechanisms which include the ethical dimensions of food production and use.

Needs Assessment in a Refugee Mental Health Project in North-east London: Extending the Counselling Model to Community Support by Kate Harris and Coralie Maxwell

In the United Kingdom, as elsewhere, mental health services are becoming increasingly aware that existing services may not meet the needs of different minority groups. This paper outlines the model used to set up a project focusing specifically on refugee mental health needs in Waltham Forest, in north-east London. Funding was available for one sole mental health worker and careful consideration was therefore given as to how her time should be used. A thorough needs assessment of refugees living in Waltham Forest determined that the provision of therapy or counselling alone would not be the most appropriate means of addressing refugees’ needs. The intervention model developed therefore included awareness raising and community mobilization, in addition to one-to-one clinical sessions. The empowerment, training and support of refugee community groups became a central part of the work, which helped to establish and then consolidate links between mainstream services and individual refugees.

Living with Rattlesnakes: Chernobyl and Dounreay by Sue Rabbitt Roff

After the Three Mile Island nuclear plant accident in 1979, a local Pennsylvania resident told The New York Times ‘You live with that plant over there for years and years and don’t think much about it. But it’s like living with a rattlesnake. Sooner or later it’s going to bite you. You just don’t know when.’ As we enter the twenty-first century, many communities find themselves living with rattlesnakes – one at least of which has already bitten. This article considers the official responses to Chernobyl in the first decade after the accident and compares them to the statements surrounding the sudden 1998 decision to decommission the nuclear reprocessing plant at Dounreay in Scotland.

Inter-group Aggression: The Multi-individual Organism and the Survival Instinct by Nevin Hughes-Jones

Inter-group aggression, carried out at the level of the in-groups and out-groups of ethnocentric theory, continued unabated throughout the twentieth century. Its frequency, together with its ferocity, indicates a potent biological cause. We have evolved as social animals, and it is postulated that evolution has proceeded to such an extent that an in-group is now a ‘multi-individual social organism’, that is, ‘a self-sustaining, self-replicating whole containing interdependent parts’. This results from the total integration of individuals into the social structure and culture of the in-group; individuals are inseparable from their society and evidence for this proposal is given. Cohesion is given through the collective consciousness and collective memory. The analogy is to multicellular organisms that evolved from the association of single cell organisms. All biological organisms are subject to the survival instinct, which is thus the potent biological cause of inter-group aggression. Groups compete for territory and see other groups as a threat. Prevention of inter-group aggression should come from the insight that threatening behaviour endangers the integrity of the society of out-groups, initiating conflict.

Report: International Week of Science and Peace (IWOSP) by Alan Cottey

Books and Journals

Book Reviews

Books Received

Recent Papers and News Items

Forthcoming Events

Abstracts of articles in Issue 16.1

Future Directions for IPPNW by Mary-Wynne Ashford

This paper is offered as my personal reflections for future directions of International Physicians for the Prevention of Nuclear War. The deep discussions that surrounded the war in Kosovo and Serbia have led me to examine some of the issues that confront IPPNW today in a different light. Rather than cataloguing all the work of IPPNW and the future steps in each, I focus on areas where we have a new opportunity, a new challenge, or a difficult decision to make in choosing a strategic direction for IPPNW. After a brief summary of our history and principles, I address the new challenges within IPPNW’s triangle of concern – disarmament, environment and development. I then outline a series of strategies that have been proposed to advance our goals. Finally, I raise other issues that seem to warrant further discussion and policy development.

Castles and Boarding-Houses by Bruce Kent

Current concepts of security, even if valid in the past, are inappropriate now. We need a new concept of security based on co-operation and interdependence, not military (and especially nuclear) confrontation. The International Court of Justice Advisory Opinion on the legality of nuclear weapons, international concern on the dangers of the arms trade, the landmines campaign, and statements by retired military leaders, are all signs of hope. But others, including non-governmental organizations, must also learn to co-operate. The Year of the Culture of Peace is an opportunity to make co-operation more effective and, particularly in schools, to make the United Nations better known and better appreciated.

A Fast Track to Zero Nuclear Weapons: The Middle Powers Initiative and the New Agenda Coalition by Rob Green

The Middle Powers Initiative is a network of international citizens’ organizations working to encourage the nuclear weapon states to undertake practical steps to reduce the danger from nuclear weapons, with the objective of establishing a Nuclear Weapons Convention. The New Agenda Coalition is a group of middle-ranking nations whose governments have called for the early elimination of nuclear weapons. The work of the MPI and NAC at the United Nations and elsewhere is described, and their impact on NATO nuclear weapons doctrine discussed.

