Thursday, June 23, 2016

Iran behind ongoing slaughter of Sunni Muslims in Fallujah-The City of Mosques in Iraq

by Latheef Farook : 20 June 2016

Implementing Iranian agenda, American installed Shiite minority government of Iraqi Prime Minister Haidar Al Abadi, began shelling the Sunni majority Fallujah known as the city of minarets, 69 kilometres from Baghdad.

It is common knowledge that ever since the US led invasion of Iraq when a Shiite minority government was installed in Baghdad, to pit the Shiites and Sunnis against each other, Iran has the final word in Baghdad.

Today’s Shiite war on Sunnis was undertaken since 22 May 2016 under the guise of fighting IS forces -created by US, trained by Israel and funded by Saudi. The current carnage was backed by aerial support from the U.S led war coalition and paramilitary forces made up of Shiite militias-Iraqi government troops.

Hundreds of thousands of people including children have been trapped with their families inside the city and face a dire humanitarian situation. In an opinion piece under the headline-Fallujah: Iranian revenge amid American silence” columnist Abdi-Al-Wahhab Badr-Khan had this to state in the AlKhaleejOnline on 30 May 2016.

“Three leaders of the Iraqi Popular Mobilisation Forces appeared on television and issued threats against Fallujah, rather than Daesh. The threats, which do not distinguish between Daesh and the people of Fallujah, are reminiscent of the events that began in late 2003.”

According to another report attacks on “Fallujah are under the direct command of Iranian Gen. Qassem Soleimani, head of Iranian forces in Iraq and Syria, who is operating from a field command center”. The US air force is helping Soleimani’s attempt to capture Fallujah. The American decision to support Soleimani’s operation shows the central role played by Iran in the wars carried out by the US and Russia in the Middle East.

This was the second major attack on Fallujah. The first barbarity was during the Holy month of Ramadhan in November 2003 when war criminal George Bush bombed and incinerated Fallujah where he roasted people with poisonous gas and chemical weapons.

The savagery unleashed was unprecedented. American forces dropped cluster bombs and used phosphorous weapons that caused severe burns in the military’s most intense urban fighting since the days of Vietnam. Within ten days Fallujah has been laid waste, a hell on earth of shattered bodies and destroyed buildings while the city entered history as the place where US imperialism carried out a crime of immense proportions. The head of Turkey’s Parliamentary Human Rights Committee said this genocide surpassed those of Pharaoh, Hitler and Mussolini.

Families fleeing Fallujah were blocked by American soldiers who forced them back to their homes and slaughtered. Those who managed to survive were deprived of electricity, water, food and medical aid, while the injured were left to die. American soldiers on house to house patrols, kicked opened doors, and grabbed men in the presence of petrified, screaming and starving women and children trapped inside their houses. Most of the abducted were never seen again.

An eyewitness account stated that US forces used artillery barrages, air strikes with 2,000-pound bombs and air-to-surface missiles together with volleys of tank fire. Homes, apartment buildings and nearly half of the city’s 120 mosques have been destroyed or severely damaged. Human corpses, bloated and rotting, littering the streets where they fell were gnawed at by starving dogs while parents were forced to watch their wounded children die and then bury their bodies in their gardens.

Later reports emerged of the US military using banned napalm, poison gas and other outlawed weapons to kill innocent civilians. Hundreds of “melted” bodies proved that the napalm gas had been used. Residents said “Americans used everything – tanks, artillery, infantry, poisonous gas and other non-conventional weapons to raze Fallujah to the ground.

A year later, in November 2005, there emerged many reports including a documentary entitled “Fallujah: the Hidden Massacre”, together with hideous photographs, videos and interviews providing clear evidence and vivid descriptions of how the American troops used chemical weapons, poisonous gas and incendiary bombs, a new and improved form of napalm, in the attack on Fallujah, in breach of the UN Convention.

A biologist in Fallujah, Mohammad Tareq, interviewed for the documentary, said: “A rain of fire fell on the city, the people struck by this multi-coloured substance started to burn, we found people dead with strange wounds, the bodies burned but the clothes intact”.

Citing a doctor who survived the attack, Amnesty International stated that twenty Iraqi medical employees and scores of civilians were killed when a US missile hit a medical clinic while a nine-year-old bled to death after he was hit in his stomach. His parents buried him in their house garden because they were not able to take him to the hospital with the fear of the killings. Within days, macabre accounts of killing of civilians began to emerge, and doctors reported that patients were forced out by the Americans who even took away a doctor while operating on a patient who was left to die.

Recalling the many US atrocities, one Iraqi who escaped from the carnage said he watched US soldiers roll over wounded people in the street with tanks so many times, and they often used tanks to pull bodies to the soccer stadium to be buried. There were dead bodies on the ground and nobody could bury them because of American snipers. They dropped some of the bodies into the Euphrates River. People who attempted to swim across the Euphrates to escape the siege were shot by American soldiers from the shore and these included civilians, including an elderly woman, who were holding white flags or white clothes over their heads to indicate they were not fighters. US troops machine-gunned an entire family of five to death when they tried to escape the fighting by swimming across the Euphrates River and they even killed the wounded. In another incident, resembling the Zionist crimes in Palestine, American troops asked people to come to a mosque if they wanted to leave Fallujah, and all those went there carrying white flags were killed.”

Refugees, moved to the comparative safety of camps, said they lived like dogs and the kids didn’t have food or clothes. Those who managed to reach refugee camps told harrowing stories of being caught in the crossfire were harassed and threatened by US troops and their Iraqi stooges.

Summing up George Bush’s savagery, a Western reporter observed as follows: “some districts reeked from the sickening odour of rotting flesh, a stench too powerful to be swept away by a brisk breeze coming in from the sandy plain surrounding the city forty miles west of Baghdad. A week of ground combat by US and Iraqi surrogates, supported by tanks and attack helicopters, added to the destruction in a city where the homes and businesses for about 300,000 people are packed into an area, a little less than two miles wide and a little more than two miles long...cats and dogs scamper along streets littered with bricks, broken glass, toppled light poles, downed power lines, twisted traffic barriers and spent cartridges. Walls are full of bullet holes. US troops have blown holes in walls and knocked down doors to search homes and shops. Dead Iraqis still lay out in the open’.

