Concepts and Practice of Humanitarian Medicine Concepts and Practice of Humanitarian Medicine Edited by S. WilliamA.Gunn, MD,FRCSC,FRCSI(Hon),DSc(Hon),Drhc President, InternationalAssociationforHumanitarianMedicine FormerlyHead, Emergency HumanitarianOperations,World Health Organization MicheleMasellis,MD Director, InternationalAssociationforHumanitarianMedicine President, MediterraneanCouncil forBurns and FireDisasters S.WilliamA.Gunn MicheleMasellis InternationalAssociation MediterraneanCouncil forHumanitarianMedicine forBurnsandFireDisasters Bogis-Bossey Palermo Switzerland Italy ISBN:978-0-387-72263-4 e-ISBN:978-0-387-72264-1 LibraryofCongressControlNumber:2007932935 (cid:2)c 2008SpringerScience+BusinessMedia,LLC Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewritten permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA),except forbrief excerpts inconnection with reviews orscholarly analysis. Usein connectionwithanyformofinformationstorageandretrieval,electronicadaptation,computersoftware, orbysimilarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarksandsimilarterms,eveniftheyare notidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubject toproprietaryrights. AllStatementsaretheresponsibilityoftheirrespectiveauthors. Printedonacid-freepaper. 9 8 7 6 5 4 3 2 1 springer.com Thisbookisdedicatedto thevisionofDr GeorgeBrockChisholm,O.C. andto theactionoftheWorldHealthOrganization, 1948–2008 Preface Parallelwiththeirspectacularandlife-savingadvancesinbiotechnology,thehealth sciences have been increasingly strengthening their responsibility and humanitar- ian action. Current inequalities, conflicts, and stresses, however, continue to dis- advantage the health and well being of an unacceptably large proportion of the world’s population, whether in developing countries, in industrially insalubrious environments, in disaster situations, in chronic poverty, or in sick opulence. Sev- eral intergovernmentaland non-governmentalinstitutions, in particular the World Health Organization and the medical profession, address these issues boldly, yet the problemcontinuesand in manyaspects is becomingworse. In the face of this situation,agroupofconcernedprofessionalsfrommanydisciplinesestablishedthe InternationalAssociationforHumanitarianMedicineBrockChisholm,basedonthe principlesoftheUnitedNations,theRedCross,theWorldHealthOrganization,the WHOCollaboratingCentre,andWHO’sfoundingfather,DrG.BrockChisholm. The beginnings of the Association go back to 1984, to the Brock Chisholm MemorialTrust,nowincorporatedastheInternationalAssociationforHumanitarian MedicineBrockChisholm(IAHM),withanexpandedmission. ThisisnotaquestionofrepeatingaRedCross,orMédecinsSansFrontières,or SavetheChildren,nor,ofcourse,ofduplicatinganyofthespecializedfunctionsof theWorldHealthOrganizationorofAmnestyInternational.Itisnota questionof rushingto anepidemicfocus,disaster site, refugeecamp,ortortureprison.Many, manyaredoingthese,andaredoingthemwell.Certainlybasic,essentialcaremust bemadeavailable,andtherearethosewhomakethemavailable.YetHealthforAll remainsfarfrombeingwithinthereachofall.Wewouldliketobeinapositionof helpingthatdreamcometrue.Itiseveryhumanbeing’srighttohaveaccesstosuch essentialcare,thehumanrighttohealth. Besidessuchbasichealthcare,manyworkingindevelopingcountriesanddisas- tersituationshavenotedwithdismaythatanypatientneedingaslightlyadvanced, let alone specialized, treatment usually falls by the wayside. Without in any way encroaching upon programmes of primary health care or disaster relief, IAHM would like to and can fill this niche, can respond to these situations and provide thekindofspecializedhealthcarethatisnotavailableinpoorcountryxordisaster sitey,allwithinahumanitarianphilosophy.Tothisend,IAHMhasanopen-ended network of hospitals on the one hand, and of health providers and specialists on theother,who,inmanycountries,haveformallyagreedtolookaftersuchpatients, vii viii Preface without charge, on an entirely humanitarian basis. It has been christened World Open Hospital (WOH), and any hospital or any physician can join it any time. Therefore: InconceptualyettangiblewaysIAHMaimsat: • promotingthepreceptofhealthasahumanright; • strengtheningthecontributionofhealthasabridgetopeace; • advancinghumanitarianprinciplesinthepracticeofmedicine; • facilitatingtheavailabilityofHealthforAll. InpracticaltermstheAssociationwilladditionally: • provide specialized medical and surgical treatment, free of