US Internal Medicine Societies’ Unequal Responses to Ukrainian and Ethiopian Crises

In April of 2022, the head of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, questioned whether “the world really gives equal attention to Black and white lives” given that conflicts in the Middle East and Africa received a “fraction” of the concern that Ukraine did.¹ The awareness of the medical community of the impact of ongoing conflicts on the health of civilians can turn into advocacy and contribute to mobilizing humanitarian assistance. Beyond conflict-related injuries, conflict also hastens the spread of infectious diseases, leads to malnutrition and mental illness, and interrupts critical access of patients with non-communicable diseases to necessary healthcare.² 
The distribution of humanitarian aid to populations struck by disasters and poverty is not necessarily just nor based on pure needs. Factors such as explicit and implicit biases, media coverage, geopolitical interests and special obligations toward certain countries may influence the decisions of the donors.^1,3,4
Both Ukraine and Ethiopia are undergoing violent conflicts that have greatly impacted national health systems and have caused deaths and suffering of civilians. According to the UN, 6,114 civilians were killed in Ukraine between February 24 and October 2, 2022.⁵ It is difficult to obtain accurate health data from Ethiopia, but the death toll may be close to half a million, especially when indirect deaths due to malnutrition are included.⁶
This study was conducted to evaluate if the reaction of the US Internal medicine organizations to these two countries, one with white Europeans the other with black Africans, was different. Compared to European organizations, the US organizations’ support to the victims of these two conflicts should be equal given the lack of geopolitical interests that might be the case of the European organizations towards Ukraine. 
In June 2022, we looked for statements from the leading professional US internal medicine and its subspecialty organizations about the Ukraine and Ethiopia conflicts. The list of 34 organizations was obtained without modifications from the American Board of Internal Medicine’s website directory.⁷
We counted statements of concern about the two conflicts through a Google search of each of the 34 medical societies. We used Google to search the name of the society in quotations and the name of the conflict country, (e.g., “American Society of Nephrology” Ukraine). We looked for statements of support, condemnation, or awareness towards conflicts in those countries on the first Google search result page. General statements about the conflict from the society were counted as yeses, and no explicit mention of the conflict were counted as nos. 
Of 34 American internal medicine societies, one made a statement about the medical situation in Ethiopia, while 18 made statements about Ukraine (Table 1). The one medical society that did mention Ethiopia released a general press statement about global conflicts’ effects on the health of civilians, mentioning Ethiopia and Ukraine in the same statement.

Country	Support statement issued	No support statement	Total
Ethiopia	1	33	34
Ukraine	18	16	34
Table 1. References of conflict by the 34 Internal Medicine Societies. Tabella 1. Riferimenti ai conflitti fatti dale 34 Società di medicina interna statunitensi.

Concerns have been raised from various authors on the fact that the Ukraine conflict has drawn more attention than other conflicts.^1,8-10 Our results found that the majority of American internal medical societies issued statements about the conflict in Ukraine, while only one made mention of the conflict in Ethiopia. Data from the Financial Tracking System of the United Nations Office for the Coordination of Human Affairs show that the funds raised for Ethiopia in 2022 were less than half of those raised for Ukraine.¹¹ About half of the funding come from the US government.
The neglect of victims of conflicts in ‘developing countries’ by the international medical community is remarkable. An outpouring of support for Ukrainian victims of the Russian invasion in Europe may be understandable due to the proximity of the conflict to European medical organizations (special obligation); however, we expect for American medical organizations to have similar responses to international conflicts in the Eastern hemisphere.  Complex geopolitical factors can be the cause of such a difference in attitude and their discussion is beyond the scope of this short paper. Additionally, the difference in reaction may be more directly due to media coverage rather than direct bias, but regardless the advocacy and aid of medical organizations should be based on objective assessment of the situations on the ground rather than the degree of news coverage.
Statements of support for Ukrainian civilians from American medical societies are not the problem. These findings are not intended to support ‘what about’ arguments that advocate for the medical community to care less about Ukraine for Ethiopia or any other conflict situation’s sake. Instead, these findings should alert the medical community that their careful support should be extended to all whose medical care is jeopardized due to violent conflict. 
Our study does not represent the official position of the examined organizations, but does provide a snapshot of the general attitude and sense of urgency of American societies towards global conflicts. It has several limitations including its narrow scope and lack of in-depth exploration of the reasons behind its findings.

Conflicts of interest: none declared.

References

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