Notes From the Field

Moroccan Health Care: A Link to Radicalization and Proposed Solution

Fed Pract. 2019 November;36(11):510-513

References

1. Nahon M, Michaloux M. L’organisation de la réponse de la sécurité civile: le dispositif ORSEC Organisation of civilian emergency services: The ORSEC plan. https://www.sciencedirect.com/science/article/pii/S2211423816300499#! Published July 2016. Accessed October 7, 2019.

2. Berman E. Hamas, Taliban and the Jewish underground: an economist's view of radical religious militias. NBER Working Paper No. w10004. https://ssrn.com/abstract=450885. Published September 2003. Accessed October 7, 2019.

3. Jordan J. Attacking the leader. Missing the mark; why terrorist groups survive decapitation strikes. Int Secur. 2014;38(4):7-38.

4. Grynkewich A. Welfare as warfare: how violent non-state groups use social services to attack the state. Stud Conflict Terrorism. 2008;31(4):350-370.

5. Marin M, Solomon H. Islamic State: understanding the nature of the beast and its funding. Contemp Rev Middle East. 2017;4(1):18-49.

6. Bressan D. November 1, 1755: the earthquake of Lisbon: wrath of god or natural disaster? Scientific American, History of Geology. https://blogs.scientificamerican.com/history-of-geology/november-1-1755-the-earthquake-of-lisbon-wraith-of-god-or-natural-disaster. Published November 2011. Accessed October 7, 2019.

7. Trading Economics. Morocco unemployment rate. Second quarter statistics. August 2019. https://tradingeconomics.com/morocco/unemployment-rate. Accessed October 7, 2019.

8. Knoema World Data Atlas 2015. Morocco adult literacy rates. https://knoema.com/atlas/Morocco/topics/Education/Literacy/Adult-literacy-rate. Accessed October 4, 2019.

9. The Legatum Prosperity Index 2018. Morocco. https://www.prosperity.com/globe/morocco. Accessed October 7, 2019.

10. University of Washington, Institute for Health Metrics and Evaluation. Morocco. http://www.healthdata.org/morocco. Published 2018. Accessed October 7, 2019.

11. Oxford Business Group. Access to health care broadens in Morocco. https://oxfordbusinessgroup.com/overview/forward-steps-access-care-has-broadened-and-infrastructure-improved-challenges-remain. Accessed September 12. 2019.

12. Wright NMJ, Hankins FM. Preventing radicalization and terrorism: Is there a GP response? Br J Gen Pract. 2016;66(647):288-289.

13. Buhi K, Everitt K, Jones E. Might depression psychosocial adversity, and limited social assets explain vulnerability to and resistance against violent radicalization? PlosOne. 2014;9(9):e105918.

14. DeAngelis T. Understanding terrorism. apa.org/monitor/2009/11/terrorism. Published November 2009. Accessed October 14, 2019.

15. Victoroff J. The mind of the terrorist: a review and critique of psychological approaches. J Conflict Resolut. 2005;49(1):3-42.

16. Lafree G, Ackerman G. The empirical study of terrorism: social and legal research. Ann Rev Law Soc Sci. 2009;5:347-374.

17. World Bank. Morocco—improving primary health in rural areas program-for-results project (English). http://documents.worldbank.org/curated/en/716821468274482723/Morocco-Improving-Primary-Health-in-Rural-Areas-Program-for-Results-Project. Published 2015. Accessed September 16, 2019.

18. Royaume du Maroc, Ministère de la Santé. Livre blanc: pour une nouvelle gouvernance du secteur de la santé. Paper presented at: 2nd National Health Conference; July 1-3, 2013; Marrakesh, Morocco.

19. Buhi K, Hicks MH, Lashley M, Jones E. A public health approach to understanding and preventing violent radicalization. BMC Med. 2012;10:16.

20. Mallonee S, Sahriat S, Stennies G, Waxweiler R, Hogan D, Jordan F. Physical injuries and fatalities resulting from the Oklahoma City bombing. JAMA. 1996;276(5):382-387.

21. Ushizawa H, Foxwell AR, Bice S, et al. Needs for disaster medicine: lessons from the field of the Great East Japan Earthquake. Western Pac Surveil Response J. 2013;4(1):51-55.

Proposed Solutions, A Beginning

A health outreach program with a regional health professional training center in a relatively stable country within the African Union (AU) would be a step toward delivering health care to Morocco and interested AU members. Interested nations have been and will continue to be invited to train at the Moroccan center and return to their countries and start training programs. This idea was echoed by the World Bank in a 2015 loan proposal to Morocco, which suggested that addressing disparities in access to health care is a social justice issue, with other benefits such as increased productivity, employment, lower out-of-pocket expenditures, and promotion of good governance.¹⁷

In 2012, Buhi reported that a positive regard for authorities and healthier influences seemed to be a protective factor against radicalization. He also suggested a public health approach to understanding and preventing violent radicalization.¹⁹The solutions are complex, especially in rural areas and in vulnerable nations common to Africa.

Medical training efforts by the US Department of Defense (DoD), Medical Readiness Training Institute (DMRT), and international health specialists working with the military and civilian entities in neighboring African countries have improved response to regional disasters. However, to address the broader issues, a more permanent, cooperative possible solution may begin with the establishment in Morocco of a regional education center for disaster preparedness and for health care providers (HCPs). This would serve as a training program for disaster first responders. Graduates of the program would receive additional training to become HCPs similar to physician assistant (PA) and nurse practitioner (NP) programs in the US. Morocco is uniquely positioned to accomplish this due to its location, political stability, and ties with other African nations.

The goal of the Moroccan regional education center (within the King Mohammed V Hospital) is to bring together global health experts and increase the intellectual infrastructure of not only Morocco, but also offer this training program to interested countries within the AU. Advancement of the regional education center will require legislative changes to expand prescriptive privileges and scope of practice within each country. The medical element of the SPP as presently constituted without the regional education center will continue its humanitarian goals, but the proposed creation of the regional education center will educate participants to serve the rural communities within each participating country. Eventually the entire educational program will be the responsibility of the Moroccan military and the AU participants. This will require reprioritizing resources from the provision of humanitarian health care services to an HCP education approach.

Disaster Response

Deficits in disaster response capabilities have been identified by members of the Moroccan military with the assistance of the UTNG. The most glaring deficit identified was the disparity in training between military and civilian first responders. Thus, a training program was initiated by the Moroccan military and the UTNG that combined internationally recognized, durable, robust emergency training programs. These programs consisted of, but were not limited to, parts or entire programs of the following: basic disaster life support, advanced disaster life support, disaster casualty care, and advanced trauma life support. The goal of this training was to improve communication, reduce mortality, and create strike teams, which can quickly provide health care independent of a hospital during a disaster.