In contemporary times, the loss of skilled staff to incidences of terrorism is a matter of concern. The prime example of this tragedy is death of Surgeon General, Pakistan, Gen Mukhtar Ahmed Baig, in an incidence involving Suicide Bombing1. Suicide bombing is a strategy in which perpetrator intends to inflict harm on his victim with no exit strategy in mind. No place is immune to such incidences; acts of terrorism and suicide bombing have been carried out in Hospitals, private clinics and places of worships. The incidence of such gastly acts has increased since induction of Pakistan as a front line state in the War on Terror. One would argue this is a heavy price to pay. In this write-up we will examine the health related variables of terrorism.
Pakistan has seen a steady rise in the incidence of suicide bombing. Although accurate statistics are not available but according to one estimate 927 people have been killed in the acts of terrorism involving 71 suicide attacks in 2007, alone2. Subsequent years have seen a rapid rise in the incidence of Suicide bombings. Though there may be no virtue in counting the dead, lessons can be learned in order to rectify the mistakes. There are various determinants of this rising extremism in the country. A discussion on the political reasons is beyond the scope of this write-up; however, some would be sighted as a background to our main discussion.
Pakistan is a country with an Agrarian economy. The health related indices read a sorry picture; the neonatal mortality of 57 per 1000 live births and infant mortality rate (under one) of 78 per 1000 live births is a source of persistent concern3. We are beleaguered by a double burden of Infectious and Non-communicable diseases. There are those who are inflicted with cardiovascular diseases, obesity – much like western countries – due to affluence while the rest suffer from poverty, malnutrition and scarcity of clean water supply. In terms of economic resources we are classified as a Low- Middle Income Country while health related variables may be at par with Sub-Saharan Low Income Countries4. Community based studies site Prevalence estimates of common mental disorders (Depression and Anxiety) to be around 30%, which is double the figures from the industrialized western countries5. Conflicts and wars lead to migration of population, foremost to erosion of protective factors for mental health. Post Traumatic Stress Disorder (PTSD) is a common disorder under these conditions. Though there are no representative figures, of 1020 Afghan refugees presenting to a psychiatric clinic in Peshawar, North West Frontier Province, Pakistan, 76.1% (n=776) met DSM-III-R diagnostic criteria of PTSD6.
In a periodical, scientific American, Susser et al. writes ‘Terror does not always come out of the barrel of a gun or in the shape of a bomb or grenade. Intimidation, harassment, threat of violence or the creation of an environment of imminent violence can be enough to paralyzed civil life and kill enterprise and creativity. Such tactics can also lead to violent retaliation by those oppressed.’7 Lack of education and poverty are a breeding ground for extremist ideologies, duly funded by external Agencies and Governments. Armed conflicts lead to alienation of marginalized communities. In Pakistan, Study of Sociology and Anthropology are relegated to those with no options. In this context the policy-decisions are not informed with Research evidence.
Suicide bombing is not an outcome of religious extremism alone. It has various social, psychological and various geo-political determinants. Lack of development and economic opportunities are a breeding ground for extremist ideologies. Fighting terrorism with force is an exercise in futility. Suicide bombing is a symptom of a disorder. There is a dire need to treat the cause rather than control the symptoms, alone. The rise in religious extremism has affected health related initiatives in many ways. In immunization program, the refusals of polio vaccines have been a recent source of concern. Self-styled clerics in North West Frontier Province of Pakistan have claimed that the vaccines have been donated by ‘Western’ countries, with the aim to affect the ‘Faith’ of their future generation. It is of prime importance that Government initiates a dialogue with these religious leaders in order to find an impasse8.
Another important, yet neglected issue which is fallout of War on terror is Drug Use disorders. Heroin as a drug of abuse was virtually unknown in Pakistan prior to 1979. With Heroin addiction reaching epidemic proportion, over the past 40 years, Pakistan has become embroiled in a growing, complex and multi faceted narcotic menace. This has affected nearly all socio-economic groups. According to the 5th and last National Survey on Drug Abuse (N.S.D.A.) conducted in 1993 by the Pakistan Narcotic Control Board, there were nearly 3 million drug addicts in Pakistan with 51% of them being heroin addicts9. United Nation’s Anti-narcotics chief warned that Afghanistan burgeoning opium production was leading to the emergence of new “Golden Triangle” of lawlessness on the country’s borders with Pakistan, Iran and Turkmenistan. “Illegality is very pervasive and trafficking (is) going on,” said Antonio Maria Costa, executive director of the UN’s Office on Drugs and Crime. Recent reports show that Afghanistan saw a record harvest of 8,200 metric tons of opium in 2007, a 34% increase over 2006. The export value of the country’s opium is estimated at $4 billion (Euro 2.73 billion), up 29% on last year and equal to more than half of Afghanistan’s legal gross domestic product. The mountain terrain in the North Western Frontier Province of Pakistan has provided trade route to goods across the Afghanistan and central Asia for centuries. This has resulted in rising sale of hard drugs in Pakistan10.
Suicide bombing and terrorist activities are particularly more devastating in the context of restricted Medical resources of a Pakistan – a developing country11. Unfortunately, an organized Emergency Medical Services does not exist in Pakistan. The initial help to such trauma victims is usually provided by people at the scene of the terrorist activity, which mostly is nothing more than sending the victims to the nearby hospital in whatever form of available transportation. Transportation of these victims to the hospitals is also delayed by the traffic congestion; though the situation has improved in major cities due to the combined efforts of government and NGOs. In-hospital care for suicide bombing victims is also not very effective. The doctors and paramedical staff in the emergency department across the country, even in tertiary care hospitals, are not well trained for the care of suicide bombing victims. The situation of medical services is even worse in tribal areas of Pakistan, which have been badly hit by such incidents lately.
The gravest issue with terrorism is that it impedes development in all facets of life. Health care sector in no exception to this problem; damage to infrastructure, loss of skilled work-force, accessibility to centers and teaching and training opportunities are compromised. Terrorism affects the mental health of the masses direct as well indirectly. The stress of uncertainty leads to state of compromised functioning among those who are vulnerable.
In a larger frame of reference, the lack of development – in terms of human capital – is the biggest loss inflicted by terrorism. In the twenty first century, when stem cell research has opened the avenues for unveiling scientific mysteries, we cannot afford relegation to deep waters of ignorance. We need to initiate dialogue on issues confronting the masses. Universities should play their part in bringing together all stakeholders. Leadership in Academia should step out of their traditional roles and confront the bigger issues, courageously. Noam Chomsky, the famous American Cognitive scientist, linguist and Philosopher in his famed essay, ‘The Responsibility of the Intellectuals’, commented on the prevailing situation after the Second World War: ‘Let me finally return to Dwight Macdonald and the responsibility of intellectuals. Macdonald quotes an interview with a death-camp paymaster who burst into tears when told that the Russians would hang him. “Why should they? What have I done?” he asked. Macdonald concludes: “Only those who are willing to resist authority themselves when it conflicts too intolerably with their personal moral code, only they have the right to condemn the death-camp paymaster.” The question, “What have I done?” is one that we may well ask ourselves, as we read each day of fresh atrocities in Vietnam—as we create, or mouth, or tolerate the deceptions that will be used to justify the next defense of freedom’.11 The same question confronts many intellectuals in this country beleaguered by war and terrorism.
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