“How to take care of our health in times of social crisis?”, by Elmer Huerta

Social Movements vs. Civil Unrest

It is very important to recognize the difference between these two terms, which are related to human activities that have occurred since time immemorial.

While the social movement or popular protest is defined as the informal activity between diverse groups of individuals, groups and/or organizations that share collective identities and can give rise to political or cultural conflict, civil unrest occurs when during a social movement certain participants provoke intentional public disturbances that violate the law, for which reason they are strongly repressed by police or military authorities. Violent police responses to civil unrest cause severe disruptions to the health of individuals and communities.

By their nature, social movements or popular protests have a relatively minor impact on public health, while civil unrest, especially those categorized as terrorist acts and of long duration, have a profound public health impact on society.

Civil unrest and its impact on health

From the point of view of personal health, the confrontations that occur during civil disturbances cause traumatic injuries, wounds and lacerations, caused by batons, sticks, bottles, stones, and the use of pellet guns and firearms.

The sudden increase in cases causes a rapid increase in visits to hospital emergencies for wounds, lacerations, bruises, burns and bruises. In addition, the use of tear gas, chemicals that cause tearing and pain in the eyes, has been associated with short- and long-term effects on the respiratory system.

The immediate consequences of violence during civil unrest have been documented to be dermatological (skin rashes), traumatological (injuries and disabilities), and respiratory (shortness of breath, coughing, choking, and chest tightness).

For its part, the violence caused by civil unrest can severely affect the health of the community. For example, restricting patient access, street closures, disruption of public transportation, and damage to public and private infrastructure negatively affect the utilization of health services.

“The recent civil unrest will only make matters worse. A rapid and coordinated response from the Ministry of Health is urgent.

The Chilean case

A publication in “The Lancet” from January 1, 2022 describes the impact of the October 2019 social demonstrations and civil unrest in Chile, events triggered by the 30-peso (US$0.04) increase in the metro fare. Considered the trigger, the popular movement quickly evolved into serious civil disturbances that denounced claims of historical injustices and inequalities in Chilean society.

According to the publication, “the protesters called for structural changes related to the distribution of wealth, the increase in the cost of living, the stagnation of wages, the access and quality of basic public services (for example, health systems , education, transport and justice), retirement pensions, among other structural processes”. Despite the lack of organized leadership, this social movement had high attendance rates and strong national support.

As a result of the police response to the civil unrest, the researchers documented that – from October 18 to December 29 – the rate of hospitalizations per 1,000 visits increased for cases of trauma and respiratory illness. More specifically, hospitalizations for trauma were found to be 40% higher than expected; while, due to respiratory conditions, hospitalizations were 59% higher.

The authors conclude that their study should be interpreted as “the first step in understanding the impact of large-scale social movements and disturbances on the individual and public health of a country.” The authors suggest that the study serve to “advocate for policy changes regarding police response to civil unrest, to prevent escalation of violence and harm among protesters, the police force, and bystanders in surrounding areas.” The Ministry of the Interior and Public Security of Chile published in mid-2020 a modification of the use of rubber bullets and other crowd control protocols. In addition, the study can be used to establish contingency plans for access to emergency services in times of social protests, as well as to strengthen emergency care in less specialized services.

Corollary

Just like the impact of an earthquake on society, the impact of civil unrest can also come in three waves.

The first wave of the earthquake is instantaneous and occurs with the collapse of the buildings and the crushing death of the inhabitants. In the case of civil disturbances, they are the deaths caused by violence from one side or the other. Until the moment of writing this column, there are 22 deceased.

The second wave of earthquakes occurs during the first hours afterward and is caused by the saturation of health services. Similarly, the second wave of social unrest is occurring when thousands of patients cannot access health services.

The third wave of earthquakes occurs days and weeks later, when –due to the absence of efficient health services– serious complications occur in the fractured and operated people. Similarly, severe disruptions to health services caused by civil unrest are expected in the coming weeks.

If the Peruvian health system was already precarious and inefficient before the pandemic, and it made it worse, there is no doubt that the recent civil unrest will only make things worse. A rapid and coordinated response from the Ministry of Health is urgent.