The Interesting Times We Live In: EPW Commentary
EPW Commentary
May 24, 2008 EPW Economic & Political Weekly
C Sathyamala
Public health issues are inextricably linked with human rights and it is only apt that many health professionals will involve themselves in such issues. The response of governments and the corporate sector to the work of such professionals suggests how they are seen as threats to the established order.
It is a year since Binayak Sen, a paediatrician and human rights activist from Chhattisgarh was arrested and placed in custody under sections of the Chhattisgarh Special Public Security Act, 2005, and Unlawful Activities (Prevention) Act, 1967 (2004) for alleged links with the banned Maoist groups. To justify his detention, evidence is being manufactured to project him as a “hard core Naxal”, who supports violent means for opposing the state. This is despite the admission of the prosecution lawyer, during framing of charges in the sessions court, that he had no evidence of Bianyak being a Naxalite [Medico Friend Circle 2008]. Binayak’s “crime” is that, apart from providing medical care to the rural poor and working class communities, he felt compelled to be involved with the issue of human rights since he perceived health work not merely as provision of medical services but as efforts that counter the suppression of the socio-economic and political rights of the marginalised [Sathyamala 2007]. It was this perspective that led to his becoming a member of the People’s Union for Civil Liberties and, later on, its vice-president due to his continued involvement in human rights issues.
Health and Human Rights
Socially sensitive public health professionals find it difficult to ignore issues of human rights as they are inextricably linked to the health and well-being of a population. And the state, in turn, finds it vital to suppress any evidence that points to such linkages. Riyadh Lafta is a professor of medicine at Al-Mustansiriya University of Baghdad, who led the Iraqi ministry of health’s Unicef funded immunisation campaign for 14 years. In May 2007, he was denied visa to visit the US where he was to give a talk and then was denied a transit visa in UK en route to Canada to deliver the same lecture in Vancouver since Canada agreed to issue him a visa [Woodward 2007]. His crime: he had co-authored a study published in the Lancet which showed the health impact of the American-led war in Iraq. The cross sectional study, conducted during September 2004, compared mortality during the period of 14.6 months before the American invasion and occupation with the 17.8 months that followed [Roberts et al 2004]. The study found that the risk of death was 2.5 folds higher, the risk of death from violence was 58 folds higher after the invasion and most individuals killed by the coalition forces were women and children. The major causes of death before invasion were myocardial infarction, cerebro-vascular accidents, while after the invasion, violence was the primary cause of death with most of the deaths attributed to coalition forces. The authors estimated an excess of 1,00,000 deaths or more in the one year following invasion. This estimate was 20 times higher than the number used by the Bush administration. For all of these “crimes”, his home in Iraq has been searched by the coalition forces, and his life is under threat, from both the pro-government people and anti-government people, according to Les Robert, his co-author from Johns Hopkins University [Woodward 2007]. Lafta has also collected data to show an increase in birth defects and a tenfold increase in childhood cancers that could be ascribed to the war and he was to have used his visit to work on completing the paper. Lafta continues to live and work under these severe conditions as he believes that it is his “duty to concentrate on the things that are alarming and disastrous to our population”.
But it is not necessary that a medical professional directly involved in raising “sensitive” human rights issues for the state to perceive a threat; conducting scientific studies which bring out evidence of adverse health outcomes and points to state policies/interventions as a source is sufficient. For instance, after the Bhopal gas leak disaster of December 1984, the activities of several organisations involved in relief and rehabilitation of the victims came under surveillance. Doctors and other health workers engaged in providing injections sodium thiosulphate as an antidote, were arrested in a midnight swoop and several of the activists had serious charges (attempt to murder for example) filed against them by the Madhya Pradesh government. This was because acceptance of sodium thisosulphate as a rational treatment for the gas affected population (a remedy that had the approval of the Indian Council of Medical Research) would have meant that the state recognised that the victims were suffering from chronic cyanide poisoning and that the gases had crossed the lung blood barrier to produce multi-systemic effects. Activists attending meetings discussing the medical consequences of the toxic gases in Bhopal were arrested. The Medico Friend Circle study on pregnancy outcome which was planned initially for June 1985 had to be postponed as the MP government declared that all “outsiders” working with the gas victims would be treated as “terrorists”. Finally when the study was carried out, the survey team was under constant surveillance and it became necessary to shift the completed schedules every night to a safe place. The reason was that the government wished to minimise damages and any independent study meant to assess health impact was viewed as a threat.