There has been nothing like the attack on Fallujah since the Nazi invasion and occupation of much of the European continent—the shelling and bombing of Warsaw in September 1939 and the terror bombing of Rotterdam in May 1940. All the talk about precision bombing in Iraq is dust thrown in the public’s eyes.

One report asked ‘what have the people of Fallujah and the rest of Iraq done to deserve such homicidal cruelty? What could conceivably justify the US military killing Iraqis for the “crime” of living in their own country?’ It’s difficult to believe that in this day and age, when people are e-mailing and communicating at the speed of light, a whole city is being destroyed and genocide is being committed - and the whole world is aware and silent. The Fallujah offensive virtually disappeared from the news cycle within weeks. But history - if written by Iraqis - may well enshrine it as the new Guernica.

Here in Sri Lanka too, by and large, people are ignorant of these atrocities. Like in the rest of the world herein the island too the media is not interested in highlighting these war crimes and educate the people in the way they always highlight Hitler’s crime.

Why? Perhaps media is ignorant, indifferent to Muslim sufferings or sold its souls to war criminals for petty benefits? Ends

Police shoot dead masked man who took hostages in German cinema

German special police leave their car after a masked man with a gun and ammunition belt opened fire in a cinema complex in the small western town of Viernheim, near Frankfurt, Germany, June 23, 2016.REUTERS/RALF BANSER--opened fire in the small western town of Viernheim, near Frankfurt, Germany, June 23, 2016.

fire in a cinema complex in the small western town of Viernheim, near Frankfurt, Germany, June 23, 2016.--Ambulance cars are waiting after a masked man with a gun and ammunition belt opened fire in a cinema complex in the small western town of Viernheim, near Frankfurt, Germany, June 23, 2016.REUTERS/RALF BANSER

BY RALF BANSER-Thu Jun 23, 2016

A masked man took hostages at a cinema in western Germany on Thursday before police stormed the complex and shot him dead, police said.

No other people were injured, a police spokesman said.

The attacker, who carried a rifle or "long gun", acted alone and appeared to have been a "disturbed man", the interior minister of Hesse state, Peter Beuth, told the regional parliament.

Police had not identified the man or established his motive, spokesman Bernd Hochstaedter said, adding that nothing immediately pointed to him having a militant background.

German television showed pictures of heavily-armed police, wearing helmets and body armour, storming the Kinopolis complex in Viernheim, south of Frankfurt, and a couple fleeing the building.

Cinema employee Guri Blakaj told Reuters the gunman, who appeared to be aged between 18 and 25 and was about 1.7 metres tall, entered the cinema at around 3 p.m. and told workers to get into an office.

He then went into a cinema theatre. Blakaj, who said there were about six workers and 30 cinemagoers in the building, then heard shots fired.

Police special forces stormed the building and shot him.

There was still a heavy police presence at the scene into the late afternoon, and a helicopter circled overhead.

(Additional reporting by Madeline Chambers, Michael Nienaber and Sabine Siebold; Editing by Andrew Roche)

Brexit: What Is It About?

The EU serves Washington and the One Percent. It serves no one else. The EU is a murderer of sovereignty and peoples. The intent is for the British, French, Germans, Italians, Greeks, Spanish, and all the rest to disappear as peoples. Brexit is the last chance to defeat this hidden agenda, and apparently the British will vote tomorrow without having a clue as to what is at stake and what the vote is about.

by Paul Craig Roberts

( June 22, 2016, Washington DC, Sri Lanka Guardian) If you read the presstitute media, Brexit—the referendum tomorrow on the UK’s exit from the EU— is about racism. According to the story line, angry rightwing racists of violent inclinations want to leave the EU to avoid having to accept more dark-skinned immigrants into England.

Despite the constant propaganda against exit, polls indicated that more favored leaving the EU than remaining until a female member of Parliament, Jo Cox, was killed by a man that a witness said shouted “Brexit.” Cox was an opponent of leaving the EU.

The UK government and presstitute media used Cox’s murder to drive home the propaganda that violent racists were behind Brexit. However, other witnesses gave a different report. The Guardian, which led with the propaganda line, did report later in its account that “Other witnesses said the attack was launched after the MP became involved in an altercation involving two men near where she held her weekly surgery.” Of course, we will never know, because Cox’s murder is too valuable of a weapon against Brexit.

There is no doubt that many in the UK are disturbed at the transformation of their country. One doesn’t have to be a racist to feel that one’s country is being stolen from them by people of alien cultures. The British have a long history of fighting off invaders, and many believe they are experiencing an invasion, although not an armed one. An armed one, of course, would not have the government’s and media’s support.

When British people hear pundits pronounce that immigrants contribute more to the UK than they absorb in social payments, what they hear is inconsistent with their experience. Moreover, many British are tired of having to avoid entire sections of their cities, including London, because of safety concerns.

It is a propaganda choice to call these concerns racism rather than cultural defense, and the UK political establishment has made that propaganda choice. Little wonder so many British citizens no longer believe that the British Establishment represents Britain.

But let’s give the propagandists the benefit of the doubt and for sake of argument assume that Brexit is about racism. What is the opposition to Brexit really about? Most certainly it is not about helping the refugees from Washington’s wars that the UK government has enabled. If the British establishment cared so much for the Muslims seeking refuge from America’s invasions, bombs, and drones, the British establishment would not have supported Washington’s attacks on these people.

Opposition to Brexit is based on two powerful interests of Washington.

One is the interests of the New York banks and Wall Street to eliminate the UK as a financial center competitor. This blatant fact has escaped the notice of the City and the Bank of England.

The British have forgotten that they only have one foot in the EU, because the UK was permitted to keep its own currency. The UK does not use the euro and, thus, retains the power to finance the British government. Greece, Portugal, Spain, Italy, France, Germany, etc., do not have this capability. They are dependent on private banks for financing.

In order to trick the UK into joining the EU, the British were given special privileges. However, these privileges cannot last forever. The EU process is one of political integration. As I reported years ago, Jean-Claude Trichet, at that time the president of the European Central Bank, said that to complete the political integration of Europe, the fiscal policies of member states would be centralized. It is impossible to centralize fiscal policies if the UK is an independent financial center with its own central bank and currency.

