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TitleConcepts and Practice of Humanitarian Medicine
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Table of Contents
	1  As an overall introduction, a brief mission statement and the definition of Humanitarian Medicine are given here to express the concepts and practices outlined in this book.
	Part I The Fundamentals: Human Rights and Health
		1  The Right to Health
		S. W. A. Gunn, MD, FRCSC, DSc(Hon), Dr h c
	2  Health and Human Rights---A Public Health Perspective
	Gudjón Magnússon, MD, PhD
	3  Health for All or Hell for All? The Role of Leadership in Health Equity
	Halfdan Mahler, MD
	4  The Declaration of Alma-Ata on Primary Health Care
	International Conference on Primary Health Care
	5  Health and Human Rights: In 25 Questions and Answers
	Helena Nygren-Krug
	6  Freedom from Fear for Human Well-being: The Need for Humanitarian Medicine in the Prevention of Torture and the Treatment of its Survivors
	Jaap A. Walkate LLD
	Part II Humanitarian Medicine
		7  Humanitarian Medicine: A Vision and Action
		M. Masellis, MD and S.W.A. Gunn, MD, FRCSC
	8  Ethical Principles for Everyone in Health Care
	C. Rollins Hanlon, MD, FACS
	9  Quality of Life and Medical Practice
	Radana Königová, MD, CSc
	10  Medical Contributors to Social Progress: A Significant Aspect of Humanitarian Medicine
	William C. Gibson, MD, DPhil, FRCPC
	11  Humanitarian Medicine Applied in a Highly Specialized Field: Cardiovascular Surgery
	Jan T. Christenson, MD, PhD, FETCS
	12  Humanitarian Medicine for a Developing Country: Outreach to Cuba
	Paddy Dewan, PhD, MS, FRCS, FRACS
	13  Humanitarian Basic Plastic Surgery
	Bishara S. Atiyeh, MD, FACS
	Part III International, UN and WHO Cooperation
		14  Find New Unity
		Kofi Annan
	15  Health and Human Rights in International Legal Instruments
	A WHO Compilation
	16  The United Nations Today: Changes in Policies and Structures---The World Summit and UN Reform
	Yves Beigbeder, LLD
	17  The Critical News Stories You Never Read
	Shashi Tharoor
	18  United Nations Humanitarian Action and the Role of Non-governmental Organizations
	Hanifa Mezoui, PhD
	19  The UN Founding Fathers and Dr Chisholm
	Sir Robert Jackson, KCVO†
	20  Brock Chisholm---Doctor to the World
	Book Review by S.W.A. Gunn, MD
	21  The Language of International Humanitarian Action: A Brief Terminology
	S. W. A. Gunn, MD, FRCSC, DSC (Hon), Drhc
	Part IV Disasters and Conflicts
		22  Humanitarian Action in Major Emergencies
		Boutros Boutros-Ghali
	23  The Humanitarian Postulate in Disaster Management
	Jean Marie Fonrouge, MD and S. W. A. Gunn, MD, FRCSC
	24  Health and Social Issues of Migrants and Refugees
	Manuel Carballo, MD
	25  Man-Conceived Disasters
	S.W.A. Gunn, MD, FRCSC, FRCSI, (Hon), DSc (Hon)
	26  The Nuclear Issue and Pugwash
	Sir Joseph Rotblat, DSc, PhD, KCMG, CBE, FRS
	27  Quantifiable Effects of Nuclear Conflict on Health and Society
	S. W. A. Gunn, MD, FRCSI(Hon), DSc(Hon), Dr h c
	28  Avoidable Tragedy Post-Chernobyl---A Critical Analysis
	Rosalie Bertell, PhD, GNSH
	Part V Science, Research and Perspectives
		29  The Role of Science to Improve the Quality of Life: Reflections on the Post-Genomic Era
		Anthony Piel, LLD
	30  The Ethics of Research: The Responsibility of the Researcher
	Ivan Wilhelm, PhD
	31  The Cost of Not Doing Health Research
	William C. Gibson OC, DPhil, FRCPC, LLD(Hon)
	32  Reflections on the Past, Present and Future of Medicine
	Radana Königová, MD, CSc
	33  Scientists, Doctors and the Nuclear Dilemma
	Sir Joseph Rotblat, DSc, PhD, KCMG, CBE, FRS
	34  Serving the Global Community Through eHealth: The Role of Academia
	Kendall Ho, MD, FRCPC
	Part VI Society, Health and Equity
		35  The Humanization of Medicine---A Religious Viewpoint
		F. Fab, DD
	36  Urban Social Exclusion---The Samusocial Response
	Xavier Emmanuelli, MD
	37  Social and Medical Progress Through Patient Education in Chronic Diseases
	J. P. Assal, MD, FMH
	38  An Equitable Society Protects the Health of its Weakest Members: Women and Children
	G. Masellis, MD, D. Vezzani, MD and G. Gargano, MD
	39  The Humanitarian Force of the UN Millennium Development Goals
	Hanifa Mezoui, PhD
	40  Science and the Health of the Poor
	Jong-Wook Lee† MD
	41  Poverty and Disease---Health and Prosperity
	Joint WHO and UN Report
Document Text Contents
Page 2

