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Humanitarian crisis in Kashmir: don't shoot the messenger

2019; Elsevier BV; Volume: 396; Issue: 10255 Linguagem: Inglês

10.1016/s0140-6736(19)32078-1

1474-547X

Zafar Mirza,

Global Maternal and Child Health

The views expressed by the Editors1The LancetFear and uncertainty around Kashmir's future.Lancet. 2019; 394: 542Scopus (16) Google Scholar about the public health dimensions of recent and past events in the Kashmir valley are entirely in line with my perspective as a public health doctor with more than 15 years of experience of working with WHO and as an avid consumer of knowledge disseminated by medical journals such as The Lancet. The Editorial1The LancetFear and uncertainty around Kashmir's future.Lancet. 2019; 394: 542Scopus (16) Google Scholar unleashed a social media storm of condemnation in India. Such knee-jerk reactions have become the norm in today's polarised world, but an open letter by an august body, the Indian Medical Association (IMA),2Indian Medical AssociationLetter to the Editor.http://www.ima-india.org/ima/pdfdata/lwKQ1ptABLqI-Letter-to-editor-The-Lancet-reg-Kashmir-issue.pdfDate: Aug 19, 2019Date accessed: August 20, 2019Google Scholar which attacks The Lancet for its credibility and calls the Editorial's intentions malafide, causes me great concern as a member of the medical fraternity. The current plight of Kashmiris being denied access to essential health care and living under great duress with no communication with the outside world was also highlighted in the BMJ.3Mahase E Kashmir communications blackout is putting patients at risk, doctors warn.BMJ. 2019; 366l5204Crossref PubMed Scopus (4) Google Scholar This report,3Mahase E Kashmir communications blackout is putting patients at risk, doctors warn.BMJ. 2019; 366l5204Crossref PubMed Scopus (4) Google Scholar substantiated by numerous doctors working in the affected area, leaves no doubt that the population in Indian-occupied Kashmir is facing a humanitarian crisis. The long-term psychological consequences, which the Editors of The Lancet dubbed as “formidable mental health crises”1The LancetFear and uncertainty around Kashmir's future.Lancet. 2019; 394: 542Scopus (16) Google Scholar on the basis of data from credible sources, will be felt for generations to come. Only last year, the Lancet Commission on Global Mental Health,4Patel V Saxena S Lund C et al.The Lancet Commission on global mental health and sustainable development.Lancet. 2018; 392: 1553-1598Summary Full Text Full Text PDF PubMed Scopus (486) Google Scholar led by an eminent Indian psychiatrist, highlighted the long-term needs of populations affected by humanitarian crises, emphasising that their human rights and mental health are frequently compromised and should be addressed as a priority. This Lancet Commission was launched on Oct 18, 2018, at the Global Ministerial Mental Health Summit in London, UK, and was endorsed by ministers or their representatives from more than 40 countries, including India and Pakistan.5Mental Health Innovation NetworkGlobal Ministerial Mental Health Summit: declarations and recommendations.https://www.mhinnovation.net/resources/global-ministerial-mental-health-summit-declarations-and-recommendationsDate: 2018Date accessed: August 20, 2019Google Scholar Less than 1 year later, influenced in part by findings of the Commission, Arif Alvi, President of Pakistan, asked ministers to develop a national plan for public mental health. There are numerous other examples where national policies have been informed by various Lancet Commissions on key issues affecting global health. To malign such an important policy and public health tool by a medical association supposedly representing the custodians of health of the world's largest democracy is misguided and immature, to say the least, and akin to shooting the messenger. It is ironic that only a few months ago, I enjoyed reading about two randomised trials conducted collaboratively by researchers in Pakistan and India that were published simultaneously in The Lancet Psychiatry.6Sikander S Ahmad I Atif N et al.Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan.Lancet Psychiatry. 2019; 6: 128-139Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 7Fuhr DC Weobong B Lazarus A et al.Delivering the Thinking Healthy Programme for perinatal depression through peers: an individually randomised controlled trial in India.Lancet Psychiatry. 2019; 6: 115-127Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar The investigators had tested innovative ways, developed jointly by Pakistani and Indian researchers, of addressing the mental health of women, another vulnerable group, in both countries. These studies are proof that collaboration between health professionals across national borders can help improve the lives of billions of people living in the region. Such sentiments are echoed by numerous ex-colleagues at WHO from all sides of the borders. Surely we need more sanity in our region, even more so in the very custodians of health in the two largest countries, each possessing enough nuclear weapons to destroy the world many times over. The authors of this statement by the IMA,2Indian Medical AssociationLetter to the Editor.http://www.ima-india.org/ima/pdfdata/lwKQ1ptABLqI-Letter-to-editor-The-Lancet-reg-Kashmir-issue.pdfDate: Aug 19, 2019Date accessed: August 20, 2019Google Scholar or at least the hundreds of thousands of doctors they represent, must not forget that when the medical profession becomes accomplice to nationalistic and ideological jingoism, the results for humanity are inevitably tragic, as evidenced by the holocaust in Europe not so long ago. I urge the IMA, or at least the individual doctors this body represents, to have the courage and moral imperative to retract this misguided and damaging statement against The Lancet and focus their attention on the suffering of the people they have taken an oath to protect. The civilised world cannot afford to repeat the mistakes of the past. I am the Minister for Health in Pakistan. Fear and uncertainty around Kashmir's futureLast week in a controversial move, India revoked the autonomous status of Jammu and Kashmir, allowing India greater authority over the state's affairs. The announcement fanned tension with Pakistan, which also claims the region and has fought India over it for more than seven decades. At least 28 000 Indian security forces have been deployed; in the capital city Srinagar, a lockdown has been implemented that suspended communication and internet links, and a strict curfew has been imposed. The militant presence raises serious concerns for the health, safety, and freedoms of the Kashmiri people. Full-Text PDF