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This week, a group of doctors and other health workers joined a demonstration in London adding our voice to the opposition to DSEI (Defence and Security Equipment International), one of the world’s largest showcases of military equipment, hosted bi-annually by Britain.
In August the American journal Annals of Internal Medicine called for a review of firearms regulation in the USA as part of a public health approach to gun violence. These two actions are connected. No-one pretends that conflict, whether inter-personal, within societies, or between nations is solely related to the possession of weapons. However, widespread availability of lethal munitions markedly exacerbates the suffering caused by conflict.
There are around 40,000 gun-related deaths in the USA each year. Worldwide, there are twice as many direct and indirect deaths from conflict as from malaria. It is for this reason that conflict with the widespread availability of firearms is seen as an ongoing public health issue.
DSEI promotes and extols everything related to increasing destructive capability, from individual firearms and body armour, to armoured vehicles and helicopters, missiles and sophisticated weapons systems. It attracts private and state customers from around the world.
Official invitations this year include a military delegation from Saudi Arabia, which is the UK’s largest customer of military equipment. This equipment has seen use over recent years in Yemen where conflict has led to the deaths of thousands of children and worrying outbreaks of cholera with the collapse of social and health infrastructure. This is a classic example of how problematic, localised conflicts are hugely magnified by the involvement of heavily armed internal and external actors.
In Yemen, much of the destruction has been by guided bombing and missile attacks. The background in Libya is different but here again the results of internal conflict are multiplied by a proliferation of weapons, in this case large quantities of small and light weapons mainly supplied to opposition groups at the time of Gaddafi’s downfall. Disruption of what had been a public health success story has led for example to a resurgence of vaccine-preventable disease.
Elsewhere the link between weapons and limited health provision relates more to lost spending opportunities exemplified by countries in north Africa, Asia and the Middle East where military spending exceeds health budgets. Such countries often bear much of the suffering from conflict while the profit from militarisation goes to large international conglomerates in the wealthier world.
Thus, five of the six largest arms exporters are the five permanent members of the UN Security Council - the five original nuclear weapons states. The British government extols its role in this trade. It was recently reported that the UK is once again the world’s second largest exporter of arms and weapons.
We face a future where the potential for local and regional disputes seems more likely to increase rather than diminish. As doctors we should take a broad public health perspective and call for a change in direction with opposition to this international arms trade.
Instead there should be a focus on countering the arms trade lobby to reduce and prevent widespread accumulation of military hardware, both legal and illegal. There is a parallel here with opposition to the international tobacco industry once the health effects of smoking were understood. Health and well-being should be prioritised over the profits accumulated through the destructive and deadly arms and weapons industry.
Medact, the organisation which campaigns on social and political determinants in health, is taking a lead on this. It has a long history of concern over issues of conflict and health. Further information can be found at medact.org
Duncan Macintyre is a retired consultant general and respiratory physician from Glasgow, and a longstanding member of Medact