Ukraine: medical advocacy must stand and deliver

THE war in Ukraine, like every modern war, is affecting primarily civilians, who are bearing the brunt of the thousands of deaths and injuries, the psychological terror, and the devastation and risks that go with displacement.

From this large-scale assault on human health that we see unfolding, feelings of anger, despair and helplessness can emerge. How can medical professionals, including those of us here in Australia half a world away from the destruction, move beyond these feelings to make a difference?

As health professionals, we can continue to uphold the core values of our profession, especially the protection of human life, from which flow a humanitarian and medical imperative to stop this war and help prevent the next.

The importance of medical voices speaking from a shared commitment to preserve life cannot be underestimated. Medical workers are trusted by the public; collectively, we have skills as healers, advocates and educators. We play an important role in addressing violence, and in helping to build peaceful societies, by acting on the values that are core to our profession.

Here in Australia, the Medical Association for Prevention of War (MAPW), of which I am the President, has long been an advocate for peace. In response to the invasion of Ukraine, we’ve drawn attention to the civilian toll of this war and called for intensive negotiations leading to a ceasefire.

Globally, medical workers have raised their voices. On 10 March, a statement was issued by International Physicians for the Prevention of Nuclear War (IPPNW), the World Medical Association (WMA), the World Federation of Public Health Associations (WFPHA) and the International Federation of Medical Students’ Associations (IFMSA). It called for an immediate ceasefire in Ukraine, the withdrawal of all invading and occupying military forces and an urgent, negotiated end to the war.

Health professionals can also raise their voices in solidarity with colleagues under attack.

The 9 March attack on a maternity hospital in Mariupol, Ukraine, was chilling in not only its cruelty but also its flagrant violation of the rules of war. Attacks on civilian health services are forbidden under the 4th Geneva Convention, which is specifically designed to protect civilians in times of war. All parties to armed conflict must respect the neutrality of health professionals, whose obligation is to protect lives and provide care for all on the basis of need.

Attacks on health care have become a regular feature of modern warfare, and have occurred in Yemen, Afghanistan, Syria, Iraq, and in even more forgotten wars such as that in the Democratic Republic of Congo. There is no place for selective outrage; human life is human life, and health care and its providers everywhere must be protected. Attacks must be consistently condemned no matter where they occur or whether the perpetrators are friend or foe. Tragically, however, there has been no precedent set for holding to account the perpetrators of these attacks.

That must change, and the process of changing it must be driven by humanitarian concerns and the protection of one of the most fundamental values of our profession – neutrality – not by political concerns which could greatly compromise the outcomes. Both Médecins sans Frontières and the International Committee of the Red Cross have been in the forefront of this advocacy.

A further area, of even deeper significance for global health – and an issue where health professionals have a profound impact – is the threat of nuclear war, which Russian President Vladimir Putin has brought to the fore again.

In 1980, at the height of the Cold War, Soviet and US medical doctors responded to the nuclear weapons threat by upholding a fundamental truth: that our common humanity was more important than Cold War politics. That was the beginning of IPPNW, an organisation driving groundbreaking advocacy, based on medical and humanitarian evidence, for nuclear weapons abolition. MAPW is the Australian affiliate of IPPNW, and the founder of the International Campaign to Abolish Nuclear Weapons (ICAN). IPPNW and ICAN each received the Nobel Peace Prize for their efforts, in 1985 and 2017 respectively.

The 10 March statement by IPPNW, the WMA, the WFPHA and the IFMSA recognised that the world’s nuclear arsenals are “primed to unleash a final epidemic for which there could be no effective treatment”. It called for the urgent elimination of these weapons and, specifically, for universal support for the Treaty on the Prohibition of Nuclear Weapons. This Treaty is the only current global instrument leading us towards a nuclear weapons-free world.

The Australian Government refuses to state that nuclear weapons must never be used in any circumstances, thereby implying that the destruction of cities and the infliction of mass casualties may be acceptable in some situations. Medical workers must continue to insist that this is never acceptable. Our goal is that Australia signs and ratifies the Treaty. In 2020, organisations representing over 500 000 medical and other health workers endorsed this goal, in recognition of the medical imperative to prevent nuclear war.

The text of the Health Professionals’ Statement on Ukraine — open for signature by individuals and by health/medical organisations — is below:

The war in Ukraine has triggered a health, human rights, refugee, and environmental crisis, causing millions of innocent people to suffer. The impacts of deeply traumatised and scarred human lives, ruined cities, and polluted lands and waters will be felt for generations. The most vulnerable members of society, including children, pay the heaviest price for the brutality of modern wars. We condemn Russia’s military aggression and call for it to cease.

Attacks on health care facilities are absolutely forbidden in armed conflict. We condemn them, in Ukraine and every other war zone in which they have occurred. We insist that all parties to this and all conflicts respect the neutrality of health professionals.

We stand in solidarity with health professionals in Ukraine as they serve their patients and their profession under often dangerous circumstances.

We stand in solidarity with health professionals in Ukraine and Russia who, in recognition of their shared commitment to preserve life, have called for a peaceful resolution.

As the war in Ukraine continues, the risk of escalation – and the use of nuclear weapons – grows. We call on Russia, the US, and NATO allies to explicitly renounce any use of nuclear weapons, and for all states, including Australia, to clearly say that any threat of use of nuclear weapons is unacceptable under any circumstances.

We urge all countries, including Australia, to give absolute priority to de-escalation of this war. Skilled diplomacy is desperately needed, and a commitment to continuing negotiations for as long as they are needed to achieve a lasting ceasefire.

There is a proud medical tradition, globally and right here in Australia, of action to cut across politics and advocate for preventive health outcomes. Our profession’s voices for climate action – through, for example, the Climate And Health Alliance and the Australian Medical Association – are other such examples, and there are many more.

As global threats to health become more prominent, so must our advocacy for preventive measures, especially when this is our only hope of survival.

Dr Sue Wareham OAM is the President of the Medical Association for Prevention of War (Australia)

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.