Old Dogs or New Tricks: Chemical Warfare at the Millennium by Alastair Hay

There were about 50,000 deaths from chemical agents in the First World War and 7,000 deaths in the Kurdish population of Iraq from mustard gas and nerve agents. Signatories to the 1925 Geneva Protocol forswore first use of chemical warfare, but were allowed to maintain stockpiles, and there were no sanctions against use. The Chemical Weapons Convention (CWC), which entered into force in 1997, establishes timetables for declaration of current and past CW activity and destruction of stocks. The Convention allows inspection of suspect sites. The Organisation for the Prohibition of Chemical Weapons has been established to give effect to the CWC, which, as of June 1999, has 125 States Parties. Progress in reporting and destroying CW agents is described. It is essential that participation in the CWC becomes universal, but until this is the case monitoring by other agencies will be needed.

Preventing Deliberate Disease by Graham S Pearson

The danger from deliberate disease as a weapon of war – biological weapons – is examined and it is concluded that biological weapons pose the greatest danger of all weapons of mass destruction. The ongoing work of the Ad Hoc Group negotiating a Protocol to strengthen the effectiveness and improve the implementation of the Biological and Toxins Weapons Convention is analysed. The Protocol is nearing completion and contains provisions for declarations of the most relevant facilities, for declaration follow up procedures including infrequent randomly-selected visits to declared sites, for investigations of non-compliance concerns as well as measures to promote international co-operation for peaceful purposes in microbiology and biotechnology. It is concluded that an efficient and effective Protocol is achievable within the coming year.

‘... to save succeeding generations from the scourge of war’: The Role of the International Court of Justice by Rosalyn Higgins

The International Court of Justice is the judicial arm of the United Nations. Its provenance and role in keeping international peace and security is described. Its role in settling disputes between states and giving advice to the UN organs and specialized agencies is illustrated from a series of past cases where it has contributed to the maintenance or restoration of international peace and security. Possible limitations to its contributions, arising from the need for consent to its jurisdiction, and from the process of international law are discussed, and it is concluded that decisions under international law are for realization of values. Finally, its relationship with the UN Security Council is examined.

An Optimum World Population by David Willey

The optimum population of the world is the one that is most likely to make the option of a good quality of life available to everyone everywhere, both now and in the future. Establishing a consensus about the size of such a population would be an important step towards achieving it. Estimates of an optimum involve three main steps. First, estimate the maximum (carrying capacity) assuming a specified lifestyle. The main criteria are the maintenance of biodiversity, the availability of freshwater, and the availability of land – for agriculture, forestry and artificial systems but above all for the conversion of energy. (In applying the criteria, there are always two questions to ask: ‘What is the maximum amount of consumption that the biosphere can stand?’ and ‘What is an adequate share of such consumption per person?’) Second, convert the maximum (two to three billion) into an optimum by applying a far wider range of criteria, including personal liberty, mobility, recreation and political representation. Third, consider just two criteria (economies of scale and technological innovation) in order to ensure that the optimum (one to two billion) has not exceeded the minimum (half to one billion). The estimates are so low because of the need for a huge increase in median per capita consumption if everyone is to have the option of an adequate material standard of living. Opinion-formers are likely not to take much notice of such estimates, but it is probable that minds will be concentrated by an energy shock some time during the next decade. Achieving an optimum world population will not solve the world’s major problems, but it would make them solvable.

Carson’s Syndrome: A Major Threat to the Public’s Health in the Twenty-First Century by Robin Stott

Our environment provides essential support for our health, but is subject to degradation from human activities. This in turn has adverse effects on health. The name ‘Carson’s Syndrome’ is proposed to characterize severe non-accidental planetary abuse. A specific example, overproduction of carbon dioxide (CO2), is described and illustrated by the concept of a ‘footprint’ for the CO2 production of an individual or group. Transport is responsible for 40% of CO2 production in developed countries. A more rational transport policy, with particular encouragement of walking and cycling, would both reduce CO2 output and benefit our health, especially in reducing cardiovascular disease.

Feeding the World in the next Millennium by John Waterlow

Food production per head in the world as a whole has begun to level off in the last decade, while the world population continues to grow, risking malnutrition, perhaps even starvation, civil unrest and environmental damage. Very little more land suitable for agriculture is available, and the factors behind the ‘green revolution’ may not produce further increases. Genetically modified crops offer the possibility of increased yields, but also present major problems. In developing countries, where yields are well below what is theoretically possible, the best approach may be better management by small farmers through improvements in their traditional methods. Much more financial support for and research in agriculture is needed, together with more equitable distribution of existing production and an end to trade practices designed to make the rich richer.