Wall Street understands that the defeat of Brexit means a shortened lifespan for London as a financial center, as it is impossible to be a financial center unless a country has its own currency and central bank. As it is impossible for the UK to be a member of the EU and not operate under the European Central Bank, once the Brexit referendum is defeated, the process of gradually forcing the UK into the euro will begin.

The other powerful interest is the interest of Washington to prevent one country’s exit from leading to the exit of other countries. As CIA documents found in the US National Archives make clear, the EU was a CIA initiative, the purpose of which is to make it easy for Washington to exercise political control over Europe. It is much easier for Washington to control the EU than 28 separate countries. Moreover, if the EU unravels, so likely would NATO, which is the necessary cover for Washington’s aggression.

Dr. Paul Craig Roberts was Assistant Secretary of the Treasury for Economic Policy and associate editor of the Wall Street Journal. He was columnist for Business Week, Scripps Howard News Service, and Creators Syndicate. He has had many university appointments. His internet columns have attracted a worldwide following. Roberts’ latest books are The Failure of Laissez Faire Capitalism and Economic Dissolution of the West, How America Was Lost, and The Neoconservative Threat to World Order.

The Problem With Kissinger’s World Order

Is there any hope for global cooperation in this new world of interstate and tribal conflict?

BY JAMES TRAUB-MAY 5, 2015

I spent the last week immersed in geopolitical conflict, but not in eastern Ukraine or the South China Sea. No, I was at NYU Abu Dhabi, one of the least conflictual places on Earth, at a Brookings
Institution conference titled “International Peace and Cooperation in an Age of Global Competition.” The 40 senior policymakers and thinkers from the United States, Europe, and emerging countries largely agreed that we have entered a new world — one which looks very much like the old world — characterized by growing conflict between states.

A few of us bridled at the premise. Someone — I think it was me — said that the return of state conflict was a gift to the foreign policy boys’ club, which in recent years had been bemused by the rise of non-state actors, popular uprisings, and “soft” issues like climate change. Suddenly the realist world of international relations theory has come back from the dead. (See Walter Russell Mead’s 2014 piece in Foreign Affairs, “The Return of Geopolitics.”) The world has turned hard.

The problem with my gibe is that while it is true that non-state forces, and above all the Islamic State and al Qaeda, are responsible for many of the worst conflicts in the world, it is also true that major states, including Russia, China, Iran, and Saudi Arabia (and the United States), are prepared to use coercion and force — often in those same conflicts — in a way that has not been true for generations. We do live in an increasingly geopolitical world. So I began to examine the sources of my resistance.

I am sorry to say this, but Henry Kissinger has me nailed.Kissinger has long lamented Americans’ unwillingness to accept that global affairs consists essentially of a remorseless struggle for advantage among states. In his recent book,World Order (see my quite laudatory review in the Wall Street Journal here), Kissinger writes that American leaders from the time of Woodrow Wilson have envisioned foreign policy as a teleological struggle for justice rather than a “permanent endeavor for contingent aims.” American foreign policy has thus remained “unmoored from a sense of history or geopolitics.”

That is one part of the story; the other part is recent events. The suppression of state competition in the aftermath of the Cold War, the sudden appearance of dangerous non-state actors, and the rise of a new set of global issues gave those who instinctively recoiled from the zero-sum formulations of power politics a reason to feel that the realist model had become archaic. Indeed, it was George W. Bush who made the decisive break with state-centric thinking. In his 2002 National Security Strategy, Bush declared that America was no longer chiefly threatened by powerful states but by “shadowy networks of individuals.” Foreign policy required changing the insides of states, rather than state behavior.

Of course, that didn’t work out very well. Barack Obama came to office promising to call off that campaign — but not in the name of a restored realism. Obama believed that the salient issues were not interstate but global. Those collective goods required an unprecedented degree of cooperation. What was most appealing about Obama — at least, I thought so at the time — was his belief that these global goods constituted a new form of national self-interest, and might be argued for as such. It was globalism, not terrorism that had superseded the old order. “The pursuit of power,” Obama declared, “is no longer a zero-sum game.”

Alas, it must be admitted that he pronounced this fine sentiment in Russia, a place where the zero-sum game often qualifies as a best-case scenario. As I pointed out in an article earlier this year, Obama soon learned that other states — at least outside of that Kantian garden known as the European Union — did not want to be summoned to their better angels. Obama was right about the supreme importance of the global issues, but he was wrong about the pursuit of power. What’s more, he had offered this transaction at precisely the moment when the states whose cooperation he needed, above all China and Russia, were, for very different reasons, adopting an increasingly bruising path of confrontation. Obama was slow to accept this; so, I now see, was I.

Yet the world we now live in is scarcely a Kissingerian one. State relations have become more conflictual than they were a decade ago; but states, collectively, are much weaker than they were, far less able to control the forces of popular discontent, cultural fragmentation, resource scarcity, environmental degradation. And the United States, for all its preeminence, no longer has either the will or the capacity to reassure allies or scare off adversaries as it once could. “World order” looks increasingly like a chimera. A good deal of the aggressive state meddling, above all in the Middle East, is an attempt to control the chaos prompted by these fissiparous forces.

Look at Libya. The storm that rages over Libya was unleashed not by aggressive neighbors but by the collapse of a hated authoritarian leader who had so hollowed out the state that nothing save tribal and local identity could fill the vacuum. Sub-state and sub-regional actors are now tearing the country to bits. But the two main Libyan factions also have external patrons — Egypt and the United Arab Emirates, and Turkey and Qatar. Or look at Yemen, where Saudi Arabia seems bent on carrying out a proxy war against Iran. Conflict among Sunni states, or between Sunnis and Shiites, keeps the pot boiling in the region’s failed states, and makes efforts at mediation all but futile.

In short, recognizing that we live in a world of rising geopolitical conflict does not mean scanting the forces that transcend states or flourish within them — including the demand of ordinary people for a better life than their government now affords them. Statecraft now means confronting, or at least recognizing, both problems at once. One of the global issues Obama identified from the outset of his tenure was the problem of failed and fragile states. That problem only seems more urgent today. There will be no long-term answer to the conflicts in the Arab world until these states achieve at least a minimal threshold of legitimacy. But neither will there be an answer without the kind of muscular diplomacy that persuades neighbors to stop fishing in troubled waters.

