EDITORIAL

Looking forward and looking back

‘Celebrate’ may not be quite the right word given the challenges that remain,but in this issue of Medicine, Conflict and Survival we mark the fact that it is50 years since the New England Journal of Medicine’s landmark publicationof a series of articles on ‘The medical consequences of thermonuclear war’.The publication of those articles, in May 1962, was a hugely significantmoment in the development of the public debate around nuclear weapons. Forthe first time the potential health consequences of a nuclear attack on the Uni-ted States were comprehensively and scientifically described. Given the scaleand nature of the effects described in those papers it was only natural that theywould have a significant impact – and even that they would provoke fear andpanic amongst governments and the public at large. Just a few months later, inOctober 1962, the public’s awareness of the threat posed by nuclear weaponsrose again, but this time not because of the results of academic research butbecause of political events. We refer, of course, to the ‘Cuban missile crisis’, aweek during which the world probably came closer than at any other time to afull-scale nuclear war.

As well as being an important contribution to the public debate overnuclear weapons, the NEJM’s publication of ‘The medical consequences ofthermonuclear war’ was also a hugely significant moment in the developmentof the medical peace movement. Here was a deliberate attempt to re-framenuclear weapons in health terms. Rather than conducting the debate on thefamiliar terrain of national security, geopolitics and military strategy, theauthors of those articles shifted the focus onto the potential human conse-quences of nuclear conflict – a vital and powerful part of the argumentationsubsequently deployed by later generations of anti-nuclear campaigners, and atactic used consistently by the medical peace movement to oppose a variety ofother weapons, from anti-personnel landmines to cluster bombs.

In this issue we are privileged to have a commentary by three of theauthors of those original NEJM articles in which they look back over the last50 years to reflect on those studies and to consider the progress that has beenmade in the intervening half century. As Geiger, Sidel and Lown make clear,there has been a mixed record of progress in the attempt to reduce nuclearstockpiles and limit proliferation. There have been some real achievements, butthere is still a long way to go, much more campaigning to be done, and a real

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danger of public attention waning as other, seemingly more pressing, issuescompete for a place on the agenda.

Yet there are still those who are actively campaigning against nuclearweapons, and our second commentary, by Kelvin Mason and Kye Askins,shows the efforts being made by activists to develop new and innovative formsof resistance. Mason and Askins report on the latest in a series of ‘academicblockades’ of the Faslane naval base on the Clyde, home to the UK’s Tridentnuclear weapons system. The blockade took the form of an academic seminarheld at the North Gate of the Faslane base. It involved scholars from a varietyof disciplines and institutions presenting papers and holding discussions whilstat the same time engaging in a determined and very public form of non-violentdirect action.

The two original articles in this issue address some other interesting andimportant topics in the field of conflict and health. In the first, Leo van Bergenlooks back at the treatment of those wounded during WWI. In particular heexamines the tension created by the ‘dual loyalty’ which physicians owed tothe individual patients on the one hand, and to the army and the state on theother. Van Bergen shows clearly how the interests of patients and the state fre-quently came into conflict, and how the ways in which individual doctors rec-onciled their dual loyalty was a product not only of their personal characterand beliefs, as has often been argued, but was also influenced by the nature ofthe patient’s injuries. The article discusses three categories of wounded sol-diers: the disfigured; the invalided-out; and ‘neurotics’. In each case van Ber-gen shows how the balance struck between the interests of the patient andthose of the state subtly altered according to the nature of the injury. Fascinat-ingly, he also shows that states had a wide range of interests at stake in thetreatment of the injured – not only did they seek, where possible, to have sol-diers made available to return to the fighting, but they also had far longer-termconcerns over the costs that the state would be required to bear to supportinjured servicemen after the war had ended. Whilst van Bergen’s focus is his-torical, there are no doubt interesting parallels to be drawn between the issueshe discusses in the context of WWI and the treatment of servicemen woundedin contemporary conflicts.

In their review article examining health in fragile and post-conflict states,Rohini J. Haar and Leonard S. Rubenstein assess the current state of knowl-edge about health and healthcare delivery in these complex settings. In sodoing they identify some important knowledge gaps, and set out a number ofcompelling future research agendas. Whilst recognizing the practical and meth-odological difficulties of conducting research in challenging environments, theyargue that we need to know much more about how effective current invest-ments are; how more stakeholders can be empowered and included within theprocess of (re)constructing the health sector; and the impact that delivery ofhealth assistance by the military (an increasing trend – see Birch 2010) has onthe development of civilian health services.

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Contributors and correspondents to the journal should note that Simontakes up a new post in the Department of Politics at the University of Sheffieldin January 2013, and that his email address for submissions will thereforechange to simon.rushton@sheffield.ac.uk. Maria’s address remains the same:m.kett@ucl.ac.uk. As ever, we welcome submissions of commentaries or arti-cles from all those interested in the issues covered by the journal.

Simon RushtonCentre for Health and International Relations

Aberystwyth University, UK

Maria KettLeonard Cheshire Disability and Inclusive Development Centre

University College, London, UK

ReferenceBirch, Marion, 2010. Delivering health care in insecure environments: UK foreign

policy, military actors and the erosion of humanitarian space. Medicine, Conflictand Survival, 26(1), 80–85.

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