Global Action to Prevent War by Jonathan Dean, Randall Caroline Forsberg and Saul Mendlowitz

Inducible Genomic Instability: New Insights into the Biological Effects of Ionising Radiation by Eric G Wright

Commentary by David Sumner

Wounds, Weapons and the Doctor by Douglas Holdstock

Book Reviews

Books Received

Recent Papers and News Items

Abstracts of articles in Issue 15.4

Editorial: The Challenged Rights of the Child by Lars H Gustafsson

Children and War by Lynn Barnett

Millions of children are not merely bystanders but targets of war. Many are killed by bombs, bullets and landmines, many more are severely traumatized, though there is disagreement among carers as to how far the resulting symptoms should be managed as conventional psychiatric illness. Although a clear breach of the Convention on the Rights of the Child, large numbers of boys become active combatants, particularly in conflicts in Africa. The background factors to this and the rehabilitation of the boy soldiers at the end of the conflicts are discussed. A recent report to the United Nations proposes that the age limit of 15 for child soldiers under the Convention should be raised to 18. Governments should set up official machinery for implementing and monitoring the Convention.

The Right to Survival and Development by Lars H Gustafsson

The United Nations Convention on the Rights of the Child grew out of protests against the male-dominated violence of war, particularly in the Balkans, during two world wars. Many children have been killed, disabled, made homeless, and psychologically traumatized, particularly in intrastate wars, since the Second World War. Recently, large numbers of children have become soldiers, often after violent indoctrination. Several community-based measures to prevent this abuse of children’s rights are proposed.

The Child’s Right to Health and Treatment by Tor Lindberg

The UN Convention on the Rights of the Child recognizes the right of the child to the highest attainable standard of health, and to treatment of illness and rehabilitation. There are very great differences in access to health care, including preventive medicine such as immunization, and adequate nutrition, between countries in the developed and developing world. These particularly affect children in war zones and in countries affected by sanctions. Developed countries are not perfect; many children in the United States are not fully immunized, and in Sweden hidden refugees and disabled children receive sub-standard care.

Traumatized Refugee Children: A Challenge for Mental Rehabilitation by Lilian Levin

The problems of rehabilitating traumatized refugee children are considered in the light of Swedish experience in aiding victims of the Holocaust of the Second World War. An active rehabilitation programme, taking into account changes in family relationships, is needed. It is important to break the silence of repression, but also to understand the variable degree of resilience of survivors of trauma.

Helping Children Affected by War: Background by Joanna Santa Barbara

The Trauma of Being a Refugee by Lynn Spouse

This article attempts to convey a human ‘feel’ for the refugee and the helper, without being oppressively expert or conveying pity. It explores differences and similarities between post-traumatic stress disorder and surviving and coping capacities, leading to an argument against biased use of western forms of psychological help and a plea for fitting in with local cultural patterns for coping with disaster. The difference between ‘victim’ and ‘survivor’ is emphasized and the problems of gratitude and envy in both helped and helper considered. In FYR Macedonia de-skilled professionals became their own ‘experts’ as they responded imaginatively to the refugees on their doorstep. They wanted professional support, literature, supervision, consultancy and friendship, but not to be told ‘how to do it’. The concept of ‘resilience’ is examined. Some children survive the disaster others do not. The latter suffer as refugees, whilst those initially terrified benefit from the security and predictability of camp life. An attempt is made to acknowledge normal coping capacities and allow for cultural differences in ways of coping, and so to emphasize survival rather than collapse or victimisation, while not denying the pain, terror, boredom, and frustration of being a refugee. This may lead to mental breakdown, PTSD, pathological grieving, but it does not automatically do so. There is no panacea of ‘treatment’, but it is essential to support and enable survivors.

A Project in Yugoslavia: Helping the Helpers by Jack Piachaud

This article describes a project run by MEDACT in conjunction with UNICEF, supporting local mental health professionals who were providing treatment to children in the Federal Republic of Yugoslavia following the war in Bosnia and Croatia. It explores issues of engagement, of the responses of professionals and of understanding some of the psychological processes at work. It also describes a model of working with overseas colleagues in disadvantaged circumstances which is compatible with life in the busy UK health service.

The UN Convention on the Rights of the Child: Some Relevant Articles

Conference Report: Royal Society of Medicine: The Roots of Violence in Children and Young People by Elisabeth James

Book Reviews

Books Received

Recent Papers and News Items

Forthcoming Events

Abstracts of articles in Issue 15.3

Editorial: Intervention Revisited by Douglas Holdstock

Simulants, Stimulants and Diseases: The Evolution of the United States Biological Warfare Programme, 1945–60 by Alastair Hay

Details about the US biological programme have largely been based on information in the open literature. More revealing aspects of the programme are now available through documents released under the Freedom of Information Act. Annual reports of the activities of the US Army Chemical Corps from 1945 to 1959 have revealed significant increases in activity in biological warfare research. The Corps research activity progressed from work on anthrax in 1941, through anti-crop agents in the mid-1940s, to a wider range of animal, plant and human diseases by 1960. A number of disease organisms were investigated sufficiently to permit some standardisation and manufacture of munitions.