The Brookings conference was off the record, but I don’t think I’m violating any confidences in saying that speakers were much more convincing on “Global Competition” than they were on “International Peace and Cooperation.” The mood was, in fact, not far from despair. Virtually everyone, Western and non-Western, craved more “American leadership,” but there was nothing like a consensus about what this meant. Should Washington be drawing a line in the South China Sea, supplying weapons to Kiev, or egging on the Saudis and the Emiratis as they shadow-box with Iran? Or does leadership require “strategic patience,” an Obamian phrase that speakers invoked both admiringly and pejoratively? Should the imperative of confronting revisionist states trump the need for cooperation on global goods? As Steven Walt recently asked, are we prepared to sacrifice Chinese cooperation on climate change in order to stare them down over the Spratly Islands?

We know what answer the Republican hopefuls for 2016 will give. Geopolitical conflict may not be a gift to foreign policy professionals, but it’s a treasure chest for the GOP. We’ll be hearing for the next year and a half about how Russia, China, and Iran left tire treads on Barack Obama. We’ll be hearing from Dr. Kissinger about world order. One thing I will say for Hillary Clinton, a hard person who has long preached the merits of the soft issues, is that she will be better positioned to refute these simple-minded arguments than anyone else out there.

Michael Loccisano/Getty Images

More than 1,200 die of starvation and illness at Nigeria refugee camp

Médecins Sans Frontières finds ‘catastrophic humanitarian emergency’ at Bama camp for people fleeing Boko Haram

A doctor attending to a child at a refugee camp in Yola, Nigeria, last year. MSF found 24,000 people, including 15,000 children, in a camp in Bama last month. Photograph: Sunday Alamba/AP

Reuters in Lagos-Thursday 23 June 2016

More than 1,200 people have died of starvation and illness at an aid camp in north-east Nigeria that houses people fleeing the Islamist militant group Boko Haram, according to the medical charity Médecins Sans Frontières.

MSF said on Thursday that its team found 24,000 people, including 15,000 children, sheltering in the camp located on a hospital compound during a visit to Bama last month – its first trip there since the city was wrested from Boko Haram’s control in March 2015.

Bama was part of an area held by Boko Haram for more than six months before the group was pushed out by the army.

MSF said a “catastrophic humanitarian emergency” was unfolding at the camp. It said around a fifth of the 800 children who underwent medical screening were acutely malnourished and almost 500 children had died.

“We have been told that people including children there have starved to death,” said Ghada Hatim, MSF’s head of mission in Nigeria. “We were told that on certain days more than 30 people have died due to hunger and illness.”

During its assessment, the MSF team counted 1,233 graves near the camp that had been dug in the past year. It said 480 of the graves belonged to children.

More than 15,000 people have been killed and 2 million displaced in Nigeria and neighbouring Chad, Niger and Cameroon during Boko Haram’s seven-year insurgency, in which the group has tried to create a state adhering to sharia law.

Nigeria’s army, aided by troops from neighbouring countries, has recaptured most of the territory that was lost to the group. But the jihadi group, which last year pledged loyalty to Islamic State, still regularly stages suicide bombings.

Chinese state media say 51 killed by powerful tornado

The remains of a steel tower are photographed in Funing County, in east China’s Jiangsu Province, on Thursday, June 23, 2016, after a tornado hit the area. A powerful tornado on Thursday killed a number of people and destroyed a large numbers of buildings in the eastern Chinese province of Jiangsu, state media reported. (Xinhua via AP) NO SALES ( /Associated Press)

By Christopher Bodeen | AP June 23 at 4:19 PM

BEIJING — A tornado and hailstorm struck the outskirts of an eastern Chinese city on Thursday, killing at least 78 people and destroying buildings, smashing trees and flipping vehicles on their roofs.

The tornado hit a densely populated area of farms and factories near the city of Yancheng in Jiangsu province, about 800 kilometers (500 miles) south of Beijing.

Nearly 500 people were injured, 200 of them critically, the official Xinhua News Agency reported. Roads were blocked with trees, downed power lines and other debris. Heavy rain and the possibility of further hailstorms and more tornadoes complicated rescue efforts, state broadcaster CCTV reported.

The disaster has been declared a national-level emergency, and on a trip to Uzbekistan, Chinese President Xi Jinping ordered central government bodies to provide all necessary assistance.

Tents and other emergency supplies were already being sent from Beijing, CCTV said.

The network showed people carrying the injured to hospitals, cars and trucks lying upside down, street light poles snapped in half, and steel electricity pylons crumpled and lying on their side. Power and telephone communications were knocked out over a broad area.

“I heard the gales and ran upstairs to shut the windows,” Xinhua quoted Xie Litian, 62, as saying. “I had hardly reached the top of the stairs when I heard a boom and saw the entire wall with the windows on it torn away.”

The roof then collapsed as he raced downstairs, Xie said. After sheltering in a corner for 20 minutes, he emerged to find the neighborhood transformed into a wasteland. “It was like the end of the world,” he said.

Jiangsu is a coastal province north of Shanghai. Yancheng is an ancient city with more than 8 million people.

The Jiangsu provincial fire and rescue service provided no word on casualties. It said on its microblog that the storm was accompanied by hail. Crews were dispatched to evacuate workers and secure chemicals and other potentially dangerous items at a sprawling solar panel factory in the Yancheng suburb of Funing, it said. No chemical leaks been reported, CCTV said.

Photos showed a wrecked three-story school with large trees strewn on its playing field. Its windows had been blown out and its roof and upper floor torn off, along with those of numerous other buildings.

Bodies were shown lying in the open or buried in rubble. At least one hog farm was hit, its livestock covered in bricks and roofing material.

The reports said the tornado struck at about 2:30 p.m. and hit Funing and Sheyang counties on the city’s outskirts the hardest, with winds of up to 125 kph (78 mph).

Tornados occasionally strike southern China during the summer, but rarely with the scale of death and damage caused by the one on Thursday.

This year, southern and eastern China have experienced weeks of torrential rain and storms that have caused widespread flooding and dozens of casualties.

