Letter to Jaw Siwek, M.D.,

Editor, American Family Physician

From Teresa K.E. Smith de Cherif, M.D., M.I.A.

The authors of "Travel Immunizations" (American Family Physician, July 1, 2004, pp. 89-99) rightfully note that "as international travel to exotic locations becomes increasingly common," physicians must "maintain familiarity with current recommendations for travel health safety." Yet, the map on American Family Physician's cover and lead page of the article does not delineate the border between Morocco and Western Sahara, Africa's last colony. Such renderings convey the impression that Western Sahara may be safe for travel, whereas it remains a war zone, riddled with millions of landmines and ripe with infectious diseases.

The Paris-based Observatory of Arms Transfers reports that Morocco has planted some three million landmines in Western Sahara, along a sand wall erected to seal off the territory from the pro-independence Sahrawi nationalist forces of the Polisario Front1. The Landmine Monitor Report cites 39 mine incidents from 1992-2000, as reported by United Nations peacekeeping forces stationed in the territory to monitor the fragile ceasefire between the Kingdom of Morocco and the Polisario nationalists2. These incidents resulted in dismemberment or death among the 10,000 Sahrawi nomads who course through the mine zones in search of pasture for their camels3. A Norwegian non-governmental organization documented 320 landmine amputees living in Sahrawi refugee camps along the West Saharan-Algerian border4. As Morocco extends its roads through the five-sixths of the Western Sahara it occupies to arrive at the port city of Nouadhibou, Mauritania, adventurers-including participants in the Paris-Dakar Rally-will be lured to the area and landmine incidents are likely to increase. This matter provoked six Nobel Peace Prize laureates to express grave concern about the "massive use of antipersonnel landmines…in the Moroccan-occupied Western Sahara5"

Readers should know that Morocco governs Western Sahara under state-of-emergency legislation and authority, which no country in the world recognizes as legitimate6. Morocco has persisted in its occupation of Western Sahara since the autumn of 1975, despite international agreements that the Sahrawi people of Western Sahara must exercise the right of self-determination and despite a United Nations mandate since 1991 to organize a free and fair plebiscite for the Spanish-speaking Sahrawi people7.

Behind the heavily mined wall of sand in Western Sahara, infectious diseases plague the local Sahrawi population. Food- and water-borne diseases are common, including E. coli diarrhea, hepatitis A, giardiasis, cholera, and trachoma8. At least 300 cases of poliomyelitis have been documented9. Political prisoners are provided no access to medicine and the overcrowding in prisons drives the spread of infectious diseases, including tuberculosis and pneumonia10. Untreated, sick political prisoners have suffered morbidity and mortality11.

Maps that indicate international boundaries do not condone illegal occupations, but rather support principles enshrined in the 1960 landmark Declaration on the Granting of Independence to Colonial Countries and Peoples. The principle of self-determination, for example, sustained the people of Namibia and East Timor through their struggle from occupation to independence. Correct maps also constitute an important measure of preventing unsuspecting travelers from venturing into areas where they may face grave health risks, including morbidity and mortality from landmines or infectious disease.

1. As reported by Agence France Presse in "Landmines," Western Sahara Weekly News, January 1- February 6, 1999 and archived at http://www.arso.org. See also "Mine Awareness Project of Norwegian People's Aid," Western Sahara Weekly News, July 5-11, 1998, archived at http://www.arso.org.

2. Human Rights Watch (International Campaign to Band Landmines), Western Sahara, Landmine Monitor Report 2002 at http://www.icbl.org/lm/2002/Western_Sahara.

3. Ibid.

4. Ibid.

5. José Ramos-Horta, Rigoberta Menchú Tum, Oscar Arias Sánchez, Adolfo Perez Esquivel, Máired Maguire, Cora Weiss (for the International Peace Bureau), Nobel Laureates Issue Appeal to Kofi Annan and the UN over the Western Sahara, December 12, 2001, at http://www.arso.org/nobel2001.htm.

6. Smith, Teresa K. "Al-Mukhtufin (the Disappeared)." In War and Refugees: The Western Sahara Conflict, edited by Richard Lawless and Laila Monahan, London: Frances Pinter Publishers, 1987.

7. Smith de Cherif, Teresa K. "Western Sahara: A Moroccan-Style Election?" Review of African Political Economy, no. 58 (1993):99-105.

8. Smith de Cherif, Teresa K. Voices from the Sand, a documentary film by the Sahara Fund, Inc.; see the section on health. See also National Center for Infectious Disease, "Health Information for Travelers to North Africa," Travelers' Health at http://www.cdc.gov/travel/nafrica.htm; and Western Sahara Health at http://www.ncbuy.com/travel/health/report_country.html

9. Voices from the Sand, op cit. and Landmine Monitor Report, op cit.

10. Freedom for Ali Salem Tamek and all the Sahrawi Political Prisoners archived at http://www.arso.org/Tamek100902.htm; "Hunger Strike," Western Sahara Weekly News, week 12 (2003); "Death of an ex-[political] prisoner," Western Sahara Weekly News, April 21-27,2002; "Hunger Strike," Western Sahara Weekly News, December 30, 2001-January 5, 2002; "Petition to the World Health Organization," Western Sahara,Weekly News, April 14-20, 1997.

11 Ibid and Smith, Teresa K. "Al-Mukhtufin," op cit.