Treating People With Dignity Not As Instruments

I began my book, The Health Gap, with the line: What good does it do to treat people and send them back to the conditions that made them sick. I did not have in mind the current crisis of mass refugees in Europe, but it brings home the question in a starkly tragic way.

Some politicians take the view that if refugees are treated well, it will only encourage others to follow. My response to that is two fold. First, you would have to treat refugees particularly badly to make things worse than the conditions in Syria, for example, from which the refugees fled; quite apart from the hazards of the journey. Ghastly idea

Second, and more fundamentally, medicine can lead by example in the ethical treatment of refugees. Doctors treat individuals who need care regardless of who they are and what made them sick. Each individual has the right to be treated with dignity. It is a core ethical concern for doctors. If someone is lying in the gutter with a broken head, the doctor does not say: I smell alcohol, I won’t treat him. The doctor delivers the best care (s)he can. So should it be with refugees. Treating people badly so as to discourage others from coming means that people have become instruments of political policy. It goes against the core ethical principles of medicine. To repeat, individuals have a right to be treated with dignity not as an instrument of someone else’s policy.

We should extend this ethical approach to the conditions in which refugees are eking out an existence: apply the social determinants of health principle. Treat the sick and be advocates for dealing with the conditions that made them sick. And that means addressing the appalling conditions in which refugees find themselves, as well as doctors speaking up for peace in the areas of conflict.

All this came to mind at the conference on War, Migration and Health, convened by the Turkish Medical Association and the World Medical Association in Istanbul, 25-27 Feb, 2016. The Turkish Medical Association had prepared an excellent report on the Turkish experience. Official figures suggest that there are between 2.5 and 3 million Syrian refugees in Turkey. The real figures are probably higher. Such numbers put enormous strain on a country’s resources – economic, social and political.

In Turkey’s case it comes with the background of the long-standing tension between the government and the Kurds and tensions over degrees of Islamisation. The Turkish Medical Association stands tall. By delivering medical care to all it has earned the opprobrium of government, but they have strong support from the World Medical Association. The declaration from the conference states this clearly.

My frustration at visiting cities and seeing little was eased by being shown something of Istanbul by our hosts. One has the feeling that the bridge over The Bosporus is the link between secular, modern, Europeanised Istanbul and traditional, more Muslim, conservative Asia. It is a tension that is playing out on the larger political stage. The secular republic of Ataturk is being challenged by the present government.

Sir Michael Marmot

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