A Magic Sword or a Big Itch: An Historical Look at the United States Biological Weapons Programme by Alastair Hay

In the late 1950s interest in entomological warfare increased, and literature describing the US biological warfare programmes on the use of the mosquito Aedes aegypti, the vector for transmitting yellow fever, has now been released. Yellow fever was considered as a suitable disease to use in southern regions of the former Soviet Union. The US destroyed its biological weapon stockpiles in the early 1970s.In addition to its offensive biological warfare programme, the US conducted extensive trials to assess its own vulnerability to biological attack. These trials and a later series of threat analyses indicate that biological agents could, indeed, affect large areas of the US if the attackers were allowed to proceed unmolested. Some of the threat analyses present highly questionable scenarios.

International Relations and Epidemics: A Short Expedition to Places Inhabited by States and Mad Cows by Mika Aaltola

The complex process of co-evolution between humans, their social structures and biological disease agents have from time to time established relationships between the three. Recently, one such set of paths has opened up faster and closer global connections. As new and more inclusive approaches emerge from the shadow of strict intra-disciplinary containment, it is tempting to formulate the relationship between epidemics and international relations in new terms deriving from new metaphors. The argument that components central to international relations (state, sovereignty, power) do not associate with disease can be viewed sceptically throughout history, epidemics have had a direct impact on political interaction by vindicating, weakening, testing, and moulding international relations. This paper examines the past relationships between epidemics and international relations, and illustrates these interactions with the example of Bovine Spongiform Encephalopathy (mad cow disease) and its link with human Creutzfeldt-Jacob disease.

Recent Medical Evidence for Torture and Human Rights Abuse in Sierra Leone by Malcolm Lawson

A study was carried out using the case notes of all Sierra Leoneans referred to the Medical Foundation for the Care of Victims of Torture between 1996 and 1998 for medical reports. Data were abstracted on the type and extent of torture reported, and the cases were followed up to the present day to ascertain how long the United Kingdom asylum and immigration process had taken to process their claims. In the sample of 36 cases there were 68 reported incidents of torture or human rights abuse. Sixty-nine per cent (18/26) of the women in the sample had been raped at least once, and 72% (26/36) of the sample had been beaten at least once. The average time for the minimum due process of the asylum claim to be processed was 44 months (3.7 years). On 31 January 1999, 61% of the sample (22 people) were still involved in the asylum process. Waiting times must be reduced and safeguards imposed so that those who have suffered torture can be rapidly identified and referred for medical treatment, care and documentation.

Peace through Sanctions? Lessons from Cuba, former Yugoslavia and Iraq by Ulrich Gottstein

The effects of total economic sanctions on Cuba, former Yugoslavia and Iraq are reviewed, in part from the personal experience of the author. Sanctions have no effect on the lives of the leaders, but seriously harm children, the poor, and the sick. Nutritional standards are seriously affected, and health systems suffer from insufficient supplies. A policy of stopping arms supplies to areas of tension, with other preventive measures is advocated. Ministries for the Prevention of Conflict and War are needed as well as Ministries of Defence.

The BMA Report on Biological and Genetic Weapons by Wendy Barnaby

A recent report from the British Medical Association warns that genetic weapons, which would attack people selectively on the basis of their ethnicity, are becoming a feasible option. 'Realistically', said Professor Vivienne Nathanson, head of science and ethics at the BMA, when I interviewed her recently, 'we have to look at less than ten years before the technology may be present to enable targeting of individual ethnic groups'.

David Pimentel on the Ecology of Increasing Disease by David Willey

Book Reviews

Letter: The Bicentenary of Malthus by Peter Tod

Volume 15 Supplement 1 July–September 1999

Mortality and Morbidity of Members of the British Nuclear Tests Veterans Association and the New Zealand Nuclear Tests Veterans Association and their Families by Sue Rabbitt Roff

