The Question of Psychological Care for War Veterans

Health Briefing Paper

The Question of psychological care for war veterans

Since September 11th, 2001, the United States of America has deployed more than 2,000,000 of its own troops to Afghanistan and Iraq. Numbers in these areas, two of the most infamous of modern combat wars, are steadily declining (for example, now only 6,600 British troops are left in Afghanistan). Delegates in the Health Committee his year will be challenged to think about what exactly goes on when these soldiers leave their tours of duty, and how they cope psychologically with a re-adjustment to civilian life.

Debate will surely (and rightly) revolve around Post-Traumatic Stress Disorder (or PTSD), an illness which, as of January 2013 103,792 returning war veterans have been diagnosed with. PTSD has many symptoms but chief among them are insomnia, bi-polar disorder and nightmares. PTSD put significant strain on the American health system particularly for those returning from the Vietnam War, where so many had been lost and violence became so normal that ex-soldiers would actually become violent in society, responsible for a spike in domestic and familial abuse statistics.

One of the most high profile cases of PTSD was with Romeo Dallaire, a Canadian who acted as the UN general during the Rwandan Genocide, and was left powerless to intervene as between half a million and a million people were slaughtered. He returned with serious mental scarring and now works as an advocate for those with PTSD. He has pointed out that he believes that the United Nations if failing war veterans with the disease. He cites the fact that his disease was brought on by an impossible mission featuring intense and violent scenes.

Delegates should also be aware of the existence of the less well-known disease of Traumatic Brain Injury (TBI) which although it has similar symptoms can often be more serious and difficult to treat than PTSD.

The main problems regarding PTSD currently include:

Inexperienced psychological healthcare systems
Re-integration of ex-servicemen/women
Cost of rigorous psychological care
Unwillingness to admit the existence of a problem among governments and veterans

Delegates should note that whilst countries such as the USA, with the institution of the VHA, are doing a lot to try and combat this problem, many do still go untreated.

Delegates should perhaps compare where the psychological care of the developing world is in relation to its more economically developed counterparts. A report of Brazil’s mental hospitals in 2009 showed that many felt under-served by the system. When the question was directed at soldiers , the majority felt that a specialised system needed to be out in for veterans in particular, and perhaps that each veteran (or group thereof) needed to be assigned a dedicated specialist whose role would extend outside of hospital visits.

When writing resolutions and drafting policies, delegates should consider:

The scale and gravity of the situation as it stands
The availability of psychological care to returning soldiers
The possibility of government-subsidised costs of treatment
The role of the United Nations in combating this issue
Any possible links between UN intervention and the condoning of military action
The reasons for the amount and type of action already taken
The involvement of charities and NGOs (eg Help for Heroes).

Further Reading:

The Question of the role of the international community in implementing health care in LEDCs

Health care and its cost is a massive topic effecting all areas of the world today. The debate still rages on even in MEDCs over weather or not a government should be supplying free health care. We however wish for you to focus on health care in LEDCs and to bear in mind as you construct resolutions, the main factors that effect health care provision:

Geographic accessibility—the physical distance or travel time from service delivery point to the user
Availability—having the right type of care available to those who need it, such as hours of operation and waiting times that meet demands of those who would use care, as well as having the appropriate type of service providers and materials
Financial accessibility—the relationship between the price of services (in part affected by their costs) and the willingness and ability of users to pay for those services, as well as be protected from the economic consequences of health costs
Acceptability—the match between how responsive health service providers are to the social and cultural expectations of individual users and communities

A huge area to consider in your resolutions is the health care in Africa. Africa is still disproportionately affected by infectious diseases that put a significant burden on struggling economies, and life expectancy in Africa is 15 years less than the global average. Malaria and other contagious, preventable diseases like HIV, tuberculosis, pneumonia and even leprosy still stand in the way of growth. In fact, 90% of global malaria deaths occur in Africa.