Corporations and Whistle-blowers
It is not merely the state that is antagonistic to public health professionals who are involved in highlighting disturbing associations through their studies. Depending on where they find themselves, the corporate sector deals with whistle-blowers in other ways. In countries where the rule of law is upheld, the corporate sector uses legal means to settle its score. Frank Nicklason and others, who spoke about the health hazards posed by a major logging company in Tasmania (Gunns Limited) were sued for damages worth $A6.3 million by the company [Zinn 2005]. Nicklason is a staff physician at the Royal Hobart Hospital, Tasmania, whose research showed that legionella bacteria, fungal organisms, and wood dust, all of which were present in the stockpiles of shredded wood at the wharf posed potential health risks to the exposed population. Nicklason said that the Hippocratic oath required him to prevent illness not just in patients but in society as well.
Closer home, on December 19, 2007, the Madras High Court was reported to have restrained two farmers’ associations and their office bearers (the Sathankulam Regional Agriculture Association and the associationfor users of irrigation water, 145, left main canal sub-channels I and II) from making any “derogatory remarks and baseless allegationsagainst the Titanium unit project being planned by the Tata Steel inTuticorin district of Tamil Nadu” (The Hindu, December 20, 2007). Thecompany had filed a civil suit seeking Rs 50 lakh damages caused tothe company “due to defamatory remarks, comments and falseallegations” made against the project. Due to these “unfoundedremarks”, the company had alleged that it faced many hurdles whileexecuting its project and that the company would suffer heavyfinancial hardships, and loss if the respondents were not restrained.The crime: the two farmers’ associations had raised questions aboutthe degradation of land and water supply and environmental damage dueto the setting up of the Tata unit and were successful in mobilisingthe local people against the industrial unit. Titanium is indicted aspotential occupational carcinogen [The National Institute forOccupational Safety and Health 2007].
Extraordinarily Political
The discipline of epidemiology is extraordinarily political as it hasthe ability to pinpoint causal associations between exposure andoutcomes. Causal associations are bound to be contentious issues. Whenconducted with integrity, epidemiological studies have pointed outthat the sources of health or ill-health lie in the socio-economic andpolitical location of a population. But as evidence of the ill effectsof anti-people policies begin to accumulate, we see epidemiology beingevoked to justify the unjust polices of the state that goes to greatlengths to generate counter-evidence. And those who challenge such badscience are accused of being anti-government, anti-patriotic andanti-science. The long-waged campaign against the injectablecontraceptives and the more recent one against the polio eradicationprogramme in the country illustrate this. In both the cases, a body ofevidence has been built systematically, step by step, against theadvisability of such programmes. But the establishment continues tocreate more “evidence” to counter facts with figures.
For Binayak, though trained as a medical professional, involvement inhuman rights issues was inescapable in a state like Chhattisgarh thatis witnessing large-scale government-sponsored terrorism in the nameof Salwa Judum, an operation whose stated objective is to combatMaoist insurgency but which in reality is to wrest ancestral land fromthe tribal communities, for the use of private industrial houses.Binayak Sen’s continued incarceration is the expression of zerotolerance by the state for anyone, who will hamper the zooming up ofthe sensex. Questioning the path of development that the country ishurtling along, and the threat it poses to the lives of people andother living beings, will be viewed as a threat to national securityand all efforts will be attempted to contain dissent.
An earlier version of this article was discussed in the annual meet ofthe Medico Friend Circle, December 28-29, 2007, at Dallihara, on thetheme ‘Role of the Health Professionals in Times of Social Violenceand Conflict’.C Sathyamala (csathyamala@gmail.com) is anepidemiologist based in Delhi.
References
Medico Friend Circle (2008): ‘Release Dr Binayak Sen! Health, Human Rights and Development Activist: Prisoner of Conscience in Chhattisgarh, 2007-08‘ (monograph), MFC Pune, p 17.
The National Institute for Occupational Safety and Health (2007): ‘Pocket Guide to Chemical Hazards‘,
accessed 24.12.07.
Roberts, L, Lafta R, Garfield R, Khudhairi J, Burnham G (2004): ‘Mortality Before and After the 2003 Invasion of Iraq: Cluster Sample Survey‘, www.thelancet.com published online October 29, 2004.
Sathyamala, C (2007): ‘Binayak Sen: Redefining Healthcare in an Unjust Society’ (editorial),
Woodward, J (2007): ‘Doctor Fears for Life in Homeland: Prevented from Speaking at SFU, Author Continues Controversial Work despite Danger’,
Zinn, Christopher (2005): ‘Doctor Who Spoke on Public Health Issue is Sued’, BMJ, .
Indian Journal of Medical Ethics 4 (3): 105-106.The Globe and Mail, April 28,.
Related posts
If you enjoyed this post, please consider to leave a comment or subscribe to the feed and get future articles delivered to your feed reader.