More than 20,000 British servicemen – many of them on their National Service, few of them volunteering for the tests, and most in their early twenties, some still boy soldiers in their teens – were required to 'participate' in the United Kingdom nuclear tests in Australia and Christmas Island in the 1950s and 1960s. 528 members of the New Zealand Navy were also present for one series of tests. There was also a Fijian Army contingent, which has been variously numbered between 100 and 500 men. An estimated 16,000 Australian servicemen and civilians were also involved in the tests at Maralinga and other sites. The men performed a wide range of duties, from highly technical preparations for the detonations to catering and clerical jobs. But whatever their role, they were all required to witness the detonations as part of their 'indoctrination' for the possibility of nuclear war. Most of them were required to line up on the beach, with their backs to the detonations and their hands over their eyes for the first minute or so. They were then allowed to turn around and look at the awesome sight as the mushroom cloud plumed thousands of feet into the air. Very few wore more than shorts and sandals during their time at the tests; only those who were thought to be at risk from radiation injury were issued with protective clothing and radiation dose badges. The UK government was sure that the troops, most of whom were standing within 20km of the detonations and some of whom were present for 25 nuclear bomb blasts in as many weeks on Christmas Island, were not irradiated. The Ministry of Defence still routinely issues a document to nuclear veterans who feel that their illnesses were caused by the radiation they encountered when they were young men which states:

The background [radiation] dose received by civilians and members of HM Forces serving at or off Christmas Island in the years 1956 to 1964 was only about 35% of that which they would have received on average had they remained, for that period of their lives, in the United Kingdom - that is, some 100 microsieverts per calendar month less at Christmas Island than in the United Kingdom.

This sanguine view of the health burden borne by nuclear veterans and their families is not borne out by the data reported in this study of the health outcomes of the 2,500 men (2,200 UK, 238 New Zealand and 62 Fijian) on whom data are available to the present researcher.

Thirty per cent of the men in this sample have already died, mostly in their fifties. Two-thirds of them died from cancers that are pensionable in the United States as presumptively radiogenic among nuclear veterans. About one in seven of the men in the sample of 1,014 who responded to the questionnaire circulated in late 1997 did not father any children after they returned from the weapons tests. Among the nearly 5,000 children and grandchildren of this group of more than a thousand veterans, there are 26 cases of spina bifida alone - more than five times the usual rate for live births in the UK.

Nearly half the health problems among the offspring of the nuclear weapons tests veterans reported in this study consist of the same dermatological, musculoskeletal and gastrointestinal conditions from which many of the men have also suffered. Among the 2,261 children of 1,041 veterans, more than 200 skeletal abnormalities were reported, including more than 30 cases of short stature and 18 spinal problems, mostly curvature and scoliosis. More than 100 skin conditions were reported, mostly eczema and dermatitis, in many cases described as congenital. Over 50 of the children are already suffering from arthritis and similar conditions, although they are only now entering their thirties. Hip deformities were reported for 19 children and kneecap deformities for 14. More than 100 of the veterans' children reported reproductive difficulties; 24 women reported problems with their ovaries. This pattern of morbidity was repeated in the grandchildren, though there seems to be some diminution of the effect.

A similar pattern is evident in the health of the men, their children and grandchildren of the 235 New Zealand veterans on whom data were collected separately. The data on the 62 Fijians are not reported here. They are currently submitted as evidence to the European Court of Human Rights.

Any bias in the respondents from the UK nuclear veterans organization for which data are reported here is in fact towards amore youthful, healthier group than the full cohort, on whom standardized mortality studies were undertaken up to December 1990 by the National Radiological Protection Board. The data in this study point to an accelerated rate of death for the UK nuclear veterans at precisely the moment the NRPB studies terminated, and the UK Ministry of Defence acknowledged in late 1998 that the finding in relation to multiple myeloma alone compels a re-analysis and updating of the NRPB studies. But radiobiological tests are now available which can detect evidence of past radiation exposure. It is a major recommendation of this study that research henceforth proceed beyond the epidemiological to the clinical and pathological levels. Then at least medical science can learn from this 40-year-old tragedy with its cast of thousands.

Abstracts of articles in Issue 15.2

Editorial: Healing the Century of Violence by Ian Maddocks

The Century of Violence and the Way Forward by Ron McCoy

For physicians, the twentieth century will stand out as a century of contrasts. We have witnessed unimaginable advances in medicine that have made it possible to save lives in ways undreamt of before, but also deadly conflict and human atrocities that have made this century the most violent and bloody in history. There has also been a deadly paradox in the political and social history of the twentieth century: on the one hand, universal recognition of human rights, including the right to life, embodied in a remarkable array of international human rights and humanitarian laws; on the other, violations of human rights and humanitarian law on a massive scale by the savagery of warfare. Weapons of mass destruction, including nuclear, chemical, biological and high-tech conventional weapons, give modern warfare an inhumane dimension.