Concepts and Practice of Humanitarian Medicine

Page 153

Chapter 22
Humanitarian Action in Major Emergencies

Boutros Boutros-Ghali

It is a great pleasure as well as a great honour for me to be with you on the occasion
of the International Conference on Emergency Medicine and Catastrophes, amongst
the men and women on the ground who have made the choice to serve their fellow
human beings.

Following the recent murders of six employees of the ICRC, I would like to begin
by paying public tribute to your actions, your dedication, and your commitment, as
eminent specialists in emergency medicine and dealing with catastrophes.

I must say that if you were looking for a completely detached view of this ques-
tion, I would be entirely the wrong man for the job. I would therefore like, quite
simply, to share with you some of the thoughts that your actions inspire in me. Let
me stress five points:

1. It is difficult to isolate the issue of humanitarian action, in the broadest sense of
the term, from a global geopolitical perspective. It is clear that, since the end of
the Cold War, and advances in promoting human rights, the humanitarian issue
has acted as a stimulus in the international political arena.

One only has to look at the increase in the number of Security Council resolutions
devoted to humanitarian issues and at the increase in the number of peacekeeping
operations, which are largely intended to come to the aid of populations in distress.
One only has to look at the increase in the number of NGOs in the humanitarian
field, and at the increased efforts and resources devoted by international organi-
sations, as well as national governments, and private institutions, to bringing help
to the victims of natural disasters or technological catastrophes; to the victims of
famine or pandemics, and to the victims of dictatorship or war.

2. Recent decades have also been characterised by the significant increase in the
number of conflicts.

Never, since the end of World War II, has the world seen so many conflicts.
Moreover, these are a new kind of conflict: conflict within nations and conflicts
about identity and disintegration. Conflicts that affect civilian populations above all
and that lead to huge migrations of displaced persons or refugees!

Conflicts that are sometimes accompanied by the disappearance of government
structures, making it very difficult to perform independent humanitarian actions, and


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154 B. B. Ghali

sometimes impossible to intervene at all. Conflicts where the boundary between acts
of war and outright crime, between civilians and combatants, disappear. Conflicts
in which the value of symbols is no longer respected, transforming humanitarian
workers into the preferred targets of those who prey on humanitarian action, and
in which international humanitarian law itself is no longer in a position to provide
an appropriate response. It means humanitarianism finds itself confronted with new
situations, new difficulties, and new challenges, all at the same time.

3. It means that beyond the controversies, humanitarian action is the subject of
more and more ethical and political debates, and it deserves to be defined more

Whether it is a question of cost or a question of organising relief to avoid what
Bernard Kouchner calls—I believe—“a catastrophe within a catastrophe.” With
all that implies in terms of disputes and coordination problems between multiple
NGOs, NGOs and the population, and NGOs and the national authorities.

Whether it is a question of the legitimacy of wanting to respond to suffering when
the country itself is opposed to it. Whether it is a question of a duty to bear witness.
Whether it is a question, faced with a saturation of resources, of the necessity of
choosing who should be abandoned.

All of this pushes us to keep on re-evaluating and to take better account of the
wide diversity of situations, to acquire a better understanding, also, of the necessary
interdependence between humanitarian action and political power, even if political
power, as represented by nation states, must continue to play its role. In particular
when, in certain situations, the disappearance of organised authority makes any kind
of humanitarian action almost impossible. It falls, then, to the international commu-
nity to avoid this kind of drifting and to compensate, through concerted political
action, within the framework of the United Nations or regional bodies, for the pow-
erlessness of humanitarian organisations.

We must also take better account of the diversity of the players involved and, as
part of this much-needed dialogue, draw the line between necessary compromise
and compromising principle. We must also define how far to take certain risks,
which are inevitable in the current context. But above all, in all circumstances, we
must keep in mind that all conflicts, all suffering—whether or not it is covered in
the media—deserve our attention.

4. If we need to pin down the scope of emergency humanitarian action, we must,
also and above all—make the connection between emergencies and prevention,
and between rebuilding and development. Emergency humanitarian intervention
must be supported and then replaced by political action, before, during, and after
the event! Let us help people to understand that humanitarian problems do not
only need humanitarian solutions!

