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Fear and uncertainty around Kashmir’s future

Last week in a controversial move, India revoked the auto­ blinded between 2016 and 2018. Both India and Pakistan
nomous status of Jammu and Kashmir, allowing India have largely dismissed the report’s recommendations to
greater authority over the state’s affairs. The announce­ end the abuse.
ment fanned tension with Pakistan, which also claims the Despite decades of instability, developmental indicators
region and has fought India over it for more than seven suggest that Kashmir is doing well compared with the
REUTERS/Akhtar Soomro

decades. At least 28 000 Indian security forces have been rest of India. In 2016, life expectancy was 68·3 years
deployed; in the capital city Srinagar, a lockdown has for men and 71·8 years for women, which are greater
been implemented that suspended communication and than the respective national averages. However, the
internet links, and a strict curfew has been imposed. The protracted exposure to violence has led to a formidable
For the human rights report militant presence raises serious concerns for the health, mental health crisis. A Médecins Sans Frontières study in
safety, and freedoms of the Kashmiri people. two rural districts affected by conflict stated that nearly
KashmirUpdateReport_ Since the insurgency of Kashmir in 1989, the state has half of Kashmiris rarely felt safe and of those who had lost
experienced bloody conflict from both sides, resulting in a family member to violence, one in five had witnessed the
For the Medact Blog on War,
violence and the mental health more than 50 000 deaths. According to a report by the death firsthand. Therefore, it is unsurprising that people in
crisis in Kashmir see https:// UN High Commissioner for Human Rights, published last the region have increased anxiety, depression, and post-
war-violence-and-the-mental- month, gross human rights violations by state security traumatic stress disorder.
health-crisis-in-kashmir/ forces and armed groups have occurred, including cross- Prime Minister Narendra Modi vows that his decision
For the Médecins Sans
Frontières study on mental
border firings, sexual violence, enforced disappearances, to revoke autonomy will bring prosperity to Kashmir. But
health status of Indian and acts of terrorism. The report emphasises continued first, the people of Kashmir need healing from the deep
Kashimiri population see
use of excessive force against civilians—for example, the wounds of this decades-old conflict, not subjugation to
india/files/research_summary.pdf use of pellet-firing shotguns has led to 1253 people being further violence and alienation. n The Lancet

The gender plight of humanitarian aid

World Humanitarian Day, which takes place on Democratic Republic of the Congo at risk. The report
Aug 19 each year, celebrates the efforts of humani­tarian focused on the variance in risk between male and
aid workers operating in war-torn, resource deprived, female aid workers. Men were more likely to be victims
or disease-affected settings to sustain human life. This of shootings and aerial bombings, whereas women
year, special tribute is paid to the unsung heroes of were more likely to be physically attacked, kidnapped,
Joel Carillet/Getty Images

humanitarian health—women. Whether they are at the or involved in complex attacks such as bombings.
forefront of an international crisis or operating within Sexual violence had the highest gender variance,
local communities, their long-lasting and stabilising comprising 8% of all attacks on female aid workers since
impact makes them true peace keepers of humanitarian 1997. The report calls for the risk of sexual violence to
See Comment page 549 health. be re-examined in humanitarian operational security.
In the past few decades, the number of major attacks Multiple reporting pathways and a higher degree of
on aid workers in hostile environments has soared. decision-making autonomy offered to survivors would
According to the Aid Worker Security Report 2019 improve case identification and analysis of security risks
update published in June by Humanitarian Outcomes, and needs. Governments need to recognise the female
2018 was the second worst year on record for aid plight in humanitarian aid. Applying a gender-focused
security, with 226 separate attacks involving 405 aid lens to the identification, assessment, and management
workers, of whom 131 were killed, 144 wounded, and of the security needs of humanitarian responders is a
For the Aid Worker Security
Report 2019 see https://www. 130 kidnapped. South Sudan continued to surpass Syria good place to start. As humanitarians, women are often
and Afghanistan in the number of major attacks on first to respond in a crisis and they should not be the last
awsr_2019_0.pdf aid workers, which also put the Ebola response in the to be considered. n The Lancet

542 Vol 394 August 17, 2019