Intervention by Kofi Annan

Nation-states have always 'intervened' (often a euphemism for 'invasion') in the affairs of others. Intervention, according to its Charter, is now the exclusive role of the United Nations, when authorized by the Security Council. The Charter excludes the UN from intervening in matters within the domestic jurisdiction of member states. However, even national sovereignty can be set aside if it affects the duty of the Security Council to preserve international peace and security and prevent genocide. Wherever possible, though, 'intervention' should consist in preventive diplomacy and correcting causes of conflict such as ethnic tension and poverty. But in the final analysis the UN exists to uphold the rights of peoples, and all of us have the obligation to halt or prevent injustice and suffering.

Nuclear Weapons and the Law by Ronald King Murray

The history of the International Court of Justice (ICJ) is summarized, with a discussion of some of its earlier Advisory Opinions. The Advisory Opinion on the legality of nuclear arms is considered in the light of the principles of international humanitarian law and a review of nuclear weapons effects. The present government's position on nuclear weapons as outlined in the Strategic Defence Review (which ignores the issue of legality) is examined critically.

Detecting the Health Effects of Radiation by Alice Stewart

Radiation can cause both non-stochastic (cell-killing) effects, leading to burns, epilation, immune system damage and lens opacities, and mutational or stochastic effects due to low dose damage to single cells. If the latter are followed by clone formation or fertilization, the mutants are not recognized by the immune system, and there is no competing cause of death, cancer or leukaemia can result. These effects did not become public knowledge until after the A-bombings of Hiroshima and Nagasaki. Subsequent analysis of the data on A-bomb survivors suggests, contrary to official views, that the immune system has a complex role in the aetiology of cancer and leukaemia, and that the A-bomb survivors were unusually resistant to the harmful effects of the bombings. These findings require the re-evaluation of the effects of low-level radiation, which has increased with the growth of the nuclear industry, both civil and military.

Going to Court not War by David Head

The work of the International Court of Justice is examined, and related to the role of international law as the route to settlement of disputes between states. The Advisory Opinion of the Court on the legality of nuclear weapons is considered. The importance of publicizing the existence and activities of the Court, particularly in schools, is stressed.

International Conflict Resolution by Elisabeth Waterston

After a brief review of past individuals and organizations involved in the settlement of disputes between states, the various forms of conflict resolution (arbitration, mediation, facilitation and integrative negotiation) are discussed. Many more workers with skills in these fields are needed.

Post-Invasion Outcome of Pregnancy in Kuwait by Ma'asoumah Makhseed, Vijaya Manav Musini, Naheda A M Hassan and Essam Saker

To assess the trend in the complications and outcome of pregnancy in Maternity Hospital, Kuwait, a retrospective analysis of yearly hospital statistics books and labour ward records of patients delivering in Maternity Hospital Kuwait was carried out for the period 1981 to 1995.In the post-invasion period there is a significant rise in: primiparity; mothers aged 35 years or older; Kuwaiti mothers; and in multiple pregnancy. The incidence of pregnancy-induced hypertension, pre-eclampsia, and hysterectomy for postpartum haemorrhage also increased. There was a significant increase in spontaneous abortions and low birth weight babies. The incidence of hydatiform mole has significantly decreased. Still birth rate shows a decreasing trend in the study period. The significant change in the age and parity of the mothers delivering in the post-invasion period might partly explain the above changes. However, the effect of environmental pollution, social and psychological stress, and anxiety due to war may have also contributed to an increase in the complications and adverse outcomes of pregnancy.

Conference Reports

Book Reviews

Recent Papers and News Items

Forthcoming Events

Abstracts of articles in Issue 15.1

Conflict Recovery by Kate Adie

I am an observer, a bystander, on the sidelines watching while others act. This, I suppose, is an excuse as much as a description of my job. I do not stand in judgement or go to preach and have no agenda other than reporting the facts. I report on all kinds of momentous events, briefly, both in time spent at the scene, and even more so on air – the world reported in a minute or so. So I offer some observations and thoughts from the sidelines, and some comment on reporters' attitudes and responsibilities, especially as regards reporting the consequences of conflict – and we see a lot of conflict. The Origins of International Physicians for the Prevention of Nuclear War: The Dr James E. Muller Diaries by Irwin Abrams Based on the diaries of Dr James E. Muller, this article reports his role in the events leading to the founding of International Physicians for the Prevention of Nuclear War, and in the early work of the organization. His early interest in US-Soviet relationships and his visits to the former Soviet Union are described. His key role in the successful cardio-pulmonary resuscitation of the Russian correspondent Lev Novikov, at the press conference in Oslo marking the award of the 1985 Nobel Peace Prize to IPPNW, is stressed.

