Wednesday, April 5, 2017

Health workers and the tragedy of Syria: rejected by the Lancet

Now that I am in my 7th decade I must be older than the current power holders in the Lancet; I fear they follow fashion but lack wisdom. They rejected this letter: read it for yourself.

Health workers and the tragedy of Syria

In 1994, Lancet published my essay which included the sentence "Those in the developed world may watch with horror  ..  if followed by closure of the demographic trap through war, epidemics, famine, or all three".(1)

To lament the 6th anniversary of the catastrophe in Syria, your editorial has repeated the “h” word: “The world has stood by in horror, watching the death toll rise and the humanitarian and refugee crises spread their indelible stain on the world map and human history.”(2)

Birth rates in Syria were declining before the war started, however they were still far above replacement.(3) A combination of systemic, interacting factors, including Syrian peak oil,(4) aquifer depletion, climate change exacerbated drought,(5) and a five-fold increase in youth unemployment between 2000 and 2011 (to 48%)(6) generated a milieu in which brutal and violent conflict took root. Checkmate – entrapment. Using alternative language, Syria, like famine and conflict beleaguered South Sudan, Yemen, Somalia and north east Nigeria exemplify contemporary cases of “regional overload,”(5) just as Rwanda did in 1994.

The identification of environmental factors as contributors to these health and humanitarian disasters is not “environmental determinism” as some critics have claimed. Nor does such identification in any way excuse egregious human rights abuses arising from entrapment. However, because these environmental and demographic contributors to past, current and future calamities have been warned of for decades,(7) it does demonstrate how many political and civic leaders have been ill-informed, if not negligent, in following their duty of care for the well-being of their populations.
But it is not just the leaders in these countries who are responsible. In most cases, such leaders have followed the majority of academic opinion, which, for decades, has sidelined, and even ridiculed anything related to limits to growth.(7) Promoters of such wishful thinking arguably, are even more responsible.

Health practitioners cannot, ourselves, do much to alter the trajectory of civilization, but it possible that a tiny nudge in the right direction could deliver a planetary rescue that currently looks improbable. Part of that nudge is to remind those who care about Syria and its people that many of the drivers of its catastrophe were predictable. This is not “I told you so” gloating, but an appeal for all with influence to look more deeply and widely at causes, in order to alleviate and prevent much future human suffering, for Syrians and many others, perhaps for us all.

1.    Butler CD. Overpopulation, overconsumption, and economics. The Lancet 1994; 343: 582-4.
2.    Editorial. Syria suffers as the world watches. The Lancet 2017.
3.    Eberstadt N, Shah A. Fertility decline in the Muslim World, c. 1975–c. 2005: a veritable sea-change, still curiously unnoticed. In: Groth H, Sousa-Poza A, eds. Population Dynamics in Muslim Countries; 2012.
4.    Ahmed N. Peak oil, climate change and pipeline geopolitics driving Syria conflict. The Guardian 2013.
5.    Butler CD. Regional overload and the consequences it has for health. BMJ blog 2017.
6.    Taleb ZB, Bahelah R, Fouad FM, Coutts A, Wilcox M, Maziak W. Syria: health in a country undergoing tragic transition. International Journal of Public Health 2015; 60(1): 63-72.
7.    Butler CD. Planetary overload, limits to growth and health. Current Environmental Health Reports 2016; 3(4): 360-9.

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