The southern part of the country is hit every year during the May-July monsoon season, but this rainy season has been particularly wet. Water levels in some major rivers have exceeded those of 1998, when China was hit by disastrous floods that affected 180 million people, according to state media reports.

Psychological Illness in Disguise

Western medicine has been slow in shifting its focus away from the biological focus – the medical model remaining predominantly a biological model. This situation has been reinforced by specialisation in medicine and parallel advances in technology, the primary concern of the ‘organ specialist’ being ‘to exclude’ organic pathology.

by Dr. Siri Galhenage

( June 23, 2016, Colombo, Sri Lanka Guardian) Patients vary in the way they perceive and evaluate their ill-health, seek medical help and present their ailments to the doctor – a process known as ‘illness behavior’. Doctors, in turn, differ in the way they evaluate the health status of their patient, arrive at a diagnostic formulation, [using laboratory and other special investigations, if necessary], discuss their findings with the patient and adopt a treatment plan – the ‘treatment behaviour’ of the doctor. During the doctor-patient interaction symptoms relating to the body and the mind may be addressed to a varying degree.

The interrelatedness of the body and the mind is well demonstrated in ill-health, as symptoms relating to both the body and the mind may be present in psychological as well as physical illness. However, clinical surveys suggest that a significant proportion of consultations in both outpatient and inpatient settings are for physical complaints which cannot be adequately accounted for by any organic pathology, and the patient showing resistance to any suggestion that a physical basis to his/her ailment is unlikely. Or, in some instances, the intensity and persistence of the complaints is not in keeping with the degree of pathology as assessed by an experienced clinician. The phenomenon has come to be known as somatisation which brings into focus the dynamics of the illness behaviour of the patient and the treatment behaviour of the doctor.

As a consequence of only a cursory reference to somatisation in medical literature, both physicians and psychiatrists have developed limited skill in the evaluation and management of patients presenting with this relatively common phenomenon. The purpose of this review is to address this issue which has wider implications for medical education and the delivery of health care.

SOMATISATION

Somatisation is best described by Lipowski as ‘a tendency to experience and communicate somatic symptoms which are unaccounted for by pathological findings, to attribute these to physical illness, and to seek medical help for them’. It is not a diagnostic entity but a process that runs through a range of clinical conditions.

Why do some people express their psycho-social distress in a somatic idiom? Somatisation is a complex intra-psychic process through which individuals come to ascribe ‘meaning’ to their inner experience in physical terms – a meaning determined by their personality make-up, past experience, current threat and the feeling state they experience and the cultural milieu they live in.

A body of research suggests that somatisation is due to ‘personality [constitutional] vulnerability’. Some individuals have a heightened perception of bodily function, are more sensitive to internal bodily cues, overestimate sensation [eg. have low pain threshold] and may even have a distorted perception of bodily sensations.

There are others who have a diminished capacity to verbalise their emotional distress. Referred to as ‘alexithymic’ they tend to lack the words for feelings. The concept is poorly understood but some studies point to past experience of adverse life events by these individuals. Suppression of emotions in relation to childhood trauma is considered to be a contributory factor.

Some research suggests that the phenomenon is a ‘learned behaviour’ – adult somatisation being developed from a family environment unduly preoccupied with health and illness. Further, a child may learn that complaining of physical symptoms may result in ‘psychological gain’ such as receiving parental attention or evading undesirable obligations which may become an enduring pattern of behaviour. In adults a somatic focus may serve to lessen the responsibility of their life predicament and avoid the need for personal change. Adoption of a ‘sick role’ enables one to receive sympathy from others, obtain relief from obligations and use it as a powerful tool in controlling relationships. Physical symptoms are taken more seriously by family members, whereas complaints of anxiety and sadness are regarded as trivial or signs of weakness not worthy of medical attention.

Clinical evidence suggests that somatic complaints are commonly a part of depressive and anxiety syndromes. In major depressive disorder, negative perception of the self and the body is part of the ‘negative cognitive set’ which may also include a bleak view of the surroundings and the future. In certain cases of psychotic depression the feeling state of sadness may be masked [or may even be denied] with prominent somatic delusions such as ‘the body is decaying’. Individuals who are prone to morbid states of anxiety with associated symptoms of tremor [shakes], sweating, palpitations, hyper-ventilation etc. due to hyper-arousal of the autonomic nervous system have a greater tendency to somatise. They tend to develop an increased sensitivity to bodily function resulting in more intense emotion which can further increase bodily symptoms.

Cultural variations in the way emotions are expressed are well known. Studies of traditional Arab cultures, where endurance of pain without the expression of emotion is highly valued, show that there is a greater tendency for emotional distress to be conveyed in physical terms. Similarly among the Hunan Chinese where emotional complaints are taboo as they imply mental disability, somatic presentation of emotional distress is usual. In some primary cultures in Africa there is a restricted vocabulary for emotions which are expressed in physical terminology. Leff put forward a rather controversial hypothesis that ‘the tendency of ‘non-western’ societies to use somatic rather than emotional representations of distress may reflect an evolutionary pattern in the development of words for unpleasant emotions. Waziri quite rightly argued that indigenous mental health professionals have no difficulty understanding the ‘language’, and the problem arises when the patient is confronted with a ‘western-trained’ doctor!

In somatisation the patient may or may not have a conscious awareness of their behaviour. It should be distinguished from malingering where physical symptoms are produced intentionally. Clinicians come across such individuals in cases of workers’ compensation or insurance claims where physical symptoms or pain may be amplified for pecuniary gain.

NOMENCLATURE

During early and mid 20th century the phenomenon of somatisation was enshrined within the concept of neurosis. Later as international nomenclatures [Diagnostic and Statistical Manual of Mental Disorders [DSM]of the American Psychiatric Association and the International Classification of Diseases [ICD] of the WHO] were developed, the concept of neurosis which was believed to have ‘unproven causative assumptions’ was abandoned, and was redefined and reclassified to embody somatisation within the new diagnostic category of Somatoform Disorders. Conditions classified as Somatoform Disorders include dysmorphic disorder, conversion disorder, hypochondriasis, somatisation disorder, somatoform pain disorder etc. The new descriptive classifications are not without fault as there is considerable overlap between diagnostic categories. I shall not be bogged down by issues of nomenclature, but prefer to remain on the central theme of somatisation and its implications on medical practice and medical education.