Who Rules? The United Nations: Democratic and Representative? by Patricia McKenna

The United Nations as presently constituted is undemocratic, unrepresentative and underfunded, and reform is urgently needed. All countries, not least the United States which owes half the UN debt, must pay their dues, but other sources of funding such as a levy on currency trading should be explored. Reform of the Security Council, though important, will be difficult to achieve, and the immediate priority must be to tackle the social and economic problems and abuses of human rights which underlie most conflict. The International Monetary Fund and the World Bank must be returned to UN control and the influence of transnational corporations curbed. The increasing role of Non-Governmental Organizations is welcome, and a People's Assembly parallel to the General Asembly should be encouraged. The role of the UN in conflict resolution should not be taken over by bodies such as the European Union or NATO; preventive diplomacy under Chapters VI and VIII of the UN Charter should be given priority over peace enforcement under Chapter VII.

A-bomb Survivors: Reassessment of the Radiation Hazard by Alice M Stewart and George W Kneale

Newly released data from the Radiation Effects Research Federation on the survivors of the Hiroshima and Nagasaki A-bombing allow a reassessment of radiation hazards. It appears that deaths from marrow damage (such as aplastic anaemia) continued after 1950. The Life Span Study cohort appears biased in favour of persons with high immunological competence, the result of infants and the elderly being more likely to die before 1950 than young adults. A study of survivors of in utero exposures suggests that embryos are more sensitive to the lethal effects of radiation than more mature foetuses. Current estimates of cancer risks from radiation may only apply to young adults with high immunological competence; young children and the elderly may be at greater risk.

Is Technetium-99 (Tc-99) Radiologically Significant? by Frank Barnaby and Egbert Boeker

According to radiological protection authorities the radioisotope technetium-99 (Tc-99) is not 'radiologically significant' to humans or other species. The Sellafield plutonium reprocessing plant discharges large amounts of Tc-99 into the Irish Sea; by the year 2015 a total of about 3,000 tera-becquerels of Tc-99, weighing about 5 tonnes, will have been discharged. This article considers the effects of Tc-99 on the environment. After discharge, Tc-99 travels large distances in the ocean. Levels of Tc-99 in Norwegian coastal waters increased by ten times between 1991 and 1996. Tc-99 becomes concentrated offshore in seaweed, winkles and mussels. A concentration factor of 120,000 has been reported in seaweed and one of 650,000 has been measured in the green gland of lobster. It may be necessary to reassess the risk to human health following the ingestion of the relevant isotopes, including Tc-99, because of the possibility of radiation induced genomic instability, as well as the cancer risk. The committed effective doses used to determine permitted levels of intake of these isotopes should be increased and the authorized limits for the discharge of radioactive wastes from Sellafield reduced. Authorized limits of the discharge of radioactivity should be based on Contaminated Food Intervention Levels rather than Generalized Derived Limits as they are now.

Personal Paper: Caviar and Cockroaches by Sue Jameson

Conference Report: Towards the Millennium: 13th Low-level Radiation Conference by Douglas Holdstock

Book Reviews

Abstracts of articles in Issue 14.4

Editorial: Economics, Ethics and Policy by Douglas Holdstock

Trident and Nuclear Law by Rupert Ticehurst

On 8 July 1996, the International Court of Justice gave its Advisory Opinion on the legality of the use or threat of nuclear weapons, in response to a resolution of the General Assembly of the United Nations. This paper considers the status of Trident, now the United Kingdom’s only nuclear weapon system, in the light of the Opinion. While it cannot be concluded definitively that the threat or use of Trident is illegal, at the very least the legality of the programme is brought into considerable doubt. The continued deployment of Trident raises important legal and military issues, which must be addressed urgently.

The Glass Bead Game: Nuclear Tourism at the Australian Weapon Test Sites by Sue Rabbitt Roff

In mid-summer 1997, just as the United States National Cancer Institute was acknowledging that the nuclear bomb tests at the Nevada Test Site may ultimately cause up to 75,000 thousand cases of thyroid cancer in people who were living in the USA in the 1950s and 1960s, the Australian authorities were mooting the possibility that the Maralinga test sites in South Australia should become a tourist attraction. Some Aboriginal tribal leaders welcomed this proposed use when the £50 million pound ‘clean-up’ being paid for by the United Kingdom government as some compensation for using the area for its weapons tests in the 1950s and 1960s is completed. This paper surveys the attempts to clean up the site of UK nuclear weapons tests in the 1950s, not least by attempting to vitrify vast tracts of desert.

Ethnicity, Forced Migration and Social Work in Croatia by Baljit Soroya and Paul Stubbs

This article outlines the development of psycho-social work with refugees and displaced persons in Croatia, in the context of war and large-scale forced migration. The article, which is based upon original research on refugees and displaced persons in Croatia, considers the dominance of ethnicized nationalism within Croatia, examines the role of global agencies and how psycho-social programmes influence aspects of ethnicity. It ends with some recommendations for the development of an anti-nationalistic psychosocial work approach in complex emergencies and wider forms of intervention.

