From doctors across borders

Once again, India and Pakistan stood at the brink of war over Kashmir, and have only just begun to tone down the posturing and threats. With nuclear weapons uncomfortably close at hand, almost 2 billion people in the region face the risk of nuclear catastrophe. For well over three decades now, multiple simulations and projections have suggested that an India–Pakistan nuclear escalation could lead to millions of deaths in the region, rivaling past great famines. The consequences of a nuclear exchange of any magnitude could affect generations to come. Kashmir has proved to be an especially intractable political predicament for the two countries. As Arundhati Roy wrote in her 2017 novel, The Ministry of Utmost Happiness, the confrontation over Kashmir is "a perfect war—a war that can never be won or lost, a war without end".

The threat of war is a matter of urgent public health concern. Health workers have a duty to speak out and plead for peace. Why would these two populous and proud nations risk disaster by such brinksmanship? The region is one of the poorest in the world with human development ranking for India and Pakistan standing at 130 and 150, respectively, in 2018. An estimated 40 per cent (59 million) of the world's stunted children and 53 per cent (27 million) of all wasted children live in south Asia, and 34 per cent of the population has no access to sanitation. Investments in health and education remain less than 4 per cent and 3 per cent of respective gross domestic product (GDP) in the region. Yet successive governments and military establishments have escalated military spending—in 2017, it was US$64 billion in India and $11 billion in Pakistan.

Perhaps the greatest disappointment is the jingoism and warmongering that have gripped both countries, with some reckless parts of the media baying for blood. We have witnessed almost hysterical calls for retribution after the deplorable suicide bombing in Pulwama, Kashmir, on Feb 14, 2019, that killed 40 Indian soldiers. Perhaps the current escalation of air and ground skirmishes along the military Line of Control (the de facto India–Pakistan border) was inevitable. But civil society representatives and activists have been silenced. Contrarian views, including calls for peace, have been ridiculed and shouted down.

With the release by Pakistan of the downed Indian air force pilot on March 1, 2019, temperatures have begun to cool somewhat, yet the situation remains extremely tense. We call upon the governments, political parties, mass media, and civil society in India and Pakistan to step back from the edge of conflict and to exercise constraint. The real causes of conflict in the region—important contributing factors to instability and the rise of extremism—include rampant poverty, inequalities, illiteracy, and lack of investment in human capital. Pakistan has lost more than 60 000 lives in fighting domestic terrorism in its tribal areas and Baluchistan, costing its economy at least $120 billion. Economic losses to the region are massive and simply unsustainable. It has been estimated that an additional terrorist incident per million persons reduces GDP per capita growth by about 1.5 per cent. These resources could have been spent on human development, religious harmony, and the promotion of grassroots democracy.

Political leaders in both countries must move away from conflict and pursue diplomacy, dialogue, and the promotion of person to person contact and engagement between civil society representatives and youth. There is no conflict that cannot be resolved at the negotiating table. As the two countries once again stare into an abyss of disaster, we fervently call for peace, pragmatism, and the prevention of further violence.

(The authors are: Dr. Arun Mitra, Vice President, Indian Doctors for Peace and Development; Zulfiqar A Bhutta, Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 75500, Pakistan (ZAB); and Dr. Arun Mitra, Zulfiqar A Bhutta and Richard Horton, The Lancet, London, UK (RH). The views expressed are strictly personal)