The mind and body dualism was conceptualised in the days of Plato. This idea that was perpetuated for religious reasons was brought into the scientific domain by Rene Descartes [1596 – 1650], the French philosopher and mathematician, who postulated that the body is a mechanical outfit. This notion that took root in the field of western medicine did influence important research into the anatomical and physiological aspects of the body, nevertheless posing a barrier to the advancement of thought regarding the interrelatedness of the mind and the body, despite the advent of modern psychology.

This preoccupation to exclude organic pathology remains prevalent in medical practice, regrettably even among the generalists. Medical practitioners are accustomed to assessing the patient system by system, and arriving at a diagnosis assisted by biochemical, haematological and radiological investigations, if necessary. Most practitioners are cognisant of the psychosocial context in which a physical condition may present but are either oblivious to or uninterested in the possible psychological content of the presenting problem once the organic pathology has been excluded. The exclusion of organic pathology for many practitioners signals the end of the diagnostic process, and the condition is often labeled ‘functional’ – a word that has negative connotations such as ‘it’s all in the mind’; ‘it will resolve itself’ etc. It has perpetuated the dichotomy of the body and the mind – a human artifact.

ABNORMAL ILLNESS BEHAVIOUR

This situation is brought to an extreme by the somatising patient whose presenting symptoms serve unconsciously to control anxiety, yet driven by the need to pursue answers to their somatic complaints, sometimes with a tendency to seek unwarranted tests, while remaining ‘guarded’ about their inner psychological conflicts – a process which has come to be known as ‘abnormal illness behaviour’ coined by Issy Pilowsky. He defines abnormal illness behaviour as ‘a maladaptive mode of experiencing, perceiving, evaluating and responding to one’s own health status, despite the doctor has provided a lucid and accurate appraisal of the situation and management to be followed’.

ABNORMAL TREATMENT BEHAVIOUR

When confronted with a somatiser, a biologically oriented doctor is drawn into a ‘wild goose chase’ in searching for a physical pathology. During the pursuit, a spurious abnormality may sometimes be found and may entice the doctor to perform more tests that may further raise the anxiety of the patient. It is known that expensive investigations such as scans are sometimes used, not in an attempt to establish a diagnosis but as a means of reassuring the patient that no serious pathology is present! The process is more commonly seen in the case of chronic somatisers who are, with time, endowed with a thick medical file! Bruce Singh described the above mentioned practice of the doctor as ‘abnormal treatment behaviour’!

In addition to the biological mind-set, the reason for this situation is manifold: a] limited interaction with the patient; b] inadequate skill on the part of the doctor in asking the right questions and eliciting verbal and non-verbal cues pointing to psychopathology; c] even if detected, the doctor may not have the necessary expertise in making a positive psychological diagnosis, and may not have the skill or confidence in addressing the psychosocial issues with the patient in a sympathetic manner, and taking adequate steps for treatment or referral; d] fear of ‘missing’ an organic pathology which may have a potential adverse effect on the doctor’s reputation, and concerns about litigation.

The so called ‘abnormal treatment behavior’ of a doctor may potentially lead to a wastage of resources in the health service delivery. Repeated invasive investigations, even if they prove to be negative, may raise the conviction of the anxious patient of an affliction that has a physical basis and may pave the way for a chronic course. Invasive tests are not without harmful effects.

It is not being argued that no initial screening tests be performed. The contention is about continuing inappropriate investigations, spurious diagnoses and unhelpful treatments without maintaining a heightened awareness of any underlying psychological dysfunction.

It is outside the scope of this brief review to enter into a detailed discussion on the management of Somatoform Disorders. Suffice to say, the therapeutic approach should be: to engage the patient; to identify the personal, interpersonal and environmental factors that initiate and maintain the pattern of abnormal illness behaviour; guiding the patient to accept the causal relationship between the emotional distress and the somatic symptoms while making the patient feel understood; once the source of discomfort is identified, to adopt appropriate therapeutic strategies such as psychotherapeutic or behavioural techniques or the judicious short–term use of anxiolytic/antidepressant medication, if necessary. The clinician has to expect some degree of resistance on the part of the patient regarding psychological explanations, which requires an empathic yet skilled approach. Both acute and sub-acute forms of Somatoform Disorder commonly seen in primary care have a good prognosis with appropriate treatment, and the general practitioner, in my view, should be better equipped to manage them.

The same could not be said about the patient with the chronic form of somatisation, who may be quite resistant to treatment, and who may require a physician working in liaison with a psychiatrist/psychologist.

CONCLUSION

Competent medical practice requires an exploration of the interrelatedness of the body and the mind in order to make a correct assessment of the patient’s condition and to devise an appropriate treatment plan. Despite the best efforts of modern medicine and psychiatry, the dualistic notion has persisted in medical education, and hence in the practice of medicine resulting in a lag in acquiring necessary skills by clinicians.

Community attitude towards mental illness is slow in changing even with educational programmes. It is unrealistic to expect a change in ‘psychological-mindedness’ of the general community. Bringing about systemic change in the deeply entrenched pattern of health service delivery in Sri Lanka is a bridge too far. But changing the focus of the medical profession from a purely biological to a bio-psycho-social model is a realistic goal if given impetus at the undergraduate level. Thankfully this is happening in most reputable medical schools around the globe. Needless to say a sound knowledge of the biological aspects of the human condition is of importance [even for psychiatrists!]. The emphasis that I wish to make is that an understanding of intra-psychic, interpersonal and social aspects of being and their dynamic interaction in producing psychopathology is as important and should be a measure of competence of a medical practitioner, especially of a general practitioner, who should ideally be the ‘hub’ of an integrated health service.

One cannot expect a medical graduand to be fully conversant with all the nuances of the above model; after all, we gain most of our medical knowledge after graduation! Continuing education, both at a formal and an informal level, and peer review, should keep both the doctor and his patient healthy and foster the Art of practice of medicine which is gradually being eroded.

Canadian Doctors Have Successfully Reversed the Effects of MS in a Patient Using Stem Cells

Ottawa Hospital

Erin Davis- June 10, 2016

Last week, we told you about 32-year-old Brooke Robinson and her fight with multiple sclerosis (MS).

