Biomedical subjects
Richard Garfield
Publications and source records attributed to Richard Garfield.
Commentary: when should we monitor mortality in humanitarian crises?
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Tsunami response: a year later. Postdisaster nursing in Aceh, Indonesia.
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Nightingale in Iraq.
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The public health context of violence in Colombia.
OBJECTIVE: Among the countries of the Americas, Colombia has the highest level of deaths due to homicides and armed conflict. The objective of this research was to combine and contrast information from various sources on deaths due to violence in Colombia in order to identify major trends in violence in the country and to compare those trends with those in other nations of the Americas. METHODS: We drew together information from a wide array of sources, including the Government of Colombia, Colombian forensic institutions, nongovernmental organizations, and international research centers. We considered the impact of the violence on mortality as well as in such areas as nonfatal injuries, displacement of persons, and kidnappings. RESULTS: While there have been many deaths in Colombia directly related to military conflict, there have been many more deaths and injuries as an indirect result of war. The highest levels of deaths directly related to violence occurred during the 1990-1995 period. Although deaths due directly to armed conflict declined in the late 1990s, the related events of kidnappings and displacement did not. CONCLUSIONS: Efforts to reduce the violence-related suffering in Colombia must consider both direct and indirect causes of mortality as well as nonfatal outcomes such as kidnappings and displacement.
Nursing in Iraq: how you can help.
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Securing Iraq's health.
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Challenges to health service development in Iraq.
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Lancet special report on Iraq.
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Commentary: The evolving role of nurses in terrorism and war.
The health care needs of people in both developed and underdeveloped countries experiencing violent conflict are strikingly similar. Nurses are key for infectious disease detection and control, social support, and rehabilitation during terrorism and war in many countries. Nurses already provide much of the care in these situations because they are present on a day-to-day basis, have key clinical and organizational skills, and tend to enjoy a high level of popular trust. There is a great potential for the profession to do more with systems training, skill development, and participation in policy and research related to reducing the effects of conflict. This is applicable for both terrorist events in developed countries and for humanitarian crises in developing countries. However, nurses have frequently been invisible, serving without discipline-specific orientation. This is partly the result of unresolved ethical and political issues among nursing leaders regarding the image and role of nursing, humanist values, and relations between the profession and the government. Major nursing organizations frequently support national pro-war policies, whereas nursing leaders more often stress support for an international humanitarian orientation. These issues have been with organized nursing since its origins with Florence Nightingale. With better organization, autonomy, and recognition of nursing's unique contributions, nursing can achieve much more in situations of conflict to prevent harm and facilitate recovery among individuals, families, and their communities. Elements of an agenda for nursing research and development are detailed.
Health care in Iraq.
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Health care in Cuba and the manipulation of humanitarian imperatives.
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Mortality before and after the 2003 invasion of Iraq: cluster sample survey.
BACKGROUND: In March, 2003, military forces, mainly from the USA and the UK, invaded Iraq. We did a survey to compare mortality during the period of 14.6 months before the invasion with the 17.8 months after it. METHODS: A cluster sample survey was undertaken throughout Iraq during September, 2004. 33 clusters of 30 households each were interviewed about household composition, births, and deaths since January, 2002. In those households reporting deaths, the date, cause, and circumstances of violent deaths were recorded. We assessed the relative risk of death associated with the 2003 invasion and occupation by comparing mortality in the 17.8 months after the invasion with the 14.6-month period preceding it. FINDINGS: The risk of death was estimated to be 2.5-fold (95% CI 1.6-4.2) higher after the invasion when compared with the preinvasion period. Two-thirds of all violent deaths were reported in one cluster in the city of Falluja. If we exclude the Falluja data, the risk of death is 1.5-fold (1.1-2.3) higher after the invasion. We estimate that 98000 more deaths than expected (8000-194000) happened after the invasion outside of Falluja and far more if the outlier Falluja cluster is included. The major causes of death before the invasion were myocardial infarction, cerebrovascular accidents, and other chronic disorders whereas after the invasion violence was the primary cause of death. Violent deaths were widespread, reported in 15 of 33 clusters, and were mainly attributed to coalition forces. Most individuals reportedly killed by coalition forces were women and children. The risk of death from violence in the period after the invasion was 58 times higher (95% CI 8.1-419) than in the period before the war. INTERPRETATION: Making conservative assumptions, we think that about 100000 excess deaths, or more have happened since the 2003 invasion of Iraq. Violence accounted for most of the excess deaths and air strikes from coalition forces accounted for most violent deaths. We have shown that collection of public-health information is possible even during periods of extreme violence. Our results need further verification and should lead to changes to reduce non-combatant deaths from air strikes.
Session 1.5: health policy and coordination: a critical review of experiences.
This is a summary of the presentations and discussion of Session 1.5 on Health Policy and Coordination: A Critical Review of Experiences during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to health policy and coordination as pertain to the responses to the damage created by the Tsunami. Key questions were answered in this session, and recommendations were made.