Does expressing concern about the health situation anywhere in the world require prior permission? An ongoing controversy swirling around a recent editorial (“Fear and uncertainty around Kashmir’s future”) in the Lancet, among the oldest and most prestigious medical journals in the world, on the health situation in Jammu and Kashmir compels one to pose the question.
The issues at stake go beyond one editorial, one journal, one state or even one country.
It throws up a basic question: Who can speak, about what, and where?
The Indian Medical Association (IMA), the country’s largest body of doctors, in an official letter to Dr Richard Horton, the journal’s editor, has lashed out at the Lancet for its recent opinion piece on Jammu and Kashmir, arguing that the journal has no “locus standi on the issue of Kashmir” and that its editorial amounts to “interference into an internal matter of the Union of India”, and that the journal has reacted to an "internal administrative decision of the Government of India under the garb of concern for the health of Kashmiris”.
As someone who has been writing for decades on health in India and in other developing countries, and who is an occasional contributor to the Lancet, the controversy took me by surprise. This is not the first time that the Lancet has looked at geopolitical conflicts through the health lens.
In the past, it has focused on the crisis in Gaza, Iraq, Syria, Afghanistan, the European migrant crisis, gun violence in the United States and many other such topics.
The Lancet has taken a stand on crises around the world, when health has been at risk. It has also been very open about why it believes in taking the positions it does. In its 2014 commentary piece “Gaza: An urgent call to protect civilian life and health”, the Lancet stated: “The role of the doctor is to protect, serve, and speak up for life. That, too, is the role of a medical journal.”
The Lancet is also not the only publication which has flagged such concerns. The BMJ (British Medical Journal), for example, also carried a report this month titled “Kashmir communications blackout is putting patients at risk, doctors warn”.
The IMA’s vitriolic reaction to the Lancet editorial resonates with many doctors in India. They have been vocal in the social media. However, not all doctors agree. Sanjay Nagral, an Indian medical doctor, tweeted: “Many doctors are outraged by this edit from Lancet, one of the world’s respected medical journals. Regular readers know that it has a long tradition of commenting on major global political developments. You could differ with the view but to question its mandate reveals ignorance.”
I was travelling in areas with poor connectivity this past week when I chanced upon the verbal slugfest between doctors and health advocates in India on the Lancet editorial. The Lancet opinion piece calls the revocation of Article 370 a “controversial move” that allows the federal government in India “greater authority over the state’s affairs”. It flags the findings of two reports — one by the UN high commissioner for human rights on human rights violations in J&K, and also another report by Medecins Sans Frontieres (Doctors without Borders), the Nobel Prize-winning international humanitarian medical NGO, on the state of mental health in J&K.
The editorial goes on to state that “despite decades of instability, developmental indicators suggest that Kashmir is doing well compared with the rest of India”. It notes that “in the capital city Srinagar, a lockdown has been implemented that suspended communications and Internet links, and a strict curfew has been imposed. The militant presence raises serious concerns for the health, safety, and freedoms of the Kashmiri people”, and goes on to raise “serious concerns for the health, safety, and freedoms of the Kashmiri people”.
This brouhaha over an editorial in a medical journal may or may not blow over soon. But it is critical to understand the context in which the heated debate is taking place.
The issue of the “locus standi” that various doctors’ bodies, including the IMA, talk about throw up questions that go far beyond the Lancet or its recent editorial.
It is also not just about the health situation in Jammu and Kashmir.
Non-interference or the non-intervention rule is a principle of international law. The understanding of what constitutes “intervention” has many grey areas, as experts have pointed out. But in its essence, it is about the right of territorial sovereignty possessed by each nation that restricts the ability of nations to interfere in the affairs of other nations.
Words like “interference” are typically part of the vocabulary of governments. A government’s remit is a function of national boundaries. It reacts when it feels its sovereignty is challenged.
But the language and idiom of governments is not the same as that of ordinary people.
If one believes in democracy, one has to concede that ordinary citizens, anywhere in the world, have a right to express their views on any issue. People in other countries or regions may agree, disagree or not pay attention, but one’s right to express oneself on a topic is not subject to territorial boundaries. Those of us who are not part of the government or the state apparatus are not circumscribed by geography.
Nothing stops anyone in India from expressing concern about adults or children in any part of this country as well as those in Pakistan, Yemen, Syria, China, the Solomon Islands, or any rich world country
Equally, nothing stops people in other regions from commenting on India. The other critical question is how one views health of a people which is a critical component of human development.
Can health be really delinked from its social determinants? The World Health Organisation describes the social determinants of health as “the conditions in which people are born, grow, live, work and age”. It points out that “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels”.
This is not applicable to just Jammu and Kashmir. It is relevant to every place.
We have every right to flag our areas of disagreement with any point of view. But if we pride ourselves on being the world’s most populous democracy, should one question anyone’s right to express concern or talk about an issue?