charge, in or from countrieswheresuchtreatmentisnotpossible; • mobilize hospitals in developed countries to receive, and doctors to treat, such patientsentirelyonahumanitarianbasis; • providesimilarservicesindisastersituations; • collaboratewithinstitutionspursuingsimilarobjectives. Our definition of humanitarian medicine should facilitate understanding the spirit and mission of the International Association for Humanitarian Medicine Brock Chisholm: Whileall medical intervention to reduce a person’s sickness and suffering is in essence humanitarian,HumanitarianMedicinegoesbeyondtheusualtherapeuticactandpromotes, provides, teaches, supports, anddelivers people’s healthasahumanright,inconformity withtheethicsofHippocraticteaching,theprinciplesoftheWorldHealthOrganization, the Charter of the United Nations, the Universal Declaration of Human Rights, the Red CrossConventionsandothercovenantsandpracticesthatensurethemosthumaneandbest possiblelevelofcare,withoutanydiscriminationorconsiderationofmaterialgain. In2005,theInternationalAssociationforhumanitarianMedicinepublishedthefirst bookentirelydedicatedtohumanitarianmedicine.Thisisasequeltothatvolume, expandingthebasicconceptsandadding14chapters.Likeitspredecessor,thisnew editionisrespectfullyofferedtotheglobalandhumanitarianhealthcommunity. S.W.A.Gunn M.Masellis Acknowledgments ThispublicationanditspredecessorHumanitarianMedicinehavebeenmadepossi- blethroughthecontinuouscollaborationoftheBrockChisholmMemorialTrust,the InternationalAssociationforHumanitarianMedicine,andwiththegenerousfinan- cialassistanceoftheSicilianRegionalParliament.Theseexpressionsofsupportare gratefullyacknowledged. Special thanks are also due to the Regents, authors, participating experts, and humanitarianhealth organizationsfortheir valuablescientific, medical, andmoral contributionstothemissionandgrowthofhumanitarianmedicine. The sources of articles reproduced by gracious permission have been duly acknowledgedintherespectivechapters.BillTuckerandKhristineQuejaofSpringer Sciencearetobethankedforvaluableeditorialassistance. ix Contents TheContributors ............................................... xv Preamble ...................................................... xix PartI TheFundamentals:HumanRightsandHealth 1 TheRighttoHealth ......................................... 3 S.W.A.Gunn 2 HealthandHumanRights—APublicHealthPerspective .......... 9 GudjónMagnússon 3 HealthforAllorHellforAll?TheRoleofLeadership inHealthEquity ............................................ 15 HalfdanMahler 4 TheDeclarationofAlma-AtaonPrimaryHealthCare ............ 21 InternationalConferenceonPrimaryHealthCare 5 HealthandHumanRights:In25QuestionsandAnswers.......... 25 HelenaNygren-Krug 6 FreedomfromFearforHumanWell-being:TheNeed for Humanitarian Medicine in the Prevention of Torture andtheTreatmentofitsSurvivors ............................. 45 JaapA.Walkate PartII HumanitarianMedicine 7 HumanitarianMedicine:AVisionandAction ................... 57 M.MasellisandS.W.A.Gunn 8 EthicalPrinciplesforEveryoneinHealthCare................... 67 C.RollinsHanlon xi xii Contents 9 QualityofLifeandMedicalPractice ........................... 79 RadanaKönigová 10 MedicalContributorstoSocialProgress:A Significant Aspect ofHumanitarianMedicine.................................... 83 WilliamC.Gibson 11 HumanitarianMedicine AppliedinaHighlySpecializedField: CardiovascularSurgery...................................... 93 JanT.Christenson 12 HumanitarianMedicineforaDevelopingCountry: OutreachtoCuba ........................................... 99 PaddyDewan 13 HumanitarianBasicPlasticSurgery............................ 107 BisharaS.Atiyeh PartIII International,UNandWHOCooperation 14 FindNewUnity ............................................. 117 KofiAnnan 15 HealthandHumanRightsinInternationalLegalInstruments...... 119 AWHOCompilation 16 TheUnitedNationsToday:ChangesinPolicies andStructures—TheWorldSummitandUNReform............. 123 YvesBeigbeder 17 TheCriticalNewsStoriesYouNeverRead ...................... 131 ShashiTharoor 18 UnitedNationsHumanitarianActionandtheRole ofNon-governmentalOrganizations............................ 133 HanifaMezoui 19 TheUNFoundingFathersandDrChisholm..................... 137 SirRobertJackson 20 BrockChisholm—DoctortotheWorld ......................... 141 S.W.A.Gunn 21 The LanguageofInternationalHumanitarianAction:A Brief Terminology................................................ 143 S.W.A.Gunn