A true inspiration, Robinson has continued to live her life to its fullest and remains hopeful that there may one day be a cure. In our conversation, she told me about a stem cell trial in Ottawa she had heard about.

Now, it won’t be too long until the entire country hears about it.

Canadian doctors have managed to reverse severe MS using stem cells, virtually eliminating it from a patient’s body. Jennifer Molson had crippling MS before she participated in a study that involved chemotherapy and a stem cell bone marrow transplant in 2002. Molson was one of a small cohort of 24 people who received the high-risk, experimental therapy.

Led by Dr. Mark Freedman and Dr. Harold Atkins at the Ottawa Hospital, the clinical trial spanned over 13 years.

Of the patients, 70 per cent saw the progression of their disease halted or reversed as their symptoms began to diminish. While Molson could barely walk or feed herself pre-trial, she now drives, kayaks, runs and skis, and hasn’t experienced any symptoms of the disease for 14 years.

It’s been hailed as remarkable by industry professionals, as the trial seems to “cure” people of their symptoms.

The experience of the cohort was documented in a paper published this week in The Lancet. It’s being called the first to describe any MS treatment that fully stops the disease over the long-term without MS medication. “This is the first treatment to produce this level of disease control or neurological recovery” from MS, said The Lancet in a news release.

MS affects 20 million people globally, but tends to target females in more temperate climates like Canada and the northern U.S.

The disease is characterized by an immune system that turns on the host and attacks the protective coating around the nerve fibres in the brain and spinal cord. These attacks can severely damage and destroy the nerves and protective coating, affecting the communication between the brain and the body and leading to symptoms like numbness, loss of balance, difficulty walking, loss of control of bowel and bladder, and even blindness.

Over time, patients lose control of their bodies and are often confined to wheelchairs.

Not all types of MS have the same affects. The least evil of the disease is “relapsing-remitting,” whereby the symptoms come and go and can be followed by long periods of remission. For most people, however, this version of the disease usually progresses into secondary progressive MS over time, whereby the symptoms start to stick. The most aggressive form of the disease is primary progressive MS. In this case, patients don’t experience bouts of remission, but rather a continuous decline in their health and a worsening of their symptoms.

At the time of her treatment, Molson had secondary progressive MS. Prior to the stem cell trials, nothing had worked to better her symptoms.

The treatment essentially involves an extensive combination of chemotherapy and stem cell transplants that are designed to reboot the immune system. It sees doctors harvest stem cells from the bone marrow of their patients, then purify and freeze the cells. Patients then undergo extensive chemotherapy before the preserved stem cells are returned to the patients.

The idea is to wipe clean and reset the immune system so it has no memory of attacking the central nervous system.

According to The Lancet, the procedure fully halted clinical relapses in all of the patients and stopped the development of any new brain lesions without any medication. Other stem cell transplants have resulted in positive short-term results in MS patients, but the symptoms always returned. What makes the Ottawa trial different is that, unlike previous trials what aimed to suppress the immune system, it wipes it out altogether.

While promising, the treatment is regarded as extremely high-risk, which places limitations on its widespread use. There are high mortality rates associated with the procedure; one patient out of the initial 24 involved in the clinical trial died from liver failure. It should also be highlighted that 30 per cent of the patients did see their symptoms worsen, likely because their MS was already too far along.

Only five per cent of MS patients are eligible for this type of treatment. But for those who are, it’s being called a ‘miracle treatment’ and The Lancet is urging more clinical trials.

Vietnamese surgeon suspended after operating on boy’s wrong arm

A Vietnamese surgeon accidentally operated on the wrong arm of a 6-year-old boy. Pic: Flickr

23rd June 2016

Everyone makes mistakes, but some mistakes are costlier than others. One surgeon in northern Vietnam found this out the hard way when he accidentally operated on the wrong arm of a six-year-old boy.

The surgeon, from a hospital in the Nghe An Province, was meant to remove the metal rods inside the child’s wrist which were placed there after he broke it in February.

On June 17, the surgeon, identified only as Dr Tuan, reportedly did not “double-check” which arm he was meant to operate – thus leading to him opening up the wrong one and having to stitch the boy back up before moving on to the correct wrist.

According to Thanh Nien News, the boy’s parents were aghast when they saw that their son had bandages on both his wrists.

SEE ALSO: Chinese man complains of abdominal pain, finds out he has four kidneys

The vice director of the hospital, Pham Van Dung, admitted that the mistake indeed took place and said the hospital would reimburse the boy’s parents for any extra cost incurred. The boy was brought to the Viet Duc Hospital in Hanoi for a second examination.

Dr Tuan has been suspended, and further punishments will be considered for him and his surgical team following a full investigation into the mistake.

The Health Department of Nghe An Province has also been asked to look into the incident, as requested by Vietnam’s ministry of health.

In August 2015, a similar accident occurred in the Vinh Long Province of southern Vietnam, where Dr Bui Vinh Phuc operated on the wrong leg of a six-year-old boy.

THE NARROW WINDOW OF OPPORTUNITY IN SRI LANKA COULD FADE AWAY SOON – ACTIVISTS

22/06/2016

Statement on Accountability and the timing of Transitional Justice Mechanisms in Sri Lanka.
We, the undersigned Sri Lankan civil society activists and organisations, note with deep concern the lack of tangible progress in ending impunity in Sri Lanka, more than seventeen months since the change of government in January 2015. We believe that no mechanism for transitional justice or reconciliation can succeed without comprehensively responding to Sri Lanka’s culture of impunity which has enabled recurring violence.

By co-sponsoring UN Human Rights Council Resolution 30/1 on ‘Promoting reconciliation, accountability and human rights in Sri Lanka’, the Government of Sri Lanka committed to establishing institutions for missing persons, reparations, a truth commission and a ‘a judicial mechanism with a special counsel to investigate allegations of violations and abuses of human rights and violations of international humanitarian law’. It also affirmed ‘the importance of participation in a Sri Lankan judicial mechanism, including the special counsel’s office, of Commonwealth and other foreign judges, defence lawyers and authorized prosecutors and investigators’.

