Kashmiri physicians in America accuse prestigious medical journal of misdiagnosis

A protest outside Srinagar turned violent on Friday after the police fired tear gas. (The New York Times)

WASHINGTON,D.C. — An editorial by the world’s oldest, and arguably the world’s most prestigious medical journal, The Lancet, raising concern over an impending mental health crisis in Kashmir following the Indian government’s siege of Kashmir, has raised the ire of the Kashmiri American Pandit community, including physicians in its midst.

In an open letter to The Lancet’s Editor-in-Chief, Dr. Richard Horton, by the Overseas Physicians of Kashmiri Origin on Aug. 22 led by Dr. Shakun Munshi Malik, president of the Kashmiri Overseas Association(KOA)—the umbrella organization of the Kashmiri Pandits in the U.S.—while acknowledging that “the overseas physicians of Kashmiri origin, appreciate your efforts in highlighting the healthcare issues of Kashmiris as published in your editorial, ‘Fear and Uncertainty Around Kashmir’s Future,’ published on August 17, 2019,” complained bitterly that, “We are, however, deeply disappointed that your opinion omits many relevant facts, and thus represents an intellectually dishonest analysis of a complex geopolitical issue.” 

The missive stated, “Our community, the Kashmiri Pandits (Kashmiri Hindus), are the original inhabitants of Kashmir. Yet we faced the specter of a cultural extinction in 1990, by Pakistan-trained militants who wanted to extend the Islamic Caliphate into Kashmir. To create terror, mosques using loudspeakers blared ‘convert, leave or die.’ Messages were posted on our doors to leave immediately or face consequences. Yet, the heavily corrupted state government under Article 370 remained silent spectators, unwilling to help.”

“We were left to bear the horrors of terrorism on our own, including being forced to witness the murders and rapes of our own family members. Thousands in our community were brutally killed, with many homes, businesses, and temples destroyed,” the letter said, and added, “More than 350,000 Pandits fled in one of the largest mass exoduses in recent history. Many of these refugees were subsequently forced to live in squalid tent camps, resulting in high rates of infection, malnutrition, hypertension, diabetes, infertility, insomnia, anxiety, depression, and suicide, among other ailments.”

Malik argued that “there have been multiple articles published in peer reviewed journals detailing the full mental and physical consequences of this ethnic cleansing, engineered by terrorists.”

“We acknowledge the feeling of uncertainty arising from the inability to instantly reach our loved ones, as security personnel dismantle terrorist communication networks by temporarily blocking internet and phone lines,” the KOA letter conceded. “However the Lancet has no locus standi to question the initiatives undertaken by a secular, sovereign and democratic nation to solve the Kashmir conundrum, while simultaneously protecting its citizens from the growing threat of radical Islamist ideology.” 

Malik said that “this threat is a direct result of secular, mainstream education being replaced by madrasas (Islamic schools) that openly tout gun violence. A vicious cycle results when Kashmiri youth, lacking education and skills necessary for employment, are living in a state that is already restricted in its investment and job opportunities imposed by Article 370. We thus believe that the abrogation of Article 370 and 35A are the first steps toward a brighter future for all religions and cultures in Kashmir, known as ‘Kashmiriyat.’”

The letter agreed that “Kashmir needs to heal,” but declared, “Let us give it time and space to heal and a chance for peace.”

“Therefore, we request that the Lancet immediately retract the editorial, or publish a viewpoint that includes a more thorough set of facts and analysis on Kashmir, particularly the medical and psychological consequences of the ethnic cleansing experienced by its indigenous inhabitants, the Kashmiri Pandits,” it added.

Malik told India Abroad that the Lancet editorial was “a mischievous one-sided story given huge publicity by a medical journal,” and said the KOA and the Kashmiri Pandit physicians in the U.S. “felt it was important to counter the disinformation in the story by providing facts.”

But the Lancet has stood its ground and refused to retract it editorial that expressed “our profound concerns about the physical and mental health of Kashmiris, which we believe have been given insufficient attention so far,” which apparently was written against the backdrop of the Indian government’s revocation of Article 370 of the Indian constitution providing special status to Kashmir and the deploying of several thousand more Indian troops to the Valley to counter the protests that have ensued.

Earlier, the Indian Medical Association had also protested the Lancet’s editorial, complaining that “The Lancet had committed a breach of propriety in commenting on this political issue.”

But the journal, in arguing that such articles and editorials are not unprecedented, said it had no plans “to take down the editorial” and pointed out that “The Lancet

regularly covers issues where politics and medicine intersect, since health is an important political issue in every society. National and international attention about the situation in Kashmir is high and ongoing.”

The editorial said that the Indian government’s action to revoke the autonomous status of Jammu and Kashmir was “controversial” and questioned Prime Minister Narendra Modi’s pledge that “his decision to revoke autonomy will bring prosperity to Kashmir.”

“But first,” it argued, “the people of Kashmir need healing from the deep wounds of this decades-old conflict, not subjugation to further violence and alienation.”

Citing a Médecins Sans Frontières (MSF) study in two conflict-affected rural districts, the editorial said that “the protracted exposure to violence has led to a formidable mental health crisis,” and that “nearly half of Kashmiris rarely felt safe and of those who had lost a family member to violence, one in five had witnessed the death first hand.”

“Therefore, it is unsurprising that people in the region have increased anxiety, depression, and post-traumatic stress disorder.”

MSF has run counseling centers in the Valley since 2001, and according to Andreas Koutepas, Chief of Operations with Doctors Without Borders India, “The complete communications blackout and severe restrictions on movement have led us to halt our mental health project activities in Kashmir for now. We have had limited contact with our staff, which has prevented us from gathering information about the medical needs of the population on the ground.”

“Years of conflict in Jammu and Kashmir have taken a toll on people’s mental health,” he added.

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