The Nuclear Arsenals and Nuclear Disarmament by Frank Barnaby

Current world stockpiles of nuclear weapons and the status of treaties for nuclear disarmament and the ultimate elimination of nuclear weapons are summarised. The need for including stockpiles of civil plutonium in a programme for ending production and disposing of fissile materials is emphasized, and the ultimate difficulty of disposing of the last few nuclear weapons discussed.

The Bicentenary of Thomas Malthus by Andrew Ferguson

Violations of Human Rights in Peace and War: Bosnia-Herzegovina, Iraq, Turkey and Turkish Kurdistan by Ulrich Gottstein

Sandwell Health Action Zone puts on its ‘SHOES’ by John Middleton and Carolyn Dimond

Book Reviews

Books Received

Recent Papers and News Items

Forthcoming Events

Indexes to Vol . 14 (1998)

Abstracts of articles in Issue 14.3

Lessons from the Cold War: A Personal View by Lee Butler

Based on the author's personal experience over more than 30 years, part of this time as Commander-in-Chief of the US Strategic Command, he now believes that the treat of mutual annihilation created by the nuclear arms race was and is intolerable. The willingness to condone nuclear weapons is the accompaniment of visceral enmity, and the consequences of failure of deterrence unthinkable. But the Cold War mindset has not ended in the minds of some; it must be replaced by the voice of reason and the individual conscience and in the interests of humanity.

The Plutonium Problem: the Royal Society Sits on the Fence by Frank Barnaby

A recent Royal Society report, Management of Separated Plutonium, considers the production and disposal of plutonium from the spent fuel from civil and nuclear power reactors. It accepts the need for dealing with plutonium stocks because of the toxicity of the element and as it can be used to fabricate nuclear weapons, and expresses concern that it might be illicitly acquired by terrorists. It recommends an independent government commission on the management of plutonium, and considers the various options for this. However, it does not analyse the arguments against plutonium as a reactor fuel, and underestimates the risks of diversion to nuclear weapons and nuclear terrorism. This paper reviews the options, and concludes that separated plutonium should be added to high-level waste, vitrified, and eventually buried in a deep geological repository.

Nations Behaving Badly by Harry Davis

Nations have always behaved badly. As unethical actions taken by nations cause increasingly severe problems because of the development of weapons of mass destruction, it has now become imperative to alter these ageold behaviour patterns. Ethical foreign policy is now probably necessary for survival.

The Psychosocial Effects of Landmines in Cambodia by Daya J Somasundaram and Kea Kiri Renol

The widespread use of landmines in conflict situations around the world and their continuing legacy for the civilian population in injuries, amputations, disabilities and economic costs has been recognized as a major problem. However, the psychosocial consequences for landmine victims are still to be realized. Although there are some facilities for the medical, orthopaedic and long-term rehabilitative care of landmine victims, hardly any exist for their psychosocial needs. This study considers the mental costs in terms of post-traumatic stress disorder, depression and anxiety. Individual difficulty in relationships and daily functioning is considerable, and the landmine victim faces social stigmatization, rejection and unemployment. Suggestions are made for brief training in relatively simple mental health care for staff working in already functioning programmes.

Changing Role of Civilian Surgeons in Conflicts: A Meta-analysis of Epidemiological Data by Masahiro Morikawa

Surgical activities in recent conflicts were reviewed based on the published epidemiological data. Ten articles on seven conflicts were identified and reviewed. The surgical activities in these articles were classified into three categories based on their activities: type 1, civilian border camp surgical activities; type 2, military hospitals in military deployment; type 3, civilian hospitals in former Yugoslavia or Palestine camp (most recent conflicts). Comparison of injuries in ratios of head-to-extremities, and critical part-to-extremities, among these three different types of surgical activities showed that type 3 hospitals had a statistically higher number of critical part injuries compared to other two types of hospitals. Type 3 hospitals represent the most recent endemic, regional, and indiscriminate killing experiences. The high rates of critical part trauma in studies of recent conflicts show the increasing importance of trauma management skills by civilian surgeons in recent conflicts. Exchange of information among civilian surgeons serving in these difficult and dangerous conditions should be encouraged.

The SIrUS Project by Douglas Holdstock, Jack Piachaud and Robin Coupland

Afghanistan and Pakistan: Stepping Back in Time by Rosalyn Taylor

Conference Reports

Pugwash: Tridentosaurus - or a Nuclear-Weapon-Free Britain by Douglas Holdstock

Group for War and Culture Studies: Committing War to Memory by Liz Willis

Book Reviews