Recent weeks witnessed rushed attempts to introduce the Office of Missing Persons. While we recognise the need for an independent and credible entity to investigate the large caseload of enforced and involuntary disappearances, we were disappointed with the process which lacked transparency and the participation of victims and civil society. We have since heard of plans by the Government of Sri Lanka to establish a truth commission and delay the establishment of the proposed accountability mechanism and the office of reparations. This betrays a deeply flawed approach to transitional justice and fails to appreciate and undermines the rights of victims to truth, justice, reparations and guarantees of non-recurrence.

Many Sri Lankan victims and members of civil society have consistently demanded that credible investigations be conducted and perpetrators held accountable with respect to credible allegations of human rights violations. Previous Commissions of Inquiries and the Criminal Justice system have only resulted in the acute re-traumatisation of victims with little satisfaction in terms of justice and reparations. Moreover, the recommendations of these Commissions with respect to the investigation of human rights violations, and the prosecution of alleged perpetrators, have not been implemented, exacerbating Sri Lanka’s culture of impunity that these institutions are meant to combat. For these reasons, yet another commission established without a meaningful guarantee of accountability and reparations will signal a lack of commitment to the Government’s own commitments and to genuinely breaking with the past.

The government’s commitments encapsulated in the Human Rights Council Resolution of October 2015, and Parliament’s near unanimous endorsement of its terms just weeks after it was passed, offers the country an unprecedented political opportunity to advance accountability. The narrow window of opportunity that exists in which the government can successfully enact necessary legislation to establish a judicial mechanism and a special counsel’s office in Sri Lanka along with other mechanisms could fade away soon. The government’s failure to decisively seize this opportunity by engaging the public in a serious conversation about dealing with the past will signal a lack of commitment and will also result in victims losing confidence in Sri Lanka’s transitional justice process, and damage any progress already achieved.

We strongly urge the Government of Sri Lanka to reaffirm its commitment to a comprehensive approach to transitional justice by enacting legislation for a judicial mechanism and a special counsel’s office, with provisions for ‘the trial and punishment of those most responsible for the full range of crimes under the general principles of law recognized by the community of nations relevant to violations and abuses of human rights and violations of international humanitarian law’, in parallel with the truth commission and office of reparations. The Government should also adhere to its other commitments in the Resolution including release of lands to legal owners, review and repeal the Prevention of Terrorism Act and security sector reform. We also call on the government to ensure that this happens in 2016 while there is a political space and offers of assistance. The implementation of the commitments must be done in a transparent manner and in consultations with victims, civil society and the public.

We also call on member states of the UN, OHCHR and all UN departments and donors to assist and advise the government towards a process to ensure the fulfilment of deep and unremitting desire of victims and civil society for truth, justice, reparations and guarantees of non-re-occurrence.
Signatories;

Individuals
1. A.M. Faaiz
2. Ainslie Joseph – Convener/Chief Animator – Christian Alliance for Social Action (CASA)
3. Asma Rahman
4. B. Gowthaman
5. Bhavani Fonseka
6. Bishop Kumara Illangasinghe
7. Cedric de Silva
8. Chandrika De Silva – Writer
9. Christine Perera – Activist
10. Damaris Wickremesekera
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11. Deanne Uyangoda
12. Deshamanya Godfrey Yogarajah
13. Dr. Alagu Caruppiah Visvalingam
14. Dr. Isabelle Lassee
15. Dr. Jayadeva Uyangoda
16. Dr. T. Balamurukan
17. Emil van der Poorten – Supporter of ALL human rights
18. Faizun Zackariya – Citizens’ Voice for Justice and Peace
19. Fr. S.V.B. Mangalarajah – President – Justice and Peace Commission, Catholic Diocese, Jaffna
20. Hans Billimoria
21. Ishan Jalill
22. Jeanne Samuel
23. K. Aingkaran – Attorney-at-Law
24. Kalani Subasinghe
25. Kusal Perera – Journalist
26. Lakshan Dias
27. Manori Kalugampitiya – Journalist
28. Marisa de Silva
29. Melisha Yapa
30. Monica Alfred
31. Nalini Ratnarajah – Human Rights Defender
32. Nicola S.
33. Nilantha Ilangamuwa – Editor – Sri Lanka Guardian
34. Nimalka Fernando
35. Niran Anketell
36. P. Selvaratnam
37. P.N. Singham
38. Philip Dissanayake
39. Philip Setunga
40. Prabodha Rathnayake – Attorney-at-Law
41. Prof. Ellen Dissanayake
42. Prof. Jayantha Seneviratne
43. R.M.B. Senanayake
44. Ralston Weinman
45. Rev. Fr. Aniston Morais, SJ
46. Rev. Fr. Emmanuel Sebamalai
47. Rev. Fr. J. Raj Claier, OMI
48. Rev. Fr. Jeyabalan Croos
49. Rev. Fr. Nandana Manatunga
50. Rev. Fr. Reid Shelton Fernando
51. Rev. Fr. T. L. Rohan, Claretians
52. Rev. Fr. Terrence Fernando
53. Rev. Jason Selvaraja – Senior Clergy – Assembly of God, Chavakachcheri
54. Rev. Sr. Helen Fernando, HF
55. Rev. Sr. Nichola
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56. Ruki Fernando
57. S.C.C. Elankovan
58. Sandun Thudugala
59. Sandya Ekneligoda
60. Sheila Richards
61. Shenali De Silva
62. Shreen Abdul Saroor
63. Sudarshana Gunawardana – Attorney-at-Law
64. Sumika Perera
65. Suren D. Perera
66. T. Mathuri – Attorney-at-Law
67. Thiruni Kelegama
68. Wilhelm Lutersz
69. Zahabia A. Adamaly
Organisations
70. Action Against Apathy
71. Human Rights Office, Kandy
72. Rights Now Collective for Democracy
73. South Asian Centre for Legal Studies (SACLS)
74. Women’s Action Network (WAN)
75. Women’s Development Innovators
76. Women’s Resource Centre, Kurunegala

(Image: Sri Lankan civil society activists hold candles and placards during a vigil for missing cartoonist and journalist Prageeth Eknaligoda in Colombo on February 24, 2010. Eknaligoda, a cartoonist and contributor for the pro-opposition,February 24, 2010