ISSJ 50th Aniversary Celebration - Special Lecture -

"Peace and Health"
(Summary)

ETSUKO KITA
International Health
The Japanese Red Cross
Kyushu International College of Nursing

Through my work experiences at Japan's ODA, UNICEF and WHO for 15 years, I have had many opportunities to be involved in many countries in dispute such as Afghanistan, Cambodia, the Great Lakes Region of Africa, Sudan, Somalia, West Africa, Kosovo, East Timor, etc. Today, I would like to talk about the health of the people in these areas in dispute, influence of the dispute on health, as well as my idea about peace and my impression during my fieldwork.

Development and assistance have increased GNP in many countries. Having checked correlation between GNP and Infant Mortality Rate (the number of infants out of 1000 who dies before 1 year old, IMR), we find the fact that more GNP grows the less infants die. It is clear that statistically IMR would decrease as GNP increases. But on the other hand, when GNP exceeds more than 10,000 dollars, there is no dramatic change observed.

In Japan, life expectancy is about 80 years old. Mortality Rates of under 5 years old is 5. IMR is 4 and also Maternal Mortality Rate (the number of women who dies out of 100,000 births, MMR) is 8. In the countries of Great Lake Region, infections, diseases, pregnancy and delivery, which do not threaten the people's lives in Japan, or other developed countries are the cause of death of many children and women.

Many people left Rwanda and escaped to the neighboring countries, especially to Zaire, because of the emergency that occurred in Rwanda in 1994. Since 1990s, the disputes called Complex Humanitarian Emergency (CHE) have been increasing all over the world.

Country	AverageLife Expectancy 1998	Under 5 Mortality Rate /1000 births 1998	Infant Mortality Rate /1000 births 1998	Maternal Mortality Rate /100,000 births 1980-98	Saturation of Sanitary shelter 1990-98	MainDiseaseExcept HIV/AIDA
Brundi	43	176	106		51	Cholera, Meningitis,Malaria
Congo	51	207	128	200-800	18	Cholera, Meningitis, Dysentery, Plague
Kenya	52	117	75	590	85
Rwanda	41	170	105		>85
Tanzania	48	142	91	530	86
Uganda	40	134	84	510	57

Complex Humanitarian Emergency (CHE) defined by Dr. Michael Toole, an expert on refuge health care is as follows; the emergency situations, emerging from religious and/or ethnic turbulence, affecting large civilian populations which usually involve a combination of factor including war or civil strife, food shortages, and population displacement, resulting in ill health of majority and significant excess mortality.

Complex Humanitarian Emergency is not the war between countries but war between local inhabitants. Disputes break out in the residential areas and at the places of work of the people such as farming and cattle raising areas, and therefore, victims are not soldiers but inhabitants. Countries of disputes such as Rwanda and the present Afghanistan require military intervention. In these areas of disputes it often happens that the security of people who are assisting the inhabitants are often threatened. As the result,assistance cannot be provided, although the assistance is urgently required. When I worked at the Department of Emergency and Humanitarian Action (EHA) in Africa during the end of 1990s, infectious diseases such as Cholera, Meningitis and Rift Valley Fever have broke out in such countries as the Great Lakes Region of Central Africa, Somalia, Sudan, Liberia, Sierra Leone, Guinea, Mozambique and Angola where there were/have been disputes.

Monkey pox is the infectious disease found among monkeys in 1959 but 10 years after in 1970 it was found out that a man was infected by the Monkey pox and the disease has been increasing year after year. In Congo, over 1000 cases of Monkey Pox infected people were found around 1998 according to the investigation of WHO. This was because people ran into jungles to escape from disputes and had chances to contact with monkeys.

I would like to discuss about dispute and health service in Congo. Congo is rich in resources like diamond, cobalt, copper, and uranium etc but very poor as a country. Population is about 52,000,000 and it is consisted from 200 ethnic groups. Congo also shares borders with 9 different countries, including Sudan, Uganda, Rwanda, Burundi, Tanzania, and Zambia. Countries other than Tanzania and Zambia are still in ethnic dispute and problems can be happened easily both politically and ethnically.

There are many kinds of Hemorrhagic fever in Africa and effective treatment for Hemorrhagic fever is yet to be found. In 1994, Ebola hemorrhagic fever has spread all over in Kikwit, the Republic of Congo (formerly Zaire) and it took 4 months for the information of such diseases to reach to Kinshasa, the capital city that is 600 km in distance because of interruption and break down of communication and transportation owing to the dispute.

The number of the people suffering from AIDS in Africa is increasing. During 2001, 2,300,000 died, 3,400,000 newly infected, and total number of infected persons was 28,000,000. The life expectancy of the Africans is presumed to be 47 years at present but if there is no HIV/AIDS it will be extended to 62 years old. AIDS is an infectious disease but is has become a serious problem individually, socially and economically relating with the development of nations and local communities. Also AIDS is not only a disease but also is the problem of human right of a person who has AIDS. If families with AIDS patients are estranged by communities and/or children who lost their parents by AIDS are not cared by local communities, then families and communities will also be disrupted. Complex Humanitarian Emergency (CHF) and HIV/AIDS destroy culture and tradition and people are left in very unsound circumstances emotionally. Within the countries in dispute, there are arms prevailed whether there are fightings or not. Children, especially boys are grown up by playing with guns and used to cruel matters. Where there is no hope, people will try to pursue unsound pleasures. Not only complex Humanitarian Emergency but also terrorist attacks have increased.

The victims of the terrorist attack are not only other people but also our life and health will be threatened anytime by CHE, HIV/AIDS, terrorist attacks and destruction of circumstances. In Africa, there are emergencies, natural disasters, infectious diseases and so on, that makes vicious circle and brings desolation of human spirit. We cannot chose date and place of our birth. According to "State of the world's children 2000" by UNICEF, the gap between 10 rich countries and 10 poor countries is very big. If we were born in a poor country, we have to suffer from unfavorable conditions that are 211 times by GNP, 40 times by IMR and 120 times by MMR. On the left  is a famous graph. Horizontal line shows the rate of women's literacy and vertical line shows IMR. To the right number of women who can read and write increases, and to downward IMR decreases. This is the famous fact found during 1980s.

Literacy rate of the countries in Great Lakes Region is not too bad. However, a number of children will drop out of school at 5th grade and they have very little chance to receive higher education. People might lose hope and future prospect because of racial disputes and infectious diseases such as HIV/AIDS. Human Development Index (HDI) by United Nations Development Plan is very low in these countries.

Complex racial composition is reflected on complex language system and religion. It is not rare that the advanced countries in Europe have more than one official language. From now on, I would like to concentrate on working with people more individually, especially with women. In order for us to educate and reinforce ability by Human Development (HD) to women, this will probably stabilize the community. I met a girl at a ruin in Afghanistan. I think that her life until now has been spent in war and violence but I hope that her long life from now will be peaceful and health.