Observations by a Stranger in a Strange Land (With apologies to Robert A. Heinlein)

by Donald L. Mellman, MD

As a recent IPPNW member, I have had the honor to join the mission to the Arms Trade Treaty meeting at the UN.

IPPNW is the only physician-driven NGO at this UN Arms Trade Treaty meeting. Therefore, its representatives bring into perspective the unstated goal of the treaty: to improve the lives and health of all peoples of the world. Certainly there is the need for the presence and passion of the other representatives of the many other NGOs who meet in a variety of ways to bring some sanity to the insane situation of armed violence and its millions of victims. Yes, IPPNW is caught up in the politics among the NGOs, the politics between the NGOs and the many state delegates, and is an observer of the (often acrimonious) politics among the state delegates. But, it is the only NGO that, by definition, speaks the language of patient care and the publics’ health.

Our co-president, Bob Mtonga, alluded to the famous Virchow quote, “Medicine is a social science, and politics is nothing but medicine on a large scale,” when he prepared remarks for the general NGO session. Interestingly, Bob is both a Zambian delegate to these proceedings and an IPPNW representative, the only NGO person so placed. He has the respect of all (> 50) the NGO members in attendance.Our panel on the opening day (Vic Sidel, Bob Mtonga, Cathey Falvo, Michael Schober, and myself) and then Ogebe Onazi, a Nigerian IPPNW physician member as a panelist on the third day, authoritatively and passionately pointed out the direct and indirect consequences of armed violence. These include not only the well-recognized injuries and the infrastructure issues of societal upheaval, famine, water shortage and sewage disposal, but also the long-lasting environmental problems of pollutants, toxins, and chromosomal changes that affect future generations. These issues were put into the context of the Haddon Matrix, a public health tool that enables the process of armed violence to be analyzed by studying the political and environmental environment in terms of the production and sale of the arms, to their actual use, to the after-effects of the violence. Looked at from a public health prism, armed violence can be seen to be a failure of leadership.

The question of including ammunition in the treaty, the necessity of special mention of women’s issues, and the matter of victim compensation are very important, and vigorously supported and debated with the state delegates. Nevertheless, no one denies the primary importance of individual and public health. IPPNW is a vital member of the Arms Trade Treaty discussion.