1. Peace Building Through Health Zeev Wiener PHR-Israel

2. By 2020 The WHO and the World Bank predict that war will be one of the top 10 causes of disability and death.

3. War and Public Health Economic and social systems are disrupted, famine and epidemics may follow, and resources are diverted to military rather than health goals-all of which make war a public health problem. Economic and social systems are disrupted, famine and epidemics may follow, and resources are diverted to military rather than health goals-all of which make war a public health problem. MacQueen G, Santa-Barbara J. Peace building through health initiatives. BMJ 2000; 293-6

4. The Role of Physicians “ The role of physicians and other health workers in the preservation and promotion of peace is the most significant factor for the attainment of health for all ”. WHO, World Health Assembly, Resolution 34.38, 1981

5. Health as a Bridge for Peace A concept based on the idea that shared health concerns can transcend political, economic, social and ethnic divisions, to promote dialogue, foster solidarity, and contribute to peace among peoples and between nations. A concept based on the idea that shared health concerns can transcend political, economic, social and ethnic divisions, to promote dialogue, foster solidarity, and contribute to peace among peoples and between nations. Guerra de Macedo 1994

6. Why? Why Medicine? Why Medicine? Is there a coherent intervention theory? Is there a coherent intervention theory? Have we the required socio-political technology? Have we the required socio-political technology? Do we posses the skills? Do we posses the skills?

7. Checking Basic Assumptions War=Disease War=Disease Violence=Bacteria Violence=Bacteria Medical Staff=Healers Medical Staff=Healers Peace=Cure Peace=Cure Health Providers in Crisis

8. Peace Through Health Vass A. BMJ (Editorial), Nov. 2001 “… even the WHO program used anecdotal comments from field teams to say that volatility had reduced and social cohesion improved. The report admits that it could have been the wider peace process and post war fatigue felt by the population that brought about these changes ”. “… With few examples of peace through health initiative, it is idiology that is driving the movement at present ”. “… humanitarian aid had even worsened conflict at times ”. (Sudan 1998)

9. War as a Disease Process Primary Prevention- ” Make love-not war ” Primary Prevention- ” Make love-not war ” Secondary prevention- Early detection of conflicts and intervention in high risk areas. Secondary prevention- Early detection of conflicts and intervention in high risk areas. Tertiary Prevention- Reduce suffering and disability through treating the victims. Tertiary Prevention- Reduce suffering and disability through treating the victims.

10. Alert Signs Violence Disease outbreak Poverty Unemployment Food Shortage Famine Oppression Political Instability/Corruption Institutional/Social Disintegration Migration

11. Health Peace Building Mechanisms Conflict management Conflict management Solidarity Solidarity Strengthening the social fabric Strengthening the social fabric Dissent Dissent Restricting destructiveness Restricting destructiveness

12. Health Peace Mechanisms Palestinian-Israeli Conflict Conflict management Medical diplomacy and health oriented superordinate goals. Present data to policy makers and public (both sides) Press professional associations to stand out (IMA, Palestine) Press Government by international establishments (Red Cross, Amnesty, professional associations)

13. Health Peace Mechanisms Palestinian-Israeli Conflict Solidarity Healthcare workers empowering peacemaking groups. Healthcare workers empowering peacemaking groups. Empower health and human rights NGO ’ s by: Finance medical supplies (home equipment, medications) medical expertise( mental health, infant development) Out of country medical facilities (special surgery)

14. Health Peace Mechanisms Palestinian-Israeli Conflict Strengthening the social fabric Restore and enforce bonds uniting populations through health. Joint medical projects relevant to both populations (DM, HT, PTSD, lifestyle modification) Professional knowledge and expertise exchange Re-Education (hate, mistrust, violence)

15. Health Peace Mechanisms Palestinian-Israeli Conflict Dissent Using medical knowledge to express disagreement with policies. Access to healthcare (Roadblocks, primary care services) Official responsibility in different types of Palestinian areas

16. Health Peace Mechanisms Palestinian-Israeli Conflict Restricting destructiveness Arguing for restricting and abolishing destructive policies and weapons using healthcare discourse. Obstacles to healthcare access House destruction Suicide bombing Prisoners ’ health

17. Public Health Problems Concerning Both Sides Physical trauma (Gun shot,burns,blast wounds) Mental trauma (PTSD) Hate,mistrust, violence Road accidents Life Style (Obesity, Smoking, ect.)

18. ViolenceConflict Acts of killing during war encourage depreciation in the value of human life, legitimizing violence and lead violence to be seen as norm. Archer D. and Gartner R. Violence and crime in cross-national perspective, New Haven: Yale University Press 1984. The more an individual feels helpless and loss of Control, the more they are prone to develop anger, anxiety, frustration and depression, expressed in behavioral terms as violence. Milgram NA. Psychological stress and adjustment in time of war and peace: the Israeli experience as presented in tow conferences. Isr Ann Psychiatr Relat Discip 1978; 16(4): 327-38.

19. What is Needed? Redefine goals. Redefine goals. Create appropriate region-specific tools. Create appropriate region-specific tools. Educate staff. Educate staff. Preserve medical neutrality and impartiality. Preserve medical neutrality and impartiality. Keep on trying. Keep on trying.