Violence in peacetime

Violence is a complex issue with various factors involved in it. Violence may be interpersonal or self-inflicted. Whereas these carry negative impact, collective violence has much larger ramifications and can cause collateral damage. According to the 'World report on Violence and Health' by the World Health Organisation (WHO), over 1.6 million people worldwide lose their lives to violence each year. In the last century, an estimated 191 million people lost their lives directly or indirectly as a result of armed conflict.

Poor people in economically underdeveloped countries are worst affected. Many develop permanent disabilities. Rapes and torture are part of major trauma inflicted in such situations. Children, women and senior citizens who do not indulge in violence are the worst affected. Due to lack of hygiene, poor medical facilities and absence of proper nutrition coupled with mental trauma, condition of refugees in detention camps is extremely grave.

Therefore, any kind of violence is an issue of serious concern for public health. Violence committed by groups of people in the name of ethnicity, religion, caste, creed, pseudo nationalism, beliefs or drug abuse can cause collateral damage, social disharmony and instability. Mob lynching on frivolous grounds is a relatively new phenomenon in our country. This has added to the fear psychosis among the vulnerable communities.

Many parts of the world are riddled with low and medium level conflicts today. Events in Iraq and Syria are very disturbing. The whole system has crumbled in these places. Here the states, as well as non-state actors, are equally responsible for the perpetration of violence. The situation in South Asia may not appear grave but a threat exists since this is a nuclear weapon-possessing region. A Military-industrial complex has developed which creates conditions and perpetuates violence to sell their arsenal.

Health is the biggest victim in conditions of violence. The health infrastructure is seriously eroded in such situations. With increasing uncertainties and stress, mental health issues increased manifold.

Terrorism is generally attributed to be a violent reaction by non-state actors. Five countries with the highest impact from terrorism as measured by the Global Terrorism Index (GTI) are Iraq, Afghanistan, Nigeria, Pakistan and Syria. These five countries accounted for 72 per cent of all deaths from terrorism in 2015. Then come Yemen, Somalia and India.

Terrorism in 2015 cost the global economy $89.6 billion. Even though this is a big amount, it is important to note that the economic impact of terrorism is small compared to other major forms of violence. This amount is only one per cent of the total global economic impact of violence which reached $13.6 trillion in 2015.

The report further highlights that economic resources devoted to peacekeeping and peacebuilding are sparse as compared to the economic losses caused by conflict and terrorism. Taking violent conflict and terrorism together, peacekeeping and peacebuilding expenditures amount to two per cent of the economic impact of these intertwined forms of violence.

Terrorism in India is characterised by left radical, Islamists and separatist groups. Left radical terrorist groups are by far the most frequent perpetrators and the main cause of terrorism deaths in India. India's northeast region has for the last three decades seen continual ethnopolitical unrest from ethnic secessionist movements.

After the violent attack on the World Trade Centre (WTC) on US soil, there has been an effort to fight the terrorist violence through force. Indian government's approach is on these lines as well. To contain terrorism, we have to understand the causes of such violence. It is true that external forces play a role in such situations but without internal support, terrorism cannot flourish. To fight terrorists, we have to isolate them from the masses. Experience of Punjab has shown that terrorism abated only after they were cut off from the masses. In that process, progressive sections of political parties and civil society played a significant role.

Investment in primary prevention activities may be more cost-effective and have large and long-lasting benefits. While all social classes experience violence, research shows that people with the lowest socioeconomic status are at greatest risk. Therefore, the strategy has to be planned to focus resources on the most vulnerable groups. In most societies, the poor do not get the desired benefits from the welfare schemes by the state. This needs to be corrected to win over the confidence of marginalised sections of society.

Political commitment to tackle violence is vital for public health effort. It is important at various levels right from policymaking to implementation.

Inequalities of any form, economic, education-related, healthcare, job opportunities and social and ethnic varieties create conditions where it is difficult to control violence and creates fertile ground for breeding of terrorists. None of these factors may be sufficient alone to cause conflicts but in combination, they may create conditions in which violence will erupt. Therefore, the focus has to be on social and educational policies, promotion of gender and social equality. Role of media campaigns is very important to strengthen social harmony. Governments have to realise that rhetoric will not yield tangible results. It is important to strengthen measures to close the gap between the rich and poor and to ensure equitable access to goods, services and opportunities.

India has always preached non-violence. It is important to once again work in that direction. Health professionals can play a vital role in this as health is the biggest victim under such circumstances. They can highlight the impact of violence on health to sensitise society. The role of International Physicians for the Prevention of Nuclear War (IPPNW), Doctors without Borders, Indian Doctors for Peace and Development (IDPD) and other organisations involved in aid to the victims of violence like the Khalsa Aid have shown positive outcomes.

Views expressed are strictly personal