South America is also largely made up of LEDCs, however 6 countries from South America have been highlighted for their healthcare success (some listed below)! From explicitly defined benefits packages to reforms of public health services provisions, there is not one single model for attaining universal health coverage. Indeed, in Latin America approaches varied from country to country, but the studies note that ensuring quality coverage reaches the region’s poorest and excluded populations has been a shared focus.

Argentina: Plan Nacer has been credited with helping to introduce landmark changes within the Argentinian health system. More than one million previously uninsured pregnant women and children now have basic health insurance and secure access to services, according to the study.

“Plan Nacer in Argentina aims to close the gap [between the insured and uninsured population] and it does it in an innovative and highly effective manner,” explains Andrew Sunil Rajkumar, Senior Economist for Health at the World Bank.

Chile: Through its Social Health Insurance program, Chile offers nearly universal health coverage to its 17 million inhabitants. Since 2005, all Chileans have had access to a basic package guaranteeing treatments for up to 80 health problems, setting upper limits to waiting times and out-of-pocket payment for treatments.

Colombia: In 1991, Colombia established the right to healthcare within its constitution. More than 20 years later, access to health care services in the country have improved considerably thanks to a subsidized national health insurance system. By making the central government responsible for providing healthcare services, the study notes that this subsidized regime has been a “pillar of Colombia’s effort to achieve the right to health care.”

Guatemala:Access to health care is enshrined within the constitution in Guatemala, however, as the case study notes, this has been challenging to guarantee. Nonetheless, formal agreements established in 1997 with NGOs working in the country now enable Guatemala to provide basic health and nutrition services to 4.3 million people, and serve the needs of 54% of the rural population, focusing particularly on those of women and children.

So delegates, what we wish to see in your resolutions are solutions, and realistic ones! Take examples from the 6 countries above, and see if they may be used in other situations by other governments. Would it be useful to set up a UN body? Would they have trained employees in selected countries and if so how would those countries be selected? Is education a factor? If you’re going to educate the masses to make them more aware and able to prevent the spreading of disease, then good, but how? These are all the sorts of questions you’re going to be facing over the weekend, and believe us when we say; it’s a lot easier to get those answers now than make them up then.

Further reading:

The Question of Euthanasia

Euthanasia is the termination of a terminallysick person's life in order to relieve them of their suffering. A person who undergoes euthanasia usually has an incurable condition. Understandably it is an issue on which there is significant difference of opinion and to which many people have a significant emotional attachment.

As social attitudes and laws regarding euthanasia begin to change across the globe, delegates in the Health committee should consider how the UN can work to address the views and concerns of the many parties involved.

Terminally ill people can have their quality of life severely damaged by physical conditions such as;

Incontinence,
Nausea and vomiting,
Breathlessness,
Paralysis

As well as the physical reasons there are psychological factors that lead to people considering euthanasia, such as;

Depression,
Fearing loss of control or dignity,
Feeling a burden,
Dislike of being dependent.

Proponents of euthanasia cite the suffering caused by these factors as one of the most significant reasons why it should be permitted. There are also arguments based around the human right to die. Those against euthanasia often point to concerns about potential for abuse or misuse of the system. In areas of the world where faith is a significant factor in terms of both governments and individuals, religious reasons are important reasons for opposition and delegates should consider this carefully.

There is an important distinction between active euthanasia which involves a deliberate action being taken to bring about death, and passive euthanasia where an action which is required to keep a person alive is not taken or is stopped.

Currently the only nations which permit active euthanasia are Belgium, The Netherlands and Luxembourg.

Many nations have explicit legislation permitting passive euthanasia, and in those which do not patients almost always retain the right to refuse treatment. For this reason it is likely that a large portion of debate will focus and the more contentious issue of active euthanasia.

When writing resolutions and drafting policies, delegates should consider;

The Religious and cultural factors influencing global views on euthanasia
The significant role of NGOs in lobbying both for and against changes to euthanasia legislation.
The often vague and ambiguous nature of euthanasia legislation in many nations cross the world
The issue of abuse or misuse of provisions for euthanasia in areas where they exist
The issue of health tourism in relation to euthanasia.