First of all, it is before catastrophe, strikes—upstream of the event—that the
problems of poverty, harm to the environment, and overpopulation must be tackled.
It is also prior to any disaster that real, preventive diplomacy needs to be developed.
Most conflicts that break out can be predicted, and an early warning system remains
the best way to help avoid delayed, improvised, or disorganised interventions.

Page 305

Index 323

truthfulness and confidentiality, principles
of, 80

tuberculosis, 304–305. See also poverty

U21 e-health steering committee, 247
UN Convention against Torture (1984)

Article 1, 47
Article 16, 47
Article 2, 47

UN Covenant on Civil and Political Rights
(1966), 47

UN Declaration of the Rights of the Child, 4,
159. See also “Right to Health”

UN Department of Peacekeeping Operations
(UNDPKO), 134

UN Special Rapporteur on Health
Professionals and Human Rights, 52

UNAIDS. See United Nations Programme on

UNDP. See United Nations Development

UNHCR. See United Nations High
Commissioner for Refugees

UNICEF, 22–23. See also Declaration of

United Nations, 133, 149. See also laws and

Article 55 and 56, 31
Charter of the United Nations (1945),

humanitarian medicine and, 58
difficulties, 127
diplomatic forum, 128–129
“Health for All” and, 6
Hiroshima and Nagasaki bombings and,

human rights systems, 30
humanitarian action, 133–136
in health sector, 128
policies and structure, changes in, 123–125

disarmament, 125
Human Rights Council, 127
nuclear proliferation, 125
on Security Council, 126
peace-building commission, 126
preventive use of force, 125
reform of secretariat, 126
Standing Police Capacity, 126
terrorism, 125

poverty and disease report, 303–308
reforms, 123
“Right to Health” and, 4
unsolved problems, 127–128
World Summit, 123–125

disarmament aspect, 125
Human Rights Council, 127

on Secutiry Council, 126
peace-building commission, 126
reform of secretariat, 126
Standing Police Capacity, 126

United Nations Convention Relating to the
Status of Refugees (1950), 41

United Nations Declaration on the Right to
Development (1986), 40

United Nations Development Assistance
Framework (UNDAF), 42

United Nations Development Program
(UNDP), 129, 133, 138

United Nations High Commissioner for
Refugees (UNHCR), 129, 133

United Nations International Childrens
Emergency Fund (UNICEF), 133

United Nations Population Fund
(UNFPA), 303

United Nations Programme on HIV/AIDS
(UNAIDS), 129, 303

Universal Declaration of Human Rights
(UDHR), 3–4, 29. See also Health and
Human Rights

Article 5, 47
Article 25, 58, 159

Universal Declaration on the Eradication of
Hunger and Malnutrition, 58, 159

UNMDG, 245
UNRRA, 138–140
UNSCEAR, 199–203

agencys responsibility aspects, 203
post-Chernobyl analysis, 204–206

urban social exclusion, 261
US Patriot Act, 219
US Presidential Decision Directive 2, 219

value-added of human rights in public
health, 34

violence against children, 26. See also Health
and Human Rights

Virchow, Rudolph, 86–87
Voluntary Fund for Victims of Torture, 52
vulnerability, defined, 145. See also disaster

and instability disasters, response to, 294
crimes, defined, 148

Waterston, J.J., 232
weapons of mass destruction (WMD), defined,

Whittle, Lieutenant Frank, 232
WHO. See World Health Organization
WOH. World Open Hospital
women health, 277–278. See also children

Beijing Declaration (1995), 277

Page 306

324 Index

maternal deaths, 280
obstetric assistance, 280–282
reproductive health, 278–279
sexually transmitted disease (STD),

working conditions

asylum seekers, 172
clandestine migrants, 172

World Association for Disaster and Emergency
Medicine, 176

World Bank
Comprehensive Development

Framework, 42
“Health for All” and, 6

World Food Program (WFP), 133
World Health Organization (WHO), 22–23,

149. See also laws and organizations
agency’s responsibility aspects, 203
Constitution, 4
health definition, 10–11
Health definition, 15
“Health for All”, 5

IAEA and WHO (1959), deal between,

Interim Commission of WHO (IC-WHO),

on poverty, 299–301
on poverty and health, 297
post-Chernobyl analysis, 204, 206
poverty and disease report, 303–308
radiation exposure, response to, 200–201
“Right for Health”, 3–5
science and quality of life aspects, 211–214

World Health Resolution 34.38, 134
World Open Hospital (WOH), 61, 63, 94. See

also humanitarian medicine
World Summit, UN, 124–127

disarmament aspect, 125
Human Rights Council, 127
on Secutiry Council, 126
peace-building commission, 126
reform of secretariat, 126
Standing Police Capacity, 126

World Trade Organization (WTO), human
rights and, 40

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