Issues in Islamic Biomedical Ethics: A Primer for the Pediatrician Available to Purchase

Dear Editors:

I wish to thank Mr. Southall for his timely and thoughtful letter. While I agree wholeheartedly for the need for a "twin track" of humanitarian assistance and pursuit of justice, I would like to point out why the current US administration's approach to this will not work.

First, as Mr. Southall pointed out, the fate of the Afghan people for the last 23 years has been controlled largely by regional powers and their interests. Unfortunately, the US has interests beyond the capture of Mr. Bin Laden and the Al-Qaeda network. The US's initial support of the Taliban regime in 1996 was based on the American oil company Unocal's need to link a pipeline from Uzbekistan to Pakistan throught Afghanistan. The US's desire to create a sphere of influence in Central Asia is a significant secondary outcome of the current campaign. It will be a significant source of tension for years to come for the regional powers, namely China, Russia, and Iran.

Second, the policy of dropping a few thousand rations from cargo planes, which incidentally, looked like unexploded cluster bombs, was an improper public relations campaign, denounced by multiple aid groups, such as Medicines Sans Frontiere.

Third, there is a saying in the Quran, the scripture of the Muslims, that it is better to not give charity than to give and follow it up with obligation. Because of the US's political and military influence, it's humanitarian aid is seldom without obligation, unlike, say, that of Sweden and Japan, who, relative to GDP are the most generous humanitarian aid donors.

Finally, there were non-military measures and institutions such as the United Nations, INTERPOL, or, the Organization of Islamic Conferences which could have been first approached in an attempt to extradite Mr. Bin Laden. Now, many civilians have been killed by US bombing with millions displaced. Furthermore, the halt in international aid due to the bombings will lead to the deaths of hundreds of thousands this winter due to starvation. This consequences of the bombings will create leagues of angry young men throughout the Islamic world from the Philipines to the Canada, some of whom may become next year's terrorists.

Sincerely, Kamyar M. Hedayat, MD Division of Critical Care Department of Pediatrics Lucille Packard Children's Hospital Stanford University Palo Alto, Ca, USA

For 22 years, families in Afghanistan have lived in a state of almost continuous terror because of armed conflict. Some of this has been imposed from outside by countries pursuing their own ideological, political or religious agendas. The majority of ordinary families are suffering from malnutrition and lack access to even basic healthcare. Problems have been made worse by a three-year drought (the worst in living memory), which seems set to continue. People are living a marginal existence with a large part of the population displaced (either internally or abroad) or dead. Now, because of the most terrible act of terrorism in the United States of America, these ordinary families will be fearful of the reactions of powerful countries which may, if they involve armed conflict, greatly worsen their already desperate suffering. Families are currently streaming away from the cities and both Iran and Pakistan are trying to close their borders.

Afghanistan has a population of 22 million, one-thirteenth the size of the USA (276 million). If mortality in Afghanistan were the same as in the USA, 7 children under 5 would die each day. The number actually dying is 802 a day.² On the same basis there would be 35 deaths in mothers during pregnancy or childbirth each year. In fact there are 17,107 such deaths each year.³ These grossly disproportionate differences in mortality are also accompanied by similar differences in suffering and permanently disabling chronic illnesses. Most of the mortality and morbidity in Afghanistan is due to malnutrition and a lack of basic medical care.

It is right that whoever was responsible for these appalling acts of terror in the USA should be brought to account and also important that States do not harbour or encourage those responsible for terrorism. However it is equally important that the antagonism in some poor Islamic States towards the United States of America is recognised and addressed.

Military action to remove today's terrorists would be of little point if the indirect consequences of such action were to create a whole new generation of terrorists for tomorrow.

An appropriate response by the international community to the appalling acts of terrorism must clearly be undertaken, but it must have long-term as well as short-term benefits. Any action which adds to the already desperate suffering faced by the defenceless people of Afghanistan (or other countries with similar problems) will not only reflect badly on the proposed alliance to take action against the terrorists and lose it the moral high ground, but could also generate a coalition of opposition where at present there is support. It should be remembered that America is currently the largest donor of humanitarian aid to Afghanistan.

There has to be firm action against those responsible but, alongside the pursuit of justice, we would like to invite the international community to introduce in a highly visible manner a massive influx of humanitarian aid focused on the ordinary people of Afghanistan. Such a 'twin track' approach would be preferable. The tragedy of the loss of innocent lives in the world's richest country will not be avenged by the taking of innocent lives in one of the world's poorest countries.

A concerted act of kindness and support to some of the most suppressed, hungry and needy people in the world would demonstrate to the many very poor countries that the Western World is sensitive to the causes of extremism as well as caring about all human life--and the quality of that life--worldwide. It could present a powerful alternative to the unacceptable violence of terrorism. Industrialised countries could, in partnership with the Afghan community worldwide, take this opportunity to bring good out of evil.

Our contacts with the Afghan people, as well as our work in other Islamic countries have convinced us that such an action is almost certain to generate even more support than is already apparent from the governments of most poor countries. Perhaps if optimism can reign for a moment, it might lead in those countries in which terrorism is nurtured to the identification and denouncement of the perpetrators and, in the long term, reduce the possibility of further acts of terrorism.

A 'twin track' approach by the country already so badly wounded by last week's terrible act would truly represent evidence of civilisation and humanity. The alternative does not bear thinking about.

David Southall, Honorary Medical Director
Judith Flacke, Director
John Bridson, Chairman of Trustees
Child Advocacy International

1. Sogan D, Bridel J, Arzomund M, Shepherd C, Southall D. 21st Century Health Care for Children in Afghanistan. Pediatrics. 1998;102:1193-1198.
2. The State of the World's Children, UNICEF, 2001. New York, NY. Oxford University Press.
3. The State of the World's Children, UNICEF, 1997. New York, NY. Oxford University Press.

This letter is supported by the Patrons, the company secretary and all of the Trustees of Child Advoacy International.