Prevalence of mental disorders and torture among Tibetan refugees: a systematic review.

BACKGROUND: Many Tibetan refugees flee Tibet in order to escape physical and mental hardships, and to access the freedoms to practice their culture and religion. We aimed to determine the prevalence of mental illnesses within the refugee population and determine the prevalence of previous torture reported within this population. METHODS: We performed a systematic literature search of 10 electronic databases from inception to May 2005. In addition, we searched the internet, contacted all authors of located studies, and contacted the Tibetan Government-in-exile, to locate unpublished studies. We included any study reporting on prevalence of mental illness within the Tibetan refugee populations. We determined study quality according to validation, translation, and interview administration. We calculated proportions with exact confidence intervals. RESULTS: Five studies that met our inclusion criteria (total n = 410). All studies were conducted in North India and 4 were specifically in adult populations. Four studies provided details on the prevalence of torture and previous imprisonment within the populations. The prevalence of post-traumatic stress disorder ranged from 11-23%, anxiety ranged from 25-77%, and major depression ranged from 11.5-57%. CONCLUSION: Our review indicates that the prevalence of serious mental health disorders within this population is elevated. The reported incidence of torture and imprisonment is a possible contributor to the illnesses. Non-government organizations and international communities should be aware of the human rights abuses being levied upon this vulnerable population and the mental health outcomes that may be associated with it.

'Iraq Water Treatment Vulnerabilities': a challenge to public health ethics.

A formerly classified US document, 'Iraq Water Treatment Vulnerabilities,' provides evidence that ill health was knowingly induced in the population of Iraq through the ruination of that country's water purification system. We believe that the uncovering of this document should stimulate the public health community to clarify principles of public health ethics and to formulate statements giving voice to these principles. We propose here two statements, one dealing with the broad issue of public health ethics and international relations, and one dealing specifically with public health ethics and water purification.

Climate science, denial and the Declaration of Delhi.

Human-induced climate change is now the central health issue facing humanity. The World Medical Association recently adopted the Declaration of Delhi, committing the medical profession to mitigate and adapt to the effects of climate change. This is new professional territory for many doctors. Even so, the profession has often engaged with issues outside 'the health sector' when the stakes are high, for example leaded petrol, road safety, tobacco, and nuclear weapons. The scientific basis to the declaration merits scrutiny in light of commonly used contrary arguments. Decisions in medicine, as elsewhere, must be taken on the evidence to hand, weighing up the risks, given that complete knowledge is seldom available and time is precious. There are strong analogies between clinical experience and our approach to planetary climate. The relevant context for scientific observations on climate is the world's multi-gigatonne annual CO2-equivalent greenhouse gas emissions. Emissions drive changes in concentrations of greenhouse gases, which matters when they are rapid or prolonged. The current variation in global temperature is alarming, even when within 'normal range'. Climate models inform and guide present-day decision-making, and perform well in explaining observed warming. They corroborate other evidence that tells us that CO2 and other greenhouse gases are harmful at current atmospheric concentrations. As a profession and as global citizens, we need to move beyond dissent and denial about anthropogenic climate change. The WMA correctly says that